title: Myocardial tissue remodeling in adolescent obesity.
abstract: BACKGROUND
  Childhood obesity is a significant risk factor for cardiovascular disease in adulthood. Although ventricular remodeling has been reported in obese youth, early tissue-level markers within the myocardium that precede organ-level alterations have not been described.
  
  
  RESULTS
  We studied 21 obese adolescents (mean age, 17.7±2.6 years; mean body mass index [BMI], 41.9±9.5 kg/m(2), including 11 patients with type 2 diabetes [T2D]) and 12 healthy volunteers (age, 15.1±4.5 years; BMI, 20.1±3.5 kg/m(2)) using biomarkers of cardiometabolic risk and cardiac magnetic resonance imaging (CMR) to phenotype cardiac structure, function, and interstitial matrix remodeling by standard techniques. Although left ventricular ejection fraction and left atrial volumes were similar in healthy volunteers and obese patients (and within normal body size-adjusted limits), interstitial matrix expansion by CMR extracellular volume fraction (ECV) was significantly different between healthy volunteers (median, 0.264; interquartile range [IQR], 0.253 to 0.271), obese adolescents without T2D (median, 0.328; IQR, 0.278 to 0.345), and obese adolescents with T2D (median, 0.376; IQR, 0.336 to 0.407; P=0.0001). ECV was associated with BMI for the entire population (r=0.58, P<0.001) and with high-sensitivity C-reactive protein (r=0.47, P<0.05), serum triglycerides (r=0.51, P<0.05), and hemoglobin A1c (r=0.76, P<0.0001) in the obese stratum.
  
  
  CONCLUSIONS
  Obese adolescents (particularly those with T2D) have subclinical alterations in myocardial tissue architecture associated with inflammation and insulin resistance. These alterations precede significant left ventricular hypertrophy or decreased cardiac function.
authors: Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Ravi V
authors: RV
authors: Shah
authors: Siddique A
authors: SA
authors: Abbasi
authors: Tomas G
authors: TG
authors: Neilan
authors: Edward
authors: E
authors: Hulten
authors: Otavio
authors: O
authors: Coelho-Filho
authors: Alison
authors: A
authors: Hoppin
authors: Lynne
authors: L
authors: Levitsky
authors: Sarah
authors: S
authors: de Ferranti
authors: Erinn T
authors: ET
authors: Rhodes
authors: Avram
authors: A
authors: Traum
authors: Elizabeth
authors: E
authors: Goodman
authors: Henry
authors: H
authors: Feng
authors: Bobak
authors: B
authors: Heydari
authors: William S
authors: WS
authors: Harris
authors: Daniel M
authors: DM
authors: Hoefner
authors: Joseph P
authors: JP
authors: McConnell
authors: Ravi
authors: R
authors: Seethamraju
authors: Carsten
authors: C
authors: Rickers
authors: Raymond Y
authors: RY
authors: Kwong
authors: Michael
authors: M
authors: Jerosch-Herold
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D009206:Myocardium / Q000473:pathology*; D063766:Pediatric Obesity / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000473:pathology* / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D014280:Triglycerides / Q000097:blood; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D018836:Inflammation Mediators; D014280:Triglycerides; C517652:hemoglobin A1c protein, human
keywords: CT or MRI; obesity; type 2 diabetes
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