title: Cardiac structure and function and insulin resistance in morbidly obese patients: does superobesity play an additional role?
abstract: OBJECTIVE
  To evaluate the impact of superobesity, defined as body mass index (BMI) ≥50, on cardiac structure and function.
  
  
  METHODS
  Using echocardiography, we studied 198 asymptomatic patients (mean age 48 ± 13 years, 29.3% were men) with a BMI ≥40. Insulin resistance was measured using the Homeostasis Model Assessment of insulin resistance (HOMA-IR). Patients were divided into 2 groups: morbidly obese (BMI ≥40 and <50; n = 160) and superobese (BMI ≥50; n = 38).
  
  
  RESULTS
  There were no significant differences in age, gender, hypertension and diabetes between groups. Superobese patients had higher LV mass (66.0 ± 14.7 vs. 59.9 ± 11.9 g/m(2.7), p = 0.007), left ventricular (LV) end-diastolic (33.8 ± 7.7 vs. 31.5 ± 7.1 ml/m(2.7), p = 0.041) and end-systolic (12.2 ± 3.6 vs. 10.9 ± 2.8 ml/m(2.7), p = 0.016) volumes, left atrial volume (13.8 ± 4.5 vs. 12.2 ± 3.9 ml/m(2.7), p = 0.029), peak velocity of transmitral flow in early diastole/early diastolic peak myocardial velocity ratio (9.1 ± 2.6 vs. 8.2 ± 2.2, p = 0.03) and HOMA-IR (9.7 ± 7.3 vs. 7.3 ± 6.5, p = 0.047). LV ejection fraction was similar.
  
  
  CONCLUSIONS
  Superobesity is associated with insulin resistance and a worse impact on cardiac remodeling and LV diastolic function than morbid obesity. Prospective studies are needed to evaluate whether such further classification of morbid obesity could stratify the cardiovascular risk in these patients more accurately.
authors: Cardiologia Preventiva e Riabilitativa, ARC, Azienda Ospedaliera S. Maria degli Angeli, Pordenone, Italy.
authors: Francesco
authors: F
authors: Antonini-Canterin
authors: Anca D
authors: AD
authors: Mateescu
authors: Olga
authors: O
authors: Vriz
authors: Salvatore
authors: S
authors: La Carrubba
authors: Vitantonio
authors: V
authors: Di Bello
authors: Scipione
authors: S
authors: Carerj
authors: Concetta
authors: C
authors: Zito
authors: Lina
authors: L
authors: Sparacino
authors: Bernardo
authors: B
authors: Marzano
authors: Cătălin
authors: C
authors: Usurelu
authors: Răzvan
authors: R
authors: Ticulescu
authors: Carmen
authors: C
authors: Ginghină
authors: Gian Luigi
authors: GL
authors: Nicolosi
authors: Bogdan A
authors: BA
authors: Popescu
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology; D002306:Cardiac Volume / Q000502:physiology; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D020257:Ventricular Remodeling / Q000502:physiology