title: Markers of cardiovascular risk, insulin resistance, and ventricular dysfunction and remodeling in obese adolescents.
abstract: OBJECTIVE
  To test our hypothesis that obese adolescents have left ventricular (LV) dysfunction and remodeling that are associated with markers of cardiovascular risk and insulin resistance (IR).
  
  
  METHODS
  In a cross-sectional study of 44 obese and 14 lean age-, sex-, Tanner stage-, and race-matched adolescents, IR, markers of cardiovascular risks, conventional and 2-dimensional speckle tracking echocardiography measures of LV function and structure were evaluated and compared.
  
  
  RESULTS
  The obese adolescents had significantly increased body mass index Z-score, systolic blood pressure, fasting insulin, IR, and atherogenic lipids compared with the lean adolescents. A subgroup of obese adolescents had LV remodeling characterized by significantly increased LV mass index (g/m(2.7)) and relative wall thickness. Almost all obese adolescents had LV dysfunction with peak LV global longitudinal strain (GLS, %), systolic GLS rate (GLSR, %/s), and early diastolic GLSR significantly lower than in lean adolescents and in the normal pediatric population. Body mass index Z-score predicted LV remodeling (LV mass index [R(2) = 0.34] and relative wall thickness [R(2) 0.10]), and peak LV GLS (R(2) 0.15), and along with systolic blood pressure, predicted systolic GLSR (R(2) 0.16); (P ≤ .01 for all). Fasting insulin predicted early diastolic GLSR (R(2) 0.17, P ≤ .01).
  
  
  CONCLUSIONS
  Obese adolescents have subclinical ventricular dysfunction associated with the severity of obesity, increased systolic blood pressure, and IR. Ventricular remodeling is present in a subgroup of obese adolescents in association with the severity of obesity. These findings suggest that obesity may have an early impact on the cardiovascular health of obese adolescents.
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO.
authors.forename: Aura A
authors.initials: AA
authors.lastname: Sanchez
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO.
authors.forename: Philip T
authors.initials: PT
authors.lastname: Levy
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Sekarski
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Arbelaez
authors.affiliation: Mallinkrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Hildebolt
authors.affiliation: Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Holland
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO. Electronic address: singh_g@kids.wustl.edu.
authors.forename: Gautam K
authors.initials: GK
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D002648:Child; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D007333:Insulin Resistance; D008297:Male; D063766:Pediatric Obesity / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology
chemical_list: D015415:Biomarkers