title: Effect of obesity on left ventricular longitudinal myocardial strain by speckle tracking echocardiography in children and adolescents.
abstract: BACKGROUND
  Impaired subclinical ventricular function may contribute to the risk of cardiovascular disease in obesity.
  
  
  OBJECTIVE
  The aim of this study was to determine the influence of obesity on left ventricular (LV) longitudinal myocardial function in normotensive obese children using two-dimensional (2D) speckle tracking echocardiography (STE).
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Sixty normotensive obese children aged 10-16 years (mean age, 13.9±2.3 years) were compared with 50 normal-weight controls. Obese participants had a body mass index (BMI)≥95(th) percentile. Regional strain/strain rate (SR) values were compared with left ventricular (LV) parameters. The correlation was studied by linear regression analysis.
  
  
  RESULTS
  Obese subjects exhibited a significantly higher LV end-diastolic diameter, left atrium/aortic diameter ratio, and LV mass/index when compared to controls (p<0.001). Left ventricular ejection fraction and regional systolic myocardial velocities were similar in the obese and control groups. By 2D STE, regional strain of both the septal wall (average strain: -16.0±3.9% vs -21.9±2.4%, p<0.001) and lateral wall (average strain: -15.6±2.3% vs -22.9±3.5%, p<0.001); regional SR of both the septal wall (average SRsys: -0.7±0.22 s(-1) vs -1.3±0.32 s(-1), p<0.001) and lateral wall (average SRsys: -0.67±0.19 s(-1) vs -1.33±0.31 s(-1), p<0.001); regional SRE/A of both the septal wall (average SRE/A: 1.8±0.83 vs. 2.2±0.91, p: 0.004) and lateral wall (average SRE/A: 1.4±0.43 vs. 2.4±1.21, p<0.001); and global strain (-14.6±7.34% vs -20.9±3.24%, p<0.001) were lower in the obese group compared with the controls. These strain imaging parameters appear to be related to the severity of obesity and can contribute to increased BMI. Left ventricular mass was found to be correlated with a decrease in global LV strain.
  
  
  CONCLUSIONS
  Our study showed that childhood obesity is associated with an alteration in the longitudinal LV function. Segmental analysis of the LV can provide subtle markers for the emergence of future obesity-related cardiac disease.
authors.affiliation: Department of Pediatric Cardiology, Mersin Women's and Children's Hospital, Mersin, Turkey.
authors.forename: Ayşe Esin
authors.initials: AE
authors.lastname: Kibar
authors.affiliation: Department of Pediatric Cardiology, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Feyza Ayşenur
authors.initials: FA
authors.lastname: Pac
authors.affiliation: Department of Pediatric Cardiology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey.
authors.forename: İbrahim
authors.initials: İ
authors.lastname: Ece
authors.affiliation: Department of Pediatric Cardiology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey.
authors.forename: Mehmet Burhan
authors.initials: MB
authors.lastname: Oflaz
authors.affiliation: Department of Pediatric Cardiology, Balıkesir Hospital, Balıkesir, Turkey.
authors.forename: Şevket
authors.initials: Ş
authors.lastname: Ballı
authors.affiliation: Department of Pediatric Endocrinology, Dr Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Ankara, Turkey.
authors.forename: Veysel Nejat
authors.initials: VN
authors.lastname: Bas
authors.affiliation: Department of Pediatric Endocrinology, Dr Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Ankara, Turkey.
authors.forename: Zehra
authors.initials: Z
authors.lastname: Aycan
keywords: Childhood obesity; left ventricular function; strain; two-dimensional speckle tracking echocardiography