title: Preclinical Systolic and Diastolic Dysfunctions in Metabolically Healthy and Unhealthy Obese Individuals.
abstract: BACKGROUND
  Despite the substantial overlap of obesity and metabolic disease, there is heterogeneity with respect to cardiovascular risk. We sought to investigate preclinical differences in systolic and diastolic function in obesity, and specifically compare obese individuals with and without metabolic syndrome (MS).
  
  
  RESULTS
  Obese individuals without cardiac disease with (OB/MS+, n=124) and without (OB/MS-, n=37) MS were compared with nonobese controls (n=29). Diastolic function was assessed by transmitral and tissue Doppler. Global longitudinal strain (LS) and time-based dyssynchrony were assessed by speckle tracking. Both OB/MS- and OB/MS+ groups had similar ejection fraction but worse systolic mechanics as assessed by LS and dyssynchrony when compared with nonobese controls. Specifically, OB/MS- had 2.5% lower LS (SE, 0.7%; P=0.001 in multivariable-adjusted analyses) and 10.8 ms greater dyssynchrony (SE, 3.3 ms; P=0.002), and OB/MS+ had 1.0% lower LS (SE, 0.3%; P<0.001) and 7.8 ms greater dyssynchrony (SE, 1.5 ms; P<0.001) when compared with controls. Obesity was associated with impaired diastolic function regardless of MS status, as evidenced by greater left atrial diameter and left ventricular mass although diastolic dysfunction was more pronounced in OB/MS+ than in OB/MS- individuals.
  
  
  CONCLUSIONS
  Obesity is associated with subclinical differences in both systolic and diastolic function regardless of the presence or absence of MS although MS seems to be associated with worse diastolic dysfunction. When compared with controls, metabolically healthy obese had lower LS, greater dyssynchrony, and early diastolic dysfunction, supporting the notion that obesity per se may have adverse cardiovascular effects regardless of metabolic disease.
authors.affiliation: From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.).
authors.forename: Yi-Chih
authors.initials: YC
authors.lastname: Wang
authors.affiliation: From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.).
authors.forename: Chang-Seng
authors.initials: CS
authors.lastname: Liang
authors.affiliation: From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.).
authors.forename: Deepa M
authors.initials: DM
authors.lastname: Gopal
authors.affiliation: From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.).
authors.forename: Nir
authors.initials: N
authors.lastname: Ayalon
authors.affiliation: From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.).
authors.forename: Courtney
authors.initials: C
authors.lastname: Donohue
authors.affiliation: From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.).
authors.forename: Rajalakshmi
authors.initials: R
authors.lastname: Santhanakrishnan
authors.affiliation: From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.).
authors.forename: Harpaul
authors.initials: H
authors.lastname: Sandhu
authors.affiliation: From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.).
authors.forename: Alejandro J
authors.initials: AJ
authors.lastname: Perez
authors.affiliation: From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.).
authors.forename: Jill
authors.initials: J
authors.lastname: Downing
authors.affiliation: From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.).
authors.forename: Noyan
authors.initials: N
authors.lastname: Gokce
authors.affiliation: From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.).
authors.forename: Wilson S
authors.initials: WS
authors.lastname: Colucci
authors.affiliation: From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.). Jennifer.Ho@bmc.org.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Ho
mesh_terms: D000328:Adult; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000503:physiopathology*; D009765:Obesity / Q000150:complications / Q000503:physiopathology*; D012307:Risk Factors; D013318:Stroke Volume; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: cardiovascular diseases; heart diseases; metabolic syndrome X; obesity; risk factors