title: Cardiac remodeling and dysfunction in childhood obesity: a cardiovascular magnetic resonance study.
abstract: Obesity affects nearly one in five children and is associated with increased risk of premature death. Obesity-related heart disease contributes to premature death. We aimed to use cardiovascular magnetic resonance (CMR) to comprehensively characterize the changes in cardiac geometry and function in obese children.
  
  
  
  Forty-one obese/overweight (age 12 ± 3 years, 56 % female) and 29 healthy weight children (age 14 ± 3 years, 41 % female) underwent CMR, including both standard cine imaging and displacement encoded imaging, for a complete assessment of left ventricular (LV) structure and function. After adjusting for age, LV mass index was 23 % greater (27 ± 4 g/m(2.7) vs 22 ± 3 g/m(2.7), p <0.001) and the LV myocardium was 10 % thicker (5.6 ± 0.8 mm vs 5.1 ± 0.8 mm, p <0.001) in the obese/overweight children. This evidence of cardiac remodeling was present in obese children as young as age 8. Twenty four percent of obese/overweight children had concentric hypertrophy, 59 % had normal geometry and 17 % had either eccentric hypertrophy or concentric remodeling. LV mass index, thickness, ejection fraction and peak longitudinal and circumferential strains all correlated with epicardial adipose tissue after adjusting for height and gender (all p <0.05). Peak longitudinal and circumferential strains showed a significant relationship with the type of LV remodeling, and were most impaired in children with concentric hypertrophy (p <0.001 and p = 0.003, respectively).
  
  
  
  Obese children show evidence of significant cardiac remodeling and dysfunction, which begins as young as age 8. Obese children with concentric hypertrophy and impaired strain may represent a particularly high risk subgroup that demands further investigation.
authors.affiliation: Departments of Pediatrics, University of Kentucky, Lexington, KY, USA.|Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville Pennsylvania, PA, 17822-4400, USA.
authors.forename: Linyuan
authors.initials: L
authors.lastname: Jing
authors.affiliation: Department of Physiology and Medicine, University of Kentucky, Lexington, KY, USA.|Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville Pennsylvania, PA, 17822-4400, USA.
authors.forename: Cassi M
authors.initials: CM
authors.lastname: Binkley
authors.affiliation: Departments of Pediatrics, University of Kentucky, Lexington, KY, USA.|Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville Pennsylvania, PA, 17822-4400, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Suever
authors.affiliation: Department of Physiology and Medicine, University of Kentucky, Lexington, KY, USA.
authors.forename: Nivedita
authors.initials: N
authors.lastname: Umasankar
authors.affiliation: Departments of Pediatrics, University of Kentucky, Lexington, KY, USA.|Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville Pennsylvania, PA, 17822-4400, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Haggerty
authors.affiliation: Center for Health Research, Geisinger Health System, Danville Pennsylvania, PA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rich
authors.affiliation: Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Wehner
authors.affiliation: Department of Electrical Engineering, University of Kentucky, Lexington, KY, USA.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Hamlet
authors.affiliation: Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA.
authors.forename: David K
authors.initials: DK
authors.lastname: Powell
authors.affiliation: Departments of Pediatrics, University of Kentucky, Lexington, KY, USA.
authors.forename: Aurelia
authors.initials: A
authors.lastname: Radulescu
authors.affiliation: Center for Health Research, Geisinger Health System, Danville Pennsylvania, PA, USA.
authors.forename: H Lester
authors.initials: HL
authors.lastname: Kirchner
authors.affiliation: Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.
authors.forename: Frederick H
authors.initials: FH
authors.lastname: Epstein
authors.affiliation: Departments of Pediatrics, University of Kentucky, Lexington, KY, USA. bkf@gatech.edu.|Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA. bkf@gatech.edu.|Department of Physiology and Medicine, University of Kentucky, Lexington, KY, USA. bkf@gatech.edu.|Department of Electrical Engineering, University of Kentucky, Lexington, KY, USA. bkf@gatech.edu.|Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville Pennsylvania, PA, 17822-4400, USA. bkf@gatech.edu.
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Fornwalt
mesh_terms: D050154:Adiposity; D000293:Adolescent; D017668:Age of Onset; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D009200:Myocardial Contraction; D015588:Observer Variation; D063766:Pediatric Obesity / Q000150:complications* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D013314:Stress, Mechanical; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: Cardiac magnetic resonance; Cardiac mechanics; Cardiac remodeling; Pediatric obesity