Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study.
It is unclear whether obesity and type 2 diabetes (T2D), either alone or in combination, induce left ventricular hypertrophy (LVH) independent of hypertension. In the current study, we provide clarity on this issue by rigorously analysing patient left ventricular (LV) structure via clinical indices and via LV geometric patterns (more commonly used in research settings). Importantly, our sample consisted of hypertensive patients that are routinely screened for LVH via echocardiography and normotensive patients that would normally be deemed low risk with no further action required.



This cross sectional study comprised a total of 353 Caucasian patients, grouped based on diagnosis of obesity, T2D and hypertension, with normotensive obese patients further separated based on metabolic health. Basic metabolic parameters were collected and LV structure and function were assessed via transthoracic echocardiography. Multivariable logistic and linear regression analyses were used to identify predictors of LVH and diastolic dysfunction.



Metabolically healthy normotensive obese patients exhibited relatively low risk of LVH. However, normotensive metabolically non-healthy obese, T2D and obese/T2D patients all presented with reduced normal LV geometry that coincided with increased LV concentric remodelling. Furthermore, normotensive patients presenting with both obesity and T2D had a higher incidence of concentric hypertrophy and grade 3 diastolic dysfunction than normotensive patients with either condition alone, indicating an additive effect of obesity and T2D. Alarmingly these alterations were at a comparable prevalence to that observed in hypertensive patients. Interestingly, assessment of LVPWd, a traditional index of LVH, underestimated the presence of LV concentric remodelling. The implications for which were demonstrated by concentric remodelling and concentric hypertrophy strongly associating with grade 1 and 3 diastolic dysfunction respectively, independent of sex, age and BMI. Finally, pulse pressure was identified as a strong predictor of LV remodelling within normotensive patients.



These findings show that metabolically non-healthy obese, T2D and obese/T2D patients can develop LVH independent of hypertension. Furthermore, that LVPWd may underestimate LV remodelling in these patient groups and that pulse pressure can be used as convenient predictor of hypertrophy status.
Metabolic Research Unit, Metabolic Reprogramming Laboratory, School of Medicine, Deakin University, Waurn Ponds, VIC, Australia. kgraham@deakin.edu.au.
Kirstie A
0000-0003-3249-1628
KA
De Jong
Metabolic Research Unit, Metabolic Reprogramming Laboratory, School of Medicine, Deakin University, Waurn Ponds, VIC, Australia.|Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich-Heine University, c/o Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.|German Center of Diabetes Research, Ingolstädter Landstraße 1, 85764, München-Neuherberg, Germany.
Juliane K
JK
Czeczor
Metabolic Research Unit, Metabolic Reprogramming Laboratory, School of Medicine, Deakin University, Waurn Ponds, VIC, Australia.
Smithamol
S
Sithara
Metabolic Research Unit, Metabolic Reprogramming Laboratory, School of Medicine, Deakin University, Waurn Ponds, VIC, Australia.
Kevin
K
McEwen
Department of Pediatrics, University of Alberta, Edmonton, AB, T6G 2H7, Canada.|Department of Pharmacology, University of Alberta, Edmonton, AB, T6G 2H7, Canada.
Gary D
GD
Lopaschuk
Cardiology Department, Barwon Health, University Hospital Geelong, Victoria, Australia.
Alan
A
Appelbe
Geelong Endocrinology and Diabetes Centre, Geelong, VIC, Australia.
Kimberly
K
Cukier
Endocrinology Department, Barwon Health, University Hospital, Geelong, VIC, Australia.|School of Medicine, Deakin University, Waurn Ponds, VIC, Australia.|Melbourne Medical School-Western Precinct, The University of Melbourne, Victoria, Australia.
Mark
M
Kotowicz
Metabolic Research Unit, Metabolic Reprogramming Laboratory, School of Medicine, Deakin University, Waurn Ponds, VIC, Australia.
Sean L
SL
McGee
D000368:Aged; D001794:Blood Pressure; D016009:Chi-Square Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling; D014739:Victoria / Q000453:epidemiology; D044465:White People
Echocardiography; Left ventricular diastolic dysfunction; Left ventricular hypertrophy; Obesity; Type 2 diabetes