Relation of grades of obesity with left ventricular functions

Irfan A. Bhat, Imran Hafeez, Hardeep Singh, Ajaz Lone, Jahangir R. Beig, Muezza Samer


Background: Obesity is a state of excess adipose tissue mass. It is a complex multifactorial condition which poses major risk for serious diet related chronic diseases including type 2 diabetes mellitus, cardiovascular disease, hypertension and stroke. Obesity is associated with atrial and ventricular re-modelling; obese individuals have both eccentric and concentric patterns of left ventricular hypertrophy. Obesity adversely impacts cardiac diastolic function. In a large community based investigation, BMI emerged as a key correlate of impaired diastolic filling indexes. The objective of this study was to evaluate left ventricular dimensions and functions in patients with obesity and to find correlation between left ventricular dimensions and functions with grades of obesity.

Methods: The present study was a hospital based study conducted in the Postgraduate Department of Internal Medicine, SMHS Hospital of Government Medical College Srinagar and SKIMS Kashmir. A total of 100 subjects of either gender across a spectrum of body mass were taken up for this study.

Results: The mean age was 44.7±11 years. Females (56%) were more than males (44%). The subjects were categorized into four groups which include normal BMI (18%) overweight (32%), obese I (31%) and obese II (19%). The mean BMI of our subjects was 26.8±0.3kg/m2. There was no significant change in left ventricular systolic functions. Diastolic abnormality was found in 24% of the subjects. Diastolic abnormalities were more prevalent in subjects with higher grades of obesity 47.4% in obese II and 12.5% in overweight.

Conclusions: With increasing grades of obesity, both LV dimensions and volumes were increased and subclinical LV diastolic dysfunction was present in all grades of obesity. Diastolic abnormalities were more prevalent in subjects with higher grades of obesity. Our study provides justification for the idea of obesity as a therapeutic target in prevention of increased prevalence of cardiovascular diseases.



Body mass index, Diastolic functions, Obesity, Systolic functions

Full Text:



WHO- Obesity preventing and managing global epidemic: report of a WHO consultation on obesity. Geneva 3-5 June 1997, Geneva WHO; 1998.

WHO/IOAF/IASO/2000; Asia pacific- perspective Redefining obesity and its treatment. Hong kong WHO. International obesity task force. International association for obesity; 2000.

Ko GTC, Chan JC, Cockran CS and Woo J. Prediction of hypertension, diabetes, dyslipidemia, or albuminuria using simple anthropometric indexes in Hong Kong Chinese. Int J Obesity. 1999;23:1136-42.

Deurenberg P, Deurenberg-Yap M, Wang J, Lin FP, Schmidt G. The impact of body builds on the relationship between body mass index and body fat percent. Int J Obesity. 1999;23:537-42.

Wang J, Thornton JC, Russell M, Burastero S, Heymsfield SB, Pierson RN. Asians have lower BMI but higher percent body fat than do Whites: comparisons of anthropometric measurements. Am J Clin Nutrit. 1994;60:23-8.

Isselbacher KJ, Braunwald E, Wilson JD, Martin JB, Fauci AS, Kasper DL. Harrison's principles of internal medicine. Shock. 1996;5(1):78.

WHO- Global Strategy Diet and Physical Activity, 2009. Available at www.whoint/dietphysicalactivity.

Gopinath N, Chadha SL, Jain P, Shekhawat S, Tandor R. An epidemiological study of obesity in adults in the urban population of Delhi. J Assoc Physicians India. 1994;42:212-5.

Mohan, Deepa. Obesity and abdominal obesity in Asian Indian. Ind J Med Res. 2006;123:593-6.

Zargar AH, Masoodi SR, Laway BA. Prevalence of obesity in adults - an epidemiological study from Kashmir valley of Indian subcontinent. JAPI. 2000;48:1170-4.

Alexander JK. Obesity and heart: Heart Disease Stroke. 1993;2:307-21.

de Simone G, Deverex RB, Roman MJ. Relation of obesity and gender to left ventricular hypertrophy in normotensive and hypertensive adults. Hypertension 1994;23:600-6.

De Simone G, Devereux RB, Roman MJ. Influence of obesity on left ventricular mid wall in arterial hypertension. Hypertension. 1996;28:276-83.

Fisher M, Baessler A, Hense HW. Prevalence of left ventricular diastolic dysfunction in community. Results from a Doppler echocardiographic based survey of a population sample. Eur Heart J. 2003;24:320-28.

Harris MI, Flegal KM, Cowie CC. Prevalence of diabetes impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1998-1994. Diabetes Care. 1998;21:518-24.

Tery RB, Wood PD, Haskue WL. Regional adioposity pattern in relation to lipids lipoproteins, cholesterol and lipoprotein subfraction mass in men. J Clin Endocrinol Metab. 1989;68:191-9.

Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity is an independent risk factor for cardiovascular disease - 26th year follow-up of participants in Framingham Heart Study. Circulation. 1983;67:968-77.

Stamler J, Wentworth D, Neaton JD. Is relationship between serum cholesterol and risk of premature death from coronary disease continuous or guided? Findings in 356222 primary screenees of multiple risk factors. Intervention Trial (MRFIT). JAMA. 1986;256:2823-8.

Singh RB, Niaz MA, Beegom R. Body fat percent by bioelectrical impedance analysis and risk of coronary artery disease among urban men with low rates of obesity: The Indian Paradox. J Am Coll Nutrition. 1999;3:268-73.

Morricone L, Malavazos AC, Coman C. Echocardiographic abnoramltieis in normotensive obese patients, relationship with visceral fat. Obes Res. 2002;10:489-98.

Wong CY, Moore TO, Leano SR. Alteration of LV myocardial characteristics associated with obesity. Circulation. 2004;110:3081-7.

Brain CD, Higgins M, Donatto KA. Body mass index and the prevalence of hypertension and dyslipidemia Obes Res. 2000;8;605-19.

Zhu L, Liu K. The impact of adiposity and insulin resistance on endothelial function in middle aged subjects. Int J Cardiovascular Res. 2002;1(1).

Valverde MA, Vitolo MR, Patin RV. Changes in lipid profile in obese children and adolescents. Archivos Latinamericanos de Nutrition. 1999;49(4):338-43.

Pascual M, Pascual DA, Soria F. Effect of isolated obesity on systolic and diastolic left ventricular function. Heart. 2003;89:1152-6.

Brain, Powel D, Redfield MM. Association of obesity with LV Remodelling and diastolic dysfunction in patients without coronary artery disease. American J Cardiol VDL. 2006;98(1):116-20.

Van Harmelen V, Ariapart P, Hoffstedt J. Increased adipose angiotensinogen gene expression in human obesity. Obes Res. 2002;8:337-41.

Harp JB, Henry SA, DiGirolamo M. Dietary weight loss decreases serum angiotensin-converting enzyme activity in obese adults. Obes Res. 2002;10:985-90.

Ruiz-Ortega M, Lorenzo O, Ruperez M. Systemic infusion of angiotensin II into normal rats activates nuclear factor-kappaB and AP-1 in the kidney: role of AT(1) and AT(2) receptors. Am J Pathol. 2001;158:1743-56.

Jain A, Avendano G, Dharamsey S. Left ventricular diastolic function in hypertension and role of plasma glucose and insulin: comparison with diabetic heart. Circulation. 1996;93:1396-402.