ABNORMAL LEFT-VENTRICULAR DIASTOLIC FILLING IN ECCENTRIC LEFT-VENTRICULAR HYPERTROPHY OF OBESITY

Left ventricular (LV) diastolic filling pattern of obese subjects with eccentric LV hypertrophy was studied. Findings were compared with those of normal control subjects and hypertensive patients with concentric LV hypertrophy. M-mode, 2-dimensional and Doppler echocardiograms were recorded in 11 obese (body mass index > 30 kg/m2) normotensive patients with eccentric LV hypertrophy, 10 normal control subjects, and 18 nonobese, hypertensive patients with concentric LV hypertrophy whose antihypertensive medications were discontinued 2 weeks before study. LV hypertrophy was defined as LV mass/height > 143 g/m. Hypertrophy in the obese patients was eccentric: Their LV internal dimension (61 +/- 3 mm) was greater than that of hypertensive patients (55 +/- 5 mm, p < 0.001) and normal control subjects (55 +/- 2 mm, p < 0.01); their septal (10.7 +/- 0.7 mm) and posterior (10.9 +/- 0.6 mm) wall thicknesses were smaller than those of the hypertensive patients (12.2 +/- 1.7 mm, p < 0.05 and 11.7 +/- 1.2 mm, respectively, difference not significant). Pulsed-wave Doppler echocardiographic filling indexes were used to evaluate LV diastolic filling. Obese patients had a higher peak velocity of atrial filling (69 +/- 14 vs 54 +/- 15 cm/s, p < 0.05), lower early/atrial filling velocity ratio (1.0 +/- 0.26 vs 1.32 +/- 0.21, p < 0.05), prolonged deceleration half-time (108 +/- 9 vs 86 +/- 15 ms, p < 0.01) and lower peak filling rate corrected to stroke volume (4.08 +/- 0.68 vs 4.96 +/- 0.88 stroke volume/s, p < 0.05) than normal control subjects. The deceleration half-time of obese patients correlated with the body mass index (r = 0.62, p < 0.05). LV filling parameters of obese patients were not significantly different from those seen in hypertensive patients, except for a prolonged deceleration half-time corrected to heart rate (137 +/- 22 vs 117 +/- 19 ms, p < 0.05). Eccentric LV hypertrophy of obesity causes an abnormal LV diastolic filling pattern similar to concentric LV hypertrophy of hypertension. Studies of LV diastolic function should take this variable into consideration.