Hostname: page-component-848d4c4894-hfldf Total loading time: 0 Render date: 2024-06-09T23:27:19.838Z Has data issue: false hasContentIssue false

Effects of childhood obesity on myocardial performance, autonomic and conduction properties of the heart

Published online by Cambridge University Press:  25 July 2023

Abdullah Kocabaş*
Affiliation:
Department of Pediatric Cardiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
Elifnur Çağlak
Affiliation:
Department of Pediatrics, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
Özlem Turan
Affiliation:
Department of Pediatric Cardiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
Gökmen Özdemir
Affiliation:
Department of Pediatric Cardiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
Işıl Yıldırım-Baştuhan
Affiliation:
Department of Pediatric Cardiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
Diyar Z. Tamburacı
Affiliation:
Department of Pediatric Cardiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
Burcu T. Öztürk-Gömeç
Affiliation:
Department of Pediatric Cardiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
Doğa Türkkahraman
Affiliation:
Department of Pediatric Endocrinology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
*
Corresponding author: A. Kocabaş; Email: dr.akocabas@gmail.com

Abstract

Background:

Childhood obesity tends to persist into adulthood and associated with increase in developing ischemic and non-ischemic cardiovascular diseases. We aimed to evaluate the effect of obesity on cardiac functions, atrial electromechanical coupling, and heart rate response, which are considered to be predictors of atrial fibrillation and sudden cardiac arrest.

Methods:

Study population included 52 obese children and 52 healthy controls. We performed 12-lead electrocardiography, echocardiographic examination, and treadmill exercise testing. Mitral, septal, and tricuspid segments were analysed by tissue Doppler imaging.

Results:

Myocardial performance index (p = 0.011, p < 0.001, and p = 0.001, respectively) was higher and E'/A' ratio (p = 0.011, p < 0.001, and p < 0.001, respectively) was lower in obese group than controls. Atrial electromechanical coupling was longer in the obese group at all three segments (p < 0.001, p = 0.009, and p = 0.04, respectively). They had significantly longer interatrial (p < 0.001) and intra-atrial (p = 0.003) electromechanical conduction delay. While chronotropic index was similar between two groups, heart rate reserve was lower in obese children than controls (p = 0.043). The 1st- and 2nd-minute heart rate recovery indices of the obese group were lower compared to controls (p < 0.001 and p = 0.03, respectively). Body mass index was positively correlated with intra- and inter-atrial conduction times, whereas it was negatively correlated with heart rate recovery indices.

Conclusion:

We showed a deterioration in the diastolic function, atrial conduction, and heart rate response properties in children with obesity. Given the prognostic importance of these parameters, obese patients are might be at risk for atrial fibrillation and severe dysrhythmias from a young age.

Type
Original Article
Copyright
© The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ogden, CL, Carroll, MD, Kit, BK, Flegal, KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014; 311: 806814.Google Scholar
Simmonds, M, Burch, J, Llewellyn, A, et al. The use of measures of obesity in childhood for predicting obesity and the development of obesity-related diseases in adulthood: a systematic review and meta-analysis. Health Technol Assess (Rockv) 2015; 19: 1336.CrossRefGoogle ScholarPubMed
Brisbois, TD, Farmer, AP, McCargar, LJ. Early markers of adult obesity: a review. Obes Rev 2012; 13: 347367.Google Scholar
Umer, A, Kelley, GA, Cottrell, LE, Giacobbi, P, Innes, KE, Lilly, CL. Childhood obesity and adult cardiovascular disease risk factors: a systematic review with meta-analysis. BMC Public Health 2017; 17: 683.Google Scholar
Sommer, A, Twig, G. The impact of childhood and adolescent obesity on cardiovascular risk in adulthood: a systematic review. Curr Diab Rep 2018; 18: 91.Google Scholar
Dilaveris, PE, Gialafos, EJ, Sideris, SK, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998; 135: 733738.Google Scholar
Ozveren, O, Izgi, C, Eroglu, E, et al. Doppler tissue evaluation of atrial conduction properties in patients with non-alcoholic fatty-liver disease. Ultrason Imaging 2016; 38: 225235.Google Scholar
Celikbilek, A, Sarikaya, S, Zararsiz, G, Tanik, N, Erbay, AR. Assessment of atrial electromechanical delay in patients with migraine. Acta Neurol Belg 2014; 114: 261267.Google Scholar
Temiz, F, Güneş, H, Güneş, H. Evaluation of atrial electromechanical delay in children with obesity. Medicina (Lithuania) 2019; 55: 228.Google Scholar
Kocabaş, A, Salman, N, Ekici, F, Çetin, I, Akcan, FA. Evaluation of cardiac functions and atrial electromechanical delay in children with adenotonsillar hypertrophy. Pediatr Cardiol 2014; 35: 785792.Google Scholar
Lauer, MS, Okin, PM, Larson, MG, Evans, JC, Levy, D. Impaired heart rate response to graded exercise prognostic implications of chronotropic incompetence in the framingham heart study. Circulation 1996; 93: 15201526.Google Scholar
Cole, CR, Blackstone, EH, Pashkow, FJ, Snader, CE, Lauer, MS. Heart-rate recovery immediately after exercise as a predictor of mortality. New Engl J Med 1999; 341: 13511357.Google Scholar
von Scheidt, F, Meier, S, Krämer, J, et al. Heart rate response during treadmill exercise test in children and adolescents with congenital heart disease. Front Pediatr 2019; 7: 65.Google Scholar
Shetler, K, Marcus, R, Froelicher, VF, et al. Heart rate recovery: validation and methodologic issues. J Am Coll Cardiol 2001; 38: 19801987.CrossRefGoogle ScholarPubMed
Neyzi, O, Bundak, R, Gökçay, G, et al. Reference values for weight, height, head circumference, and body mass index in Turkish children. J Clin Res Pediatr Endocrinol 2015; 7: 280293.Google Scholar
Tei, C, Nishimura, RA, Seward, JB, Tajik, AJ. Noninvasive doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiog 1997; 10: 169178.Google Scholar
Özer, N, Yavuz, B, Can, I, et al. Doppler tissue evaluation of intra-atrial and interatrial electromechanical delay and comparison with P-wave dispersion in patients with mitral stenosis. J Am Soc Echocardiog 2005; 18: 945948.Google Scholar
Wilkoff, BL, Miller, RE. Exercise testing for chronotropic assessment. Cardiol Clin 1992; 10: 705717.Google Scholar
El-Assaad, I, Al-Kindi, SG, v., Saarel E, Aziz, PF. Lone pediatric atrial fibrillation in the United States: analysis of Over 1500 Cases. Pediatr Cardiol 2017; 38: 10041009.Google Scholar
Frost, L, Hune, LJ, Vestergaard, P. Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish diet, cancer, and health study. Am J Med 2005; 118: 489495.Google Scholar
Schmidt, M, Bøtker, HE, Pedersen, L, Sørensen, HT. Comparison of the frequency of atrial fibrillation in young obese versus young nonobese men undergoing examination for fitness for military service. Am J Cardiol 2014; 113: 822826.Google Scholar
Elsherbiny, IAE. Arterial stiffness is associated with tissue Doppler atrial conduction times and P wave dispersion in hypertensive patients. Intern Med 2012; 51: 147153.Google Scholar
Avci, BK, Gulmez, O, Donmez, G, Pehlivanoglu, S. Early changes in atrial electromechanical coupling in patients with hypertension. Chin Med J (Engl) 2016; 129: 13111315.Google Scholar
Chao, TF, Sung, SH, Wang, KL, et al. Associations between the atrial electromechanical interval, atrial remodelling and outcome of catheter ablation in paroxysmal atrial fibrillation. Heart 2011; 97: 225230.Google Scholar
Dilaveris, PE, Gialafos, JE. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvas Electro 2001; 6: 159165.Google Scholar
Reilly, JJ, Kelly, J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes 2011; 35: 891898.CrossRefGoogle ScholarPubMed
Yagmur, J, Cansel, M, Acikgoz, N, et al. Assessment of atrial electromechanical delay by tissue doppler echocardiography in obese subjects. Obesity 2011; 19: 779783.Google Scholar
Imai, K, Sato, H, Hori, M, et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol 1994; 24: 15291535.CrossRefGoogle ScholarPubMed
Vivekananthan, DP, Blackstone, EH, Pothier, CE, Lauer, MS. Heart rate recovery after exercise is apredictor of mortality, independent of the angiographic severity of coronary disease. J Am Coll Cardiol 2003; 42: 831838.CrossRefGoogle Scholar
Franssen, WMA, Keytsman, C, Marinus, N, et al. Chronotropic incompetence is more frequent in obese adolescents and relates to systemic inflammation and exercise intolerance. J Sport Health Sci 2023; 12: 194201.Google Scholar
Ozveren, O, Dogdu, O, Sengul, C, et al. Deterioration of heart rate recovery index in patients with non-alcoholic fatty liver disease (NAFLD). Med Sci Monitor 2014; 20: 15391543.Google Scholar