Strain Imaging in Morbid Obesity: Insights Into Subclinical Ventricular Dysfunction

Background: Obesity has become an important health problem throughout the world. Early detection of cardiovascular abnormalities may be useful in the future for patient management. This study aimed to identify subclinical ventricular dysfunction in obese patients. Hypothesis: Morbid obesity is associated with ventricular dysfunction. Methods: Doppler echocardiogram was performed in 92 morbidly obese and in 31 healthy controls. Conventional echocardiography and tissue Doppler-based strain imaging were used to analyze ventricular function. Intra-and interobserver strain imaging variabilities were tested on 15 randomly selected cases. Results: Left ventricular (LV) global strain (22.5% +/- 3.5 vs 24.4% +/- 2.5, P < 0.005) and right ventricular (RV) strain (25.8% +/- 5.2 vs 28.2% +/- 5.2, P < 0.029) were lower in obese patients when compared with healthy controls. Echocardiographic parameters of diastolic function were also different from controls. LV strain correlated with LV mass, E/e' ratio, left atrial volume, and RV strain. At multivariate analysis, morbid obesity remained a significant determinant of global LV strain, independently of associated comorbidities. Conclusions: These findings suggest that incipient biventricular dysfunction is present in morbidly obese patients when new echocardiographic indices are used to investigate ventricular function. In addition, strain imaging may provide a more accurate assessment of the ventricular function in obese patients.