Evidence of occult right ventricular dysfunction in morbidly obese patients

Title

Evidence of occult right ventricular dysfunction in morbidly obese patients

Creator

Kulifay SLKS;Lattanzio DSLD;Mikolich BMMB;Mikolich JRMR

Publisher

European Heart Journal

Date

2020
2020-11

Description

Background Abnormalities of right ventricular (RV) strain have been shown to occur prior to impairment of global right ventricular function, measured by global RV ejection fraction (RVEF) in patients with increased RV afterload, such as pulmonary hypertension. Obesity is a form of increased afterload involving both the right and left cardiac circulations, raising suspicion that impaired RV strain may be an early indicator of myocardial dysfunction. Purpose This study was designed to assess impairment of RV strain in obese patients with normal right ventricular ejection fraction (RVEF) using cardiac MRI Fast SENC (strain encoded) pulse sequences. Methods An institutional cardiac imaging database was queried for all patients with body mass index (BMI) greater than 35 kg/m2 who underwent measurement of RV global longitudinal strain (GLS), RV global circumferential strain (GCS) and 37 segmental strain measurements using cardiac MRI Fast-SENC pulse sequences. Global RVEF was computed for all patients using a standard cardiac MRI method using non-automated hand drawn RV endocardial borders. Global and regional strain measurements were compared to a cohort of healthy volunteers who also underwent CMR Fast-SENC imaging. Abnormal myocardial strain was defined as a value greater than −17%. Results Of the 356 patients in the database, 48 had a BMI greater than 35 kg/m2. Mean RV GLS and GCS for the study cohort were −16.6 and −15.8 respectively. For healthy volunteers RV GLS and GCS were −20.8 and −19.0 respectively. Comparison of mean RV GLS and GCS of both groups were statistically significant ANOVA p<0.001. The number of normal RV segmental strain values was significantly decreased in obese patients when compared to the normal cohort, ANOVA p<0.001 (Figure 1). Furthermore, the prevalence of abnormal RV GCS in morbidly obese patients with normal RVEF greater than or equal to 40% was 84% (21 of 25 patients). Conclusions These findings suggest that morbidly many obese patients have occult RV dysfunction despite a normal RVEF. This occult RV dysfunction not only affects RV global GLS and GCS, but also the percentage of normal segmental strain values. Detection of occult RV dysfunction is of clinical significance in that it may provide an opportunity for treatment before development of symptomatic right heart failure.

Subject

obesity; Ventricular Dysfunction; endocardium; heart failure; pulmonary hypertension; Diagnostic Techniques; chronic heart failure; body mass index procedure; right-sided; right ventricular ejection fraction; myocardial dysfunction

Format

journalArticle

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Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

1024

Issue

2

Volume

41

ISSN

0195-668X

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NEOMED Department

NEOMED Student Publications

Update Year & Number

February 2021 List

Citation

Kulifay SLKS;Lattanzio DSLD;Mikolich BMMB;Mikolich JRMR, “Evidence of occult right ventricular dysfunction in morbidly obese patients,” NEOMED Bibliography Database, accessed September 23, 2021, https://neomed.omeka.net/items/show/11576.

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