Use of body weight and insulin resistance to select obese patients for echocardiographic assessment of subclinical left ventricular dysfunction

Kosmala, W., Wong, C., Kuliczkowska, J., Leano, R.L., Przewlocka-Kosmala, M. and Marwick, T.H. (2008) Use of body weight and insulin resistance to select obese patients for echocardiographic assessment of subclinical left ventricular dysfunction. American Journal of Cardiology, 101 9: 1334-1340. doi:10.1016/j/amjcard.2007.12.034


Author Kosmala, W.
Wong, C.
Kuliczkowska, J.
Leano, R.L.
Przewlocka-Kosmala, M.
Marwick, T.H.
Title Use of body weight and insulin resistance to select obese patients for echocardiographic assessment of subclinical left ventricular dysfunction
Journal name American Journal of Cardiology   Check publisher's open access policy
ISSN 0002-9149
Publication date 2008-01-01
Sub-type Article (original research)
DOI 10.1016/j/amjcard.2007.12.034
Open Access Status
Volume 101
Issue 9
Start page 1334
End page 1340
Total pages 7
Editor Roberts, W.C.
Place of publication USA
Publisher Excertpa Medica, Inc
Language eng
Subject C1
920103 Cardiovascular System and Diseases
110201 Cardiology (incl. Cardiovascular Diseases)
Abstract Obesity is associated with heart failure. Recognition of subclinical left ventricular (LV) dysfunction may permit the initiation of therapy to prevent the development of heart failure. In this study of anthropometric, biochemical, and echocardiographic measurements in 295 healthy overweight subjects, we sought to investigate the effect of insulin resistance and severity of obesity on LV function and to establish a strategy for detection of LV dysfunction using metabolic and echocardiographic measurements. Correlates of subclinical dysfunction (defined from myocardial deformation in a matched group of 98 slim controls) were sought, and receiver operator characteristic curves for clinical and laboratory parameters were performed to identify optimal cutoffs to permit an effective diagnostic strategy. Subclinical impairment of LV function (average strain <18%) was present in 124 subjects (42%), and 52% of severely obese patients (body mass index [BMI] >35 kg/m). Independent correlates of strain were BMI (beta = -0.25, p <0.0001), fasting insulin (beta = -0.22, p <0.001), and age (beta = -0.18, p <0.003). In patients with a BMI <35 kg/m, subclinical impairment was uncommon in the absence of hyperinsulinemia. Using a BMI <35 kg/m and an insulin level <13 mIU/L to select patients for further testing allowed echocardiography to be avoided in 35% of subjects in whom the prevalence of LV dysfunction was low. In conclusion, obesity and insulin resistance are important contributors to LV dysfunction, a deleterious effect of hyperinsulinemia on LV performance is particularly seen in overweight and moderately obese subjects, and the combination of BMI, fasting insulin, and echocardiography appears optimal for efficient identification of subclinical LV dysfunction in overweight and obese subjects.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2009 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Tue, 24 Mar 2009, 01:20:58 EST by Denise Wilson on behalf of School of Medicine