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Huang J, Yang C, Yan ZN, Fan L, Ni CF. Global myocardial work: A new way to detect subclinical myocardial dysfunction with normal left ventricle ejection fraction in essential hypertension patients: Compared with myocardial layer-specific strain analysis. Echocardiography 2021; 38:850-860. [PMID: 34008233 DOI: 10.1111/echo.15063] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/10/2021] [Accepted: 04/17/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine whether global myocardial work (MW), derived from non-invasive left ventricle (LV) pressure-strain loops (PSL) at rest, could predict subclinical LV myocardial dysfunction in preserved left ventricular ejection fraction (LVEF) essential hypertension (EHT) patients. METHODS A total of 105 untreated EHT patients and 55 normal controls were enrolled in this study. Apical 4-, 3- and 2-chamber views were acquired by two-dimensional echocardiography. The peak systolic myocardial layer-specific longitudinal strain (epimyocardial: GLSEpi; middle layer: GLSMid; and endomyocardial: GLSEndo), global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and myocardial work efficiency (GWE) were generated by speckle-tracking echocardiography (STE). RESULTS The values of GLSEpi, GLSMid, and GLSEndo were significantly lower in EHT patients with LVH than in EHT patients without LVH and normal controls. GWW was significantly increased in EHT patients with LVH compared with without LVH and normal subjects, while GWE was significantly reduced in EHT patients with LVH compared with without LVH and normal subjects. ROC analysis showed that combined global MW values were a more sensitive predictor for detecting the accuracy of LV subclinical dysfunction in EHT patients than layer-specific GLS. CONCLUSION From the research, we conclude that global MW is more sensitive to layer-specific GLS in its ability to detect subclinical LV dysfunction even in EHT patients even without LVH.
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Affiliation(s)
- Jun Huang
- Department of Interventional Radiology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Chao Yang
- Department of Interventional Radiology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zi-Ning Yan
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Li Fan
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Cai-Fang Ni
- Department of Interventional Radiology, the First Affiliated Hospital of Soochow University, Suzhou, China
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Ali SI, Li Y, Adam M, Xie M. Evaluation of Left Ventricular Systolic Function and Mass in Primary Hypertensive Patients by Echocardiography. J Ultrasound Med 2019; 38:39-49. [PMID: 30027675 DOI: 10.1002/jum.14687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 06/08/2023]
Abstract
Hypertension is an independent risk factor for cardiovascular diseases. The accurate evaluation of cardiovascular risk is of paramount importance in the management of hypertensive patients. Conventional echocardiographic methods have provided the assessment of left ventricular systolic function and mass for many years. Tissue Doppler imaging, 3-dimensional echocardiography, and speckle tracking echocardiography are newer echocardiographic modalities for the left ventricular systolic function and mass quantification. The major emphasis of this review is to evaluate the left ventricular systolic function and mass by conventional and newly developed echocardiographic in hypertensive patients.
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Affiliation(s)
- Shima Ibrahim Ali
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- Faculty of Radiological Sciences and Medical Imaging, Alzaiem Alazhari University, Khartoum North, Sudan
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mohamed Adam
- Colleges of Applied Medical Science, Radiology Department, King Khalid University, Kingdom of Saudi Arabia
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Leggio M, Lombardi M, Caldarone E, Mazza A, Fusco A. High body mass index, healthy metabolic profile and low visceral adipose tissue: The paradox is to call it obesity again. Eur J Intern Med 2018; 52:e15-e16. [PMID: 29636273 DOI: 10.1016/j.ejim.2018.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Rome, Italy.
| | - Mario Lombardi
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Elisa Caldarone
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Andrea Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
| | - Augusto Fusco
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
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Abstract
OBJECTIVES Masked hypertension is associated with an increased risk for cardiovascular conditions. The aim of the study was to evaluate the relationship obesity parameters, including body weight, waist circumference, and body mass index. METHODS The study group consisted of 251 consecutive outpatient subjects without overt hypertension. Subjects were classified according to BMI. After a complete medical history and laboratory examination, patients' height, weight, waist circumference heart rate, and office blood pressure were recorded. All subjects underwent ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level. RESULTS Baseline characteristics in patients and controls were similar. Prevalence of Masked hypertension was significantly higher in patients with obesity than controls (30.9% vs 5.7%, p < 0.001). Body mass index (33.2 ± 4.3 vs 25.1 ± 2.7 p < 0.001), waist circumference (98.5 ± 11.7 vs 86.8 ± 8.8, p < 0.001), and weight (86.5 ± 11.8 vs. 69 ± 9.1, p < 0.001) in patients with obesity were significantly higher than in patients with normal weight. Office Systolic BP (121.8 ± 4.4 vs 120.5 ± 4.78, p = 0.035), ambulatory daytime systolic BP (128.8 ± 8.9 vs 124.5 ± 7.4, p < 0.001), ambulatory daytime diastolic BP (73.9 ± 9.5 vs 71.5 ± 7.0, p = 0.019), ambulatory night-time systolic BP in patients with obesity was significantly higher than in patients with normal weight. CONCLUSION This study demonstrated that masked hypertension prevalence is higher in patients with obesity than control patients. It can be suggested that predefining obesity might be helpful in early detection of masked hypertension.
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Affiliation(s)
- Selçuk Özkan
- a Department of Cardiology , Medical Park Ankara Hospital , Ankara , Turkey
| | - Naim Ata
- b Department of Internal Medicine , 29 Mayis Government Hospital , Ankara , Turkey
| | - Bunyamin Yavuz
- c Medical Park Ankara Hospital, Department of Cardiology , Kemerburgaz University , Ankara , Turkey
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Leggio M, Fusco A, Limongelli G, Sgorbini L. Exercise training in patients with pulmonary and systemic hypertension: A unique therapy for two different diseases. Eur J Intern Med 2018; 47:17-24. [PMID: 28911936 DOI: 10.1016/j.ejim.2017.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 02/07/2023]
Abstract
Pulmonary hypertension is a potentially life-threatening condition. Given its evolving definition, the incidence and prevalence of the disease is difficult to define, but registries suggest an increased global awareness. The management of patients with pulmonary arterial hypertension is highly specialised and requires multi-disciplinary input from a range of healthcare professionals, including cardiologists, respiratory physicians, rheumatologists, rehabilitation physicians and cardio-pulmonary physiotherapists. Historically, exercise training in pulmonary hypertension has not been recommended because of safety concerns. However, an increasing number of studies have demonstrated the benefit of exercise training on exercise capacity, peak oxygen consumption and quality of life. Systemic hypertension is one of the most important risk factors for cardiovascular disease, and has been ranked as the leading cause for death and disability worldwide: therefore, adequate control of blood pressure is important for public health. Lowering of blood pressure and prevention of hypertension is in first instance preferable by lifestyle changes. These include weight loss, moderation of alcohol intake, a diet with increased fresh fruit and vegetables, reduced saturated fat, reduced salt intake, reduced stress, and, finally, increased physical activity. With regard to the latter, former guidelines predominantly recommended aerobic exercises such as walking, jogging, and cycling for lowering blood pressure. The main focus of this narrative overview paper is to briefly examine and summarize the benefit of exercise training in patients with pulmonary and systemic hypertension, suggest mechanisms by which exercise may improve symptoms and function and provide evidence-based recommendations regarding the frequency and intensity of exercise in these patients.
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Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Rome, Italy.
| | - Augusto Fusco
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Giorgio Limongelli
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, Santo Spirito Hospital - Villa Betania Clinic, Rome, Italy
| | - Luca Sgorbini
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, Santo Spirito Hospital - Villa Betania Clinic, Rome, Italy
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Leggio M, Lombardi M, Caldarone E, Severi P, D'emidio S, Armeni M, Bravi V, Bendini MG, Mazza A. The relationship between obesity and hypertension: an updated comprehensive overview on vicious twins. Hypertens Res 2017; 40:947-63. [DOI: 10.1038/hr.2017.75] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/07/2017] [Accepted: 04/14/2017] [Indexed: 02/07/2023]
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Abstract
Left ventricular (LV) diastolic dysfunction (LVDD) is characterized by alterations in LV diastolic filling, and is a strong predictor of cardiovascular events and heart failure. Hypertension is the most important risk factor for LVDD in the community and promotes LVDD through several mechanisms, including hemodynamic overload and myocardial ischemia. Associated factors such as age, ethnicity, dietary sodium, obesity, diabetes mellitus, and chronic kidney disease also contribute to LVDD in hypertensive individuals. Blood pressure lowering using antihypertensive medications can improve LVDD; however, it remains unclear whether this improvement in LV diastolic function can improve cardiovascular outcomes.
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Affiliation(s)
- Wilson Nadruz
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Department of Internal Medicine, University of Campinas, Campinas, Brazil
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Tracy RE. Cardiac myocyte sizes in right compared with left ventricle during overweight and hypertension. ACTA ACUST UNITED AC 2014; 8:457-63. [DOI: 10.1016/j.jash.2014.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/05/2014] [Accepted: 05/05/2014] [Indexed: 11/20/2022]
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Leggio M, Mazza A, Cruciani G, Sgorbini L, Pugliese M, Bendini MG, Severi P, Jesi AP. Effects of exercise training on systo-diastolic ventricular dysfunction in patients with hypertension: an echocardiographic study with tissue velocity and strain imaging evaluation. Hypertens Res 2014; 37:649-54. [PMID: 24694644 DOI: 10.1038/hr.2014.44] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 01/17/2014] [Accepted: 01/21/2014] [Indexed: 11/09/2022]
Abstract
There is a lack of detailed data regarding the effect of exercise training in pharmacologically treated hypertensive patients. Therefore, the aim of this study was to evaluate the effects of exercise training on left and right ventricular morphologic and functional parameters by means of conventional echocardiography and sensitive new echocardiographic techniques including tissue Doppler velocity and strain imaging, that were performed in pharmacologically treated hypertensive patients at baseline and at the end of a specific exercise training protocol for primary prevention of cardiovascular disease. We selected 116 pharmacologically treated hypertensive patients who completed the exercise training protocol. All patients underwent a clinical history and examination; transthoracic echocardiography and exercise testing were performed at baseline and at the end of the exercise training protocol. Conventional echocardiography revealed a mild degree of diastolic dysfunction without significant differences or variations from baseline to the end of the exercise training protocol. In contrast, tissue Doppler velocity and strain imaging measurements demonstrated and highlighted the positive influence of exercise training: for both left and right ventricle myocardial early peak diastolic velocities (Em), the ratio of myocardial early-late peak diastolic velocity (Em/Am), myocardial peak systolic velocities (Sm) and peak strain and strain rate values significantly increased at the end of the exercise training protocol, suggesting a relationship between exercise capacity and both left and right ventricular systo-diastolic function. Our study, by means of newer more sensitive echocardiographic techniques, clearly demonstrated the positive impact of exercise training on both left and right ventricular systo-diastolic function, in terms of adjunctive subclinical improvement, in pharmacologically treated hypertensive patients.
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Abstract
The cluster of metabolic and hemodynamic abnormalities which characterize the metabolic syndrome (MS) is responsible for subclinical cardiac and extra-cardiac damage such as left ventricular hypertrophy, diastolic dysfunction, carotid atherosclerosis and microalbuminuria. The development of different non-invasive imaging methods enabled a detail investigation of right ventricular structure and function, and revealed that right ventricular remodeling followed changes in the left ventricular structure and function in patients with arterial hypertension, diabetes or obesity. Previous investigations also reported that the coexistence of two components of the MS induced more significant cardiac remodeling than the presence of only one MS risk-factor. The relationship between different components of the MS (increased blood pressure, abdominal obesity, increased fasting glucose level and dyslipidemia) and right ventricular remodeling could be explained by several hemodynamic and non-hemodynamic mechanisms. However, the association between right ventricular remodeling and the MS has not been sufficiently investigated so far. The aim of this article was to review recent articles focusing on the association between metabolic syndrome components and the metabolic syndrome itself with impairments in right ventricular structure and function assessed by different imaging techniques.
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Affiliation(s)
- Marijana Tadic
- University Clinical Hospital Centre "Dr Dragisa Misovic", Heroja Milana Tepica 1, 11000 Belgrade, Serbia.
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Obert P, Gueugnon C, Nottin S, Vinet A, Gayrard S, Rupp T, Dumoulin G, Tordi N, Mougin F. Two-dimensional strain and twist by vector velocity imaging in adolescents with severe obesity. Obesity (Silver Spring) 2012; 20:2397-405. [PMID: 22653310 DOI: 10.1038/oby.2012.111] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The prevalence of severe obesity is increasing worldwide in adolescents. Whether it is associated with functional myocardial abnormalities remains largely unknown, potentially because of its frequent association with other cardiovascular risk factors and also use of insensitive techniques to detect subclinical changes in myocardial function. We used 2D vector velocity imaging (VVI) to investigate early changes in left ventricular (LV) myocardial function in youths with isolated severe obesity. Thirty-seven asymptomatic severely obese adolescents free of diabetes and hypertension, and 24 lean controls were enrolled. LV longitudinal, basal, and apical circumferential strain, strain rate (SR), rotations, and LV twist were measured. Obese adolescents had greater LV mass and reduced systolic and early diastolic tissue Doppler imaging (TDI) velocities than lean counterparts. L strain (-24%) and systolic and early diastolic SR were also diminished in the obese, whereas no intergroup differences existed for the circumferential deformation indexes. LV twist was more pronounced in the obese (+1.7°, P < 0.01) on account of greater apical rotation only (4.1 ± 0.9 vs. 5.2 ± 1.2°, P < 0.01), potentially compensating for the loss in longitudinal function. Systolic-diastolic coupling, an important component of early filling and diastolic function, was maintained with severe obesity. No intergroup differences were reported regarding time to peak values for all VVI indexes highlighting that dynamics of strain and twist/untwist along the cardiac cycle was preserved with severe obesity. Isolated severe obesity in adolescents, at a preclinical stage, is associated with changes in myocardial deformation and torsional mechanics that could be in part related to alterations in relaxation and contractility properties of subendocardial fibers.
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Affiliation(s)
- Philippe Obert
- EA 4278, "Laboratoire de Pharm-Ecologie Cardiovasculaire", Faculty of Sciences, University of Avignon, Avignon, France.
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Aljaroudi W, Halley C, Houghtaling P, Agarwal S, Menon V, Rodriguez L, Grimm RA, Thomas JD, Jaber WA. Impact of body mass index on diastolic function in patients with normal left ventricular ejection fraction. Nutr Diabetes 2012; 2:e39. [PMID: 23448803 PMCID: PMC3432184 DOI: 10.1038/nutd.2012.14] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Obesity is a major public health epidemic and is associated with increased risk of heart failure and mortality. We evaluated the impact of body mass index (BMI) on the prevalence of diastolic dysfunction (DD). Methods: We reviewed clinical records and echocardiogram of patients with baseline echocardiogram between 1996 and 2005 that showed normal left ventricular ejection fraction (LVEF). Diastolic function was labeled as normal, stage 1, stage 2 or stage 3/4 dysfunction. Patients were categorized as normal weight (BMI <25 kg m−2), overweight (25–29.9 kg m−2), obese (30–39.9 kg m−2) and morbidly obese (⩾40 kg m−2). Multivariable ordinal and ordinary logistic regression were performed to identify factors associated with DD, and evaluate the independent relationship of BMI with DD. Results: The cohort included 21 666 patients (mean (s.d.) age, 57.1 (15.1); 55.5% female). There were 7352 (33.9%) overweight, 5995 (27.6%) obese and 1616 (7.4%) morbidly obese patients. Abnormal diastolic function was present in 13 414 (61.9%) patients, with stage 1 being the most common. As BMI increased, the prevalence of normal diastolic function decreased (P<0.0001). Furthermore, there were 1733 patients with age <35 years; 460 (26.5%) and 407 (23.5%) were overweight and obese, respectively, and had higher prevalence of DD (P<0.001). Using multivariable logistic regression, BMI remained significant in both ordinal (all stages of diastolic function) and binary (normal versus abnormal). Also, obesity was associated with increased odds of DD in all patients and those aged <35 years. Conclusions: In patients with normal LVEF, higher BMI was independently associated with worsening DD.
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Affiliation(s)
- W Aljaroudi
- Department of Cardiovascular Medicine, Heart and Vascular Imaging Institute, Cleveland, OH, USA
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Khoo NS, Smallhorn JF, Atallah J, Kaneko S, Mackie AS, Paterson I. Altered Left Ventricular Tissue Velocities, Deformation and Twist in Children and Young Adults with Acute Myocarditis and Normal Ejection Fraction. J Am Soc Echocardiogr 2012; 25:294-303. [DOI: 10.1016/j.echo.2011.10.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Indexed: 01/31/2023]
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Barbosa JAA, Nunes MCP, Simões e Silva AC, Barbosa MM. Newer Doppler echocardiography techniques in assessment of heart function in obese patients. J Pediatr Endocrinol Metab 2012; 25:69-77. [PMID: 22570953 DOI: 10.1515/jpem.2011.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Obesity is one of the major health problems of modem society. The prevalence of this condition has increased at an alarming rate, especially the most severe form (body mass index >40 kg/m2). The cardiovascular problems that generally accompany obesity are the focus of a large number of studies. Conventional echogram and more current modalities, such as tissue Doppler, strain and strain rate are valuable tools for the detection of subclinical dysfunction and the early diagnosis and treatment of patients.
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Affiliation(s)
- José Augusto A Barbosa
- Department of Pediatrics/Echocardiography, Federal University of Minas Gerais, Avenida Alfredo Balena, 190 Belo Horizonte, Minas Gerais 30130 100, Brazil.
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