Chest
Volume 92, Issue 6, December 1987, Pages 1042-1046
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Left Atrial Abnormalities Indicating Diastolic Ventricular Dysfunction in Cardiopathy of Obesity

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Electrocardiograms and M-mode echocardiograms were evaluated in lean and obese patients, either normotensive or hypertensive, who were paired for mean arterial pressure, age, and sex. Electrocardiographic evidence of left atrial abnormalities (LAA) occurred more frequently (p<0.01) and left atrial size was greater in the obese than in the lean patients (p<0.01). The left atrial emptying index, an indicator of early diastolic ventricular function, was reduced in obese patients (p<0.01), most markedly in those with obesity-hypertension. The left atrial emptying index was reduced in obese patients with electrocardiographic LAA compared to obese patients without this electrocardiographic sign (p<0.02). A close correlation (r = 0.61, p<0.001) was obtained between the left atrial emptying index and atrial ECG abnormalities. These left atrial abnormalities in obesity and particularly in obesity-hypertension indicate diastolic ventricular dysfunction.

Section snippets

SUBJECTS AND METHODS

Twelve obese normotensive and 20 obese patients with mild established essential hypertension were matched for mean arterial pressure, age, and sex with an equal number of lean patients, either hypertensive or normotensive. Thus, there were 12 pairs of lean and obese normotensive subjects and 20 pairs of lean and obese patients with established essential hypertension. Patients were considered to have established essential hypertension if their diastolic blood pressure on an outpatient basis was

RESULTS

When compared to lean patients with similar arterial pressure, obese patients had, as previously reported,2 greater ventricular end-diastolic (p<0.01) and end-systolic (p<0.05) diameters, left atrial dimension (p<0.01), and left atrial dimension index (p<0.05), posterior wall thickness (p<0.01), septal thickness (p<0.01), left ventricular mass (p<0.01) and left ventricular mass index (p<0.05) (Table 2). Left ventricular systolic function as determined by fractional fiber shortening and velocity

DISCUSSION

The present study demonstrates that obese patients, when compared to lean subjects, have a greater prevalence of electrocardiographic left atrial abnormality and have larger left atrial diameters independent of the level of arterial pressure. The left atrial emptying index was only slightly reduced in lean hypertensives and was reduced by 15 percent in all hypertensive compared to all normotensive subjects. However, the atrial emptying index, an indicator of early diastolic ventricular filling

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    Presented in part at the 58th Scientific Session, American Heart Association, November 11-14, 1985, Washington, DC; and at the 36th Scientific Session, American College of Cardiology, March 8-12, 1987, New Orleans.

    Manuscript received March 6; revision accepted May 18.

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