TY - JOUR
T1 - Abnormal central pulsatile hemodynamics in adolescents with obesity
T2 - Higher aortic forward pressure wave amplitude is independently associated with greater left ventricular mass
AU - Pierce, Gary L.
AU - Pajaniappan, Mohanasundari
AU - Dipietro, Amy
AU - Darracott-Woei-A-Sack, Kathryn
AU - Kapuku, Gaston K.
N1 - Publisher Copyright:
© 2016 American Heart Association, Inc.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - We hypothesized that increased aortic forward pressure wave amplitude (Pf), which is determined by characteristic impedance (Zc) in the proximal aorta, is the primary hemodynamic determinant of obesity-associated higher left ventricular (LV) mass in adolescents. Aortic pulsatile hemodynamics were measured noninvasively in 60 healthy adolescents (age 14-19 years; 42% male; 50% black) by sequential recordings of pulse waveforms via tonometry, brachial blood pressure, and pulsed Doppler and diameter of the LV outflow tract using 2-dimensional echocardiography. Adolescents who were overweight/obese (n=23; age 16.0±0.3 years; body mass index ≥85th percentile) had higher LV mass index, brachial and carotid systolic blood pressure and pulse pressure, normalized Zc and Pf compared with adolescents with healthy weight (n=37; 16.7±0.3 years; body mass index <85th percentile, all P<0.01). In contrast, there was no difference in mean or diastolic blood pressure, carotid-femoral pulse wave velocity, carotid augmentation index, or aortic backward wave amplitude (all P>0.05). Stepwise multiple linear regression analysis that included age, sex, race, normalized Zc, and brachial systolic blood pressure revealed that body mass index (B±SE; 0.49±0.20, P=0.02, R 2 =0.26), aortic Pf (0.22±0.07; P<0.02, R 2 change=0.11), and cardiac output (2.82±1.02, P<0.01; R 2 change=0.08) were significant correlates of LV mass index (total R 2 =0.44, P<0.01). These findings suggest that higher aortic Pf is a major hemodynamic determinant of increased LV mass in adolescents with elevated adiposity. Improper matching between aortic diameter and pulsatile flow during early systole potentially contributes to the early development of LV hypertrophy in childhood obesity.
AB - We hypothesized that increased aortic forward pressure wave amplitude (Pf), which is determined by characteristic impedance (Zc) in the proximal aorta, is the primary hemodynamic determinant of obesity-associated higher left ventricular (LV) mass in adolescents. Aortic pulsatile hemodynamics were measured noninvasively in 60 healthy adolescents (age 14-19 years; 42% male; 50% black) by sequential recordings of pulse waveforms via tonometry, brachial blood pressure, and pulsed Doppler and diameter of the LV outflow tract using 2-dimensional echocardiography. Adolescents who were overweight/obese (n=23; age 16.0±0.3 years; body mass index ≥85th percentile) had higher LV mass index, brachial and carotid systolic blood pressure and pulse pressure, normalized Zc and Pf compared with adolescents with healthy weight (n=37; 16.7±0.3 years; body mass index <85th percentile, all P<0.01). In contrast, there was no difference in mean or diastolic blood pressure, carotid-femoral pulse wave velocity, carotid augmentation index, or aortic backward wave amplitude (all P>0.05). Stepwise multiple linear regression analysis that included age, sex, race, normalized Zc, and brachial systolic blood pressure revealed that body mass index (B±SE; 0.49±0.20, P=0.02, R 2 =0.26), aortic Pf (0.22±0.07; P<0.02, R 2 change=0.11), and cardiac output (2.82±1.02, P<0.01; R 2 change=0.08) were significant correlates of LV mass index (total R 2 =0.44, P<0.01). These findings suggest that higher aortic Pf is a major hemodynamic determinant of increased LV mass in adolescents with elevated adiposity. Improper matching between aortic diameter and pulsatile flow during early systole potentially contributes to the early development of LV hypertrophy in childhood obesity.
KW - adiposity
KW - adolescents
KW - cardiac output
KW - pediatrics
KW - pulse wave velocity
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U2 - 10.1161/HYPERTENSIONAHA.116.07918
DO - 10.1161/HYPERTENSIONAHA.116.07918
M3 - Article
C2 - 27620396
AN - SCOPUS:84987677814
SN - 0194-911X
VL - 68
SP - 1200
EP - 1207
JO - Hypertension
JF - Hypertension
IS - 5
ER -