Abnormal central pulsatile hemodynamics in adolescents with obesity

Higher aortic forward pressure wave amplitude is independently associated with greater left ventricular mass

Gary L. Pierce, Mohanasundari Pajaniappan, Amy Dipietro, Kathryn Darracott-Woei-A-Sack, Kakota Gaston Kapuku

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1200-1207
Number of pages8
JournalHypertension
Volume68
Issue number5
DOIs
StatePublished - Nov 1 2016

Fingerprint

Pediatric Obesity
Arterial Pressure
Hemodynamics
Blood Pressure
Body Mass Index
Arm
Pulsatile Flow
Systole
Manometry
Adiposity
Left Ventricular Hypertrophy
Electric Impedance
Cardiac Output
Echocardiography
Pulse
Aorta
Linear Models
Obesity
Regression Analysis
Weights and Measures

Keywords

  • adiposity
  • adolescents
  • cardiac output
  • pediatrics
  • pulse wave velocity

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Abnormal central pulsatile hemodynamics in adolescents with obesity : Higher aortic forward pressure wave amplitude is independently associated with greater left ventricular mass. / Pierce, Gary L.; Pajaniappan, Mohanasundari; Dipietro, Amy; Darracott-Woei-A-Sack, Kathryn; Kapuku, Kakota Gaston.

In: Hypertension, Vol. 68, No. 5, 01.11.2016, p. 1200-1207.

Research output: Contribution to journalArticle

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abstract = "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.",
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