Cardiovascular dysfunction and associated risk factors in extremely obese adolescents scheduled for bariatric surgery
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BioMed Central
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Cardiovascular dysfunction and associated risk factors in extremely obese adolescents scheduled for bariatric surgery Stephen C Cook*1, Robert Murray2, Thomas H Inge3, Marc P Michalsky2, Subha V Raman1 and John A Bauer2 Address: 1The Ohio State University, Columbus, OH, USA, 2Nationwide Children's Hospital, Columbus, OH, USA and 3Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA * Corresponding author
from 13th Annual SCMR Scientific Sessions Phoenix, AZ, USA. 21-24 January 2010 Published: 21 January 2010 Journal of Cardiovascular Magnetic Resonance 2010, 12(Suppl 1):P307
doi:10.1186/1532-429X-12-S1-P307
Abstracts of the 13th Annual SCMR Scientific Sessions - 2010
Meeting abstracts - A single PDF containing all abstracts in this Supplement is available here. http://www.biomedcentral.com/content/files/pdf/1532-429X-11-S1-infoThis abstract is available from: http://jcmr-online.com/content/12/S1/P307 © 2010 Cook et al; licensee BioMed Central Ltd.
Introduction
Results
Extreme obesity is a major risk factor for diabetes and several forms of heart disease in adults, but the corresponding impact on risks in children are less well defined.
A majority of patients (7/10) had hypertension, evidence of LV hypertrophy (6/10 had 20 g above predicted LV mass), LV dilation (5/10 had >40 mL/cm above predicted) and epicardial fat (0.1-0.7 cm thickness). Furthermore, MPRI was 1.8 ± 0.48 (range 0.8-2.6, substantially lower than expected values >4.0), suggesting perfusion reserve limitations. In contrast, LVEF was normal (61 ± 4%) and there was no evident myocardial fibrosis or diastolic dysfunction. Blood analysis showed that 7/10 had C-reactive protein (CRP) >2.0 mg/L, and 8/10 had Homeostasis Model Assessment of insulin resistance (HOMA-IR) scores >1.5, demonstrating increased inflammation and insulin resistance, respectively. CRP correlated with epicardial fat thickness (p < 0.05); systolic blood pressure correlated to LV mass (p < 0.02) and diastolic blood pressure correlated with LV volume (p < 0.05).
Purpose The aim of our study was to assess metabolic and cardiovascular (CV) risk factors in addition to cardiac structure and function as determined by cardiac magnetic resonance (CMR), in a cohort of morbidly obese adolescents scheduled for bariatric surgery.
Methods We conducted a retrospective analysis of a series of extremely obese patients (n = 10; BMI = 37-76 kg/m2) undergoing pre-operative metabolic and cardiovascular assessments with CMR (using a standard protocol; 1.5 T; Siemens Espree). Measures of LV systolic and diastolic performance and pericardial fat were made. In addition, stress perfusion was used to assess myocardial perfusion reserve index (MPRI), determined by the upslope of myocardial signal enhancement during adenosine stress vs. rest. Post-analysis comparisons were compared to reference values derived from age matched lean controls and normalized for height and gender. Blood pressure and fasting blood samples were also stu
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