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The Impact of Obesity on Cardiac Function and Morphology in Aortic Stenosis
Session:
Painel 9 - Doença Valvular 1
Speaker:
Inês Meira da Cunha Pereira
Congress:
CPC 2020
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.14 Cardiovascular Disease in Special Populations - Other
Session Type:
Posters
FP Number:
---
Authors:
Inês Meira ; Jenifer Mancio; Guilherme Amorim; Luís Vouga; Pedro Braga; Ricardo Fontes-Carvalho
Abstract
<p>Introduction: It is known that obesity can affect cardiac structure and function leading to an entity described as obesity cardiomyopathy. Several pathophysiological mechanisms can be involved in this association, such as hemodynamic changes and endocrine and paracrine effects related with epicardial fat. In this study we aimed to evaluate the effect of adipose tissue parameters on cardiac function and structure in patients with severe aortic stenosis (sAS).</p> <p>Methods: We evaluated a cohort of patients with sAS referred to cardiac surgery (EPICHEART study). Body weight and height were measured to derive body mass index (BMI) and body composition was determined using bioelectrical impedance analysis. Epicardial fat volume (EFV) was evaluated by thoracic multidetector CT and visceral, subcutaneous and total abdominal fat were evaluated by a single-slice abdominal CT at L4-L5. Echocardiography was performed to analyze cardiac structure (LA volume index; LV volumes; LV mass), systolic (Simpson ejection fraction, S’ velocity) and diastolic function (E/A ratio; E’ velocities; E/E’ ratio). In a subset of patients, LA function was assessed by speckle-tracking using Velocity Vector Imaging software to determine peak LA strain, peak strain before atrial contraction and LA passive emptying strain.</p> <p>Results: The final analysis included 272 participants (75,5±8,4 years old, 50%males). Patients with higher weight have an enlarged septum and posterior wall and an increased LV mass and volume (ρ=0.274, p<0.001 and ρ=0.208, p<0.01, ρ=466, p<0,01 respectively). We also found a significant correlation between other adipose tissue parameters (BMI, waist circumference (WC), visceral abdominal fat (VAF) and EFV) and LV mass. We did not observe a significant correlation between adipose tissue parameters and systolic function (correlation between BMI and Ejection fraction (EF) ρ= 0,040, p=0,59; between EFV and EF ρ=- 0,003, p=0,96; between VAF and EF ρ= 0,043, p=0,58). Regarding the effects on diastolic function, there was no significant association between adipose tissue parameters and diastolic function (correlation between BMI and E/E’ ratio ρ= 0,120, p=0,23; between EFV and E/E’ ρ=0,173, p=0,10). Although we observed that patients with increased WC and higher EFV have an increased LA area (20,65 to 23,12 cm<sup>2</sup>, p<0,01; 20,88 to 23,78 cm<sup>2</sup>, p=0,04, respectively), adipose tissue parameters did not influence LA reservoir, conduit or pump function assessed by speckle-tracking.</p> <p>Conclusions: Contrary to what has been observed in other populations, in patients with sAS we did not observe a significant effect of adipose tissue parameters in cardiac structure or function. LA function also did not correlate with adipose tissue. Therefore, it is likely that, in patients with sAS, the impact of increased post-load in cardiac structure and function off-sets the effect of adipose tissue in heart remodeling.</p>
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