Early Myocardial Deformation Changes in Hypercholesterolemic and Obese Children and Adolescents

Dyslipidemia and obesity are considered strong risk factors for premature atherosclerotic cardiovascular disease and increased morbidity and mortality and may have a negative impact on myocardial function. Our purpose was to assess the presence of early myocardial deformation abnormalities in dyslipidemic children free from other cardiovascular risk factors, using 2-dimensional speckle tracking echocardiography (2DSTE) and 3-dimensional speckle tracking echocardiography (3DSTE). We studied 80 consecutive nonselected patients (6–18 years of age) with hypercholesterolemia (low-density lipoprotein [LDL] cholesterol levels >95th percentile for age and sex). Forty of them had normal weight and 40 were obese (body mass index >95th percentile for age and sex). Forty healthy age-matched children were selected as controls. Left ventricular (LV) global longitudinal, circumferential, and radial strains were calculated by 2DSTE and 3DSTE. Global area strain (GAS) was calculated by 3DSTE as percentage of variation in surface area defined by the longitudinal and circumferential strain vectors. Right ventricular (RV) global and free-wall longitudinal strain and LV and RV diastolic strain rate parameters were obtained. Data analysis was performed offline. LV global longitudinal strain and GAS were lower in normalweight and obese dyslipidemic children compared with normal controls and reduced in obese patients compared with normalweight dyslipidemic children. LV early diastolic strain rate was lower compared with normals. RV global and free-wall longitudinal strain was significantly reduced in obese patients when compared with the control group. A significant inverse correlation was found between LV strain, LDL cholesterol levels, and body mass index. 2DSTE and 3DSTE show LV longitudinal strain and GAS changes in dyslipidemic children and adolescents free from other cardiovascular risk factors or structural cardiac abnormalities. Obesity causes an additive adverse effect on LV strain parameters and RV strain impairment. (Medicine 93(12):e71) Abbreviations: 2DSTE = 2-dimensional speckle tracking echocardiography, 3DSTE = 3-dimensional speckle tracking echocardiography, A = transmitral peak late diastolic velocity, E = transmitral peak early diastolic velocity, E0STE = peak early diastolic longitudinal strain rate, FW-RVLS = free-wall right ventricular longitudinal strain, GAS = global area strain, GCS = global circumferential strain, GLS = global longitudinal strain, GRS = global radial strain, LDL = low-density lipoprotein, LV = left ventricular, LVEF = left ventricular ejection fraction, RV = right ventricular, RV-E0STE = RV longitudinal early diastolic strain rate, RVLS = right ventricular longitudinal strain. INTRODUCTION Dyslipidemia and obesity are considered strong risk factors for premature atherosclerotic cardiovascular disease and increased morbidity and mortality and may have an adverse effect on left ventricular (LV) performance. Two-dimensional speckle tracking echocardiography (2DSTE) allows the assessment of subclinical cardiac dysfunction in different diseases on the basis of myocardial deformation parameters. Reductions in longitudinal and circumferential deformation were demonstrated in children with heterozygous familial hypercholesterolemia, and left and right systolic–diastolic ventricular impairment using 2-dimensional (2D) speckle tracking longitudinal strain has also been described in obese children and adolescents without comorbidities. Three-dimensional speckle tracking echocardiography (3DSTE) provides additive information regarding different parameters of LV myocardial deformation. Our aim was to assess the presence of early myocardial abnormalities using 2DSTE and 3DSTE in nonselected normal-weight and obese dyslipidemic children and adolescents free from other cardiovascular risk factors. Editor: Xiaowen Hu. Received: May 11, 2014; revised and accepted: July 7, 2014. From the Department of Cardiology (AV, LC, RA, YC, FaM); Department of Pediatrics (FrM, EM, CC, CZ); and Department of Medicine (SR, MV, SDC), Sapienza University, Rome, Italy. Correspondence: Antonio Vitarelli, Sapienza University, Via Lima 35, 00198 Rome, Italy (e-mail: [email protected]). AV and FrM devised the study design. AV interpreted the data and wrote the manuscript. EM, CC, and CZ collated the data and provided study samples for blood analyses. LC, SR, RA, YC, FaM, MV, and SDC did literature searches and helped to draft the manuscript. All authors read the manuscript and contributed to the final version. AV is responsible for the overall content as the guarantor. This study was presented in part at Quality of Care and Outcomes Research American Heart Association Scientific Sessions; May 15– 17, 2013; Baltimore, Maryland. The authors have no funding and conflicts of interest to disclose. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ISSN: 0025-7974 DOI: 10.1097/MD.0000000000000071 Medicine • Volume 93, Number 12, September 2014 www.md-journal.com | 1