Left Ventricular Morphology and Diastolic Function in Severe Obesity: Current Views Morfologı́a ventricular izquierda y función diastólica en la obesidad grave: perspectivas actuales

Early observations of cardiac morphology in obesity focused primarily on the prominence of epicardial fat. These include anecdotal descriptions by such luminaries as René Laennec, William Harvey, and Jean Nicholas Corvisart. In 1933, Smith and Willius reported autopsy findings on 135 obese patients including 4 who were severely obese. In this study heart weight increased in proportion to the degree of obesity up to 105 kg and to a lesser extent thereafter. Heart weight was greater than predicted for normal weight and height in both men and women and was far greater than expected in severely obese persons. Nearly all patients had excess epicardial fat and the authors ascribed increased heart weight to this phenomenon. In 1957, Lillington reported biventricular hypertrophy in a severely obese man who died of pulmonary embolism, thus raising the question of left heart involvement in obesity. In 1962, Alexander reported the results of a retrospective survey of autopsy studies of extremely obese patients previously cited as having cor pulmonale. Left ventricular hypertrophy (LVH) and pulmonary congestion had been present in each case. In 1965, Amad et al. reported the results of postmortem studies of 12 severely obese patients. They confirmed that heart weight was increased in all individuals, but demonstrated that it was largely due to LVH. The left ventricle (LV) wall thickness was increased in 11 of the 12 patients and myocyte hypertrophy on microscopic examination was present in all 12. Right ventricular wall thickness was increased in 1 patient and epicardial fat was increased in 6. A later study of 12 severely obese patients by Warnes and Roberts reported increased heart weight, LV wall thickness, microscopic LVH, and excess epicardial fat in all cases and increased right ventricular wall thickness in 4 patients. Complicating these observations was the fact that systemic hypertension and/or coronary artery disease were present premortem in many of the subjects in these studies. The advent of echocardiography permitted premortem assessment of cardiac structure in morbidly obese patients. In a study of 62 normotensive severely obese subjects, Alpert et al. reported LV