L’obésité chez le patient hypertendu, un facteur prédictif de la cardiopathie infraclinique
Keywords:
hypertension, obésité, échocardiographie, strain.
Abstract
Introduction :
L’hypertension et l'obésité sont bien connus chacun aboutir à une insuffisance cardiaque à fraction d'éjection préservée. Les facteurs prédisposant à l’insuffisance cardiaque à FEVG préservée sont l'âge avancé, l'hypertension, le diabète, la dyslipidémie et l’obésité.
Le développement du 2D strain a permis de faire un diagnostic précoce des dysfonctionnements ventriculaires chez les patients présentant des facteurs de risques cardiovasculaires.
Matériels et méthodes :
Ce travail consiste à réaliser chez une série de 128 patients hypertendus (âgés de 25 à 75 ans) répartis en deux sous-groupes : 58 patients obèses (IMC>30kg/m2) et 70 patients non obèses, une étude écho cardiographique complète, ainsi que l’étude de la déformation longitudinale du VG par la technique du speckle tracking (calcul du GLS).
Résultats :
La dyslipidémie et le diabète étaient nettement plus prévalents dans le bras HTA+obésité. La moyenne des chiffres tensionnels était légèrement supérieure dans le bras HTA+obésité.
L’HVG était nettement prédominante dans le bras HTA+obésité avec une baisse plus conséquente de l’indice de contraction longitudinale. Chez les patients hypertendus obèses, l’HVG était le plus souvent concentrique (55,1%). Une élévation des pressions de remplissage a été retrouvée chez 15patients hypertendus obèses contre seulement 7 patients (p=0,0001) hypertendus non obèses, avec une bonne corrélation avec la baisse du GLS, dont le pourcentage de réduction était de 64% chez les patients obèses.
Conclusion :
La baisse de l'indice de fonction longitudinale, malgré la préservation de la FEVG, est bien corrélée à la présence d’une obésité chez les patients hypertendus, et ceci pourrait être dû à une plus forte prévalence de l’hypertrophie ventriculaire gauche chez ce sous-groupe de patients.
References
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Cardiology. Eur Heart J 2007; 28: 2539–2550. DOI: 10.1093/eurheartj/ehm037.
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Henaoui, L.; Benkhedda, S. Factors associated with global longitudinal strain decline in
hypertensive patients with normal left ventricular ejection fraction. Eur. J. Prev. Cardiol.
2017, 14, 1133–1135. doi: 10.1177/2047487317721644.
20. Di Bello V, Santini F, Di Cori A, Pucci A, Palagi C, Delle Donne MG, et al. Obesity
cardiomyopathy: is it a reality? An ultrasonic tissue characterization study. J Am Soc
Echocardiogr: official publication of the American Society of Echocardiography 2006; 19:1063–
71. DOI: 10.1016/j.echo.2006.03.033.
21. Barbosa JA, Mota CC, Simo ̃ es E, Silva AC, Nunes Mdo C, Barbosa MM. Assessing pre-clinical
ventricular dysfunction in obese children and adolescents: the value of speckle tracking imaging.
Eur Heart J – Cardiovasc Imaging September 2013;14(9):882–9. DOI: 10.1093/ehjci/jes294.
22. Drabik WK, Chrzanowski L, Kapusta A, Uznan ́ska-Loch B, Pon ́ska E, Krzemin ́ska-Pakua M,
et al. Severe obesity impairs systolic and diastolic heart function - the significance of pulsed
tissue Doppler, strain, and strain rate parameters. Echocardiography September 2013;30(8):904–
11. DOI: 10.1111/echo.12164.
23. Di Salvo G, Pacileo G, Del Giudice E, Natale F, Limongelli G, Verrengia M, et al. Abnormal
myocardial deformation properties in obese, non-hypertensive children: an ambulatory blood
pressure monitoring, standard echocardiographic, and strain rate imaging study. Eur Heart J
2006; 27:2689–95. doi: 10.1093/eurheartj/ehl163.
24. Dhuper S, Abdullah RA, Weichbrod L, Mahdi E, Cohen HW. Association of obesity and
hypertension with left ventricular. geometry and function in children and adolescents. Obesity
2011;19: 128–33. DOI: 10.1038/oby.2010.134.
25. Abel E, Litwin S, Sweeney G. Cardiac remodeling in obesity. Physiol Rev 2008;88: 389–419. doi:
10.1152/physrev.00017.2007.
26. Di Bello V, Santini F, Di Cori A, Pucc A. Relationship between preclinical abnormalities of
global and regional left ventricular function and insulin resistance in severe obesity: a Color
Doppler Imaging Study. Int J Obes 2006 ;30 : 948–56. DOI : 10.1038/sj.ijo.0803206.27. Saltijeral A, Isla LP, Pe ́rez-Rodrı ́guez O, Rueda S, Fernandez- Golfin C, Almeria C, et al. Early
myocardial deformation changes associated to isolated obesity: a study based on 3D-wall motion
tracking analysis. Obesity 2011;19: 2268–73. DOI: 10.1038/oby.2011.157.
28. Tumuklu MM, Etikan I, Kisacik B, Kayikcioglu M. Effect of obesity on left ventricular structure
and myocardial systolic function: assessment by tissue Doppler imaging and strain/strain rate
imaging. Echocardiography 2007;24(8):802–9. DOI: 10.1111/j.1540-8175.2007.00484.x.
29. Lorch S, Sharkey A. Myocardial velocity, strain, and strain rate abnormalities in healthy obese
children. J Cardiometab Syndr 2007;2: 30–4. DOI : 10.1111/j.1559-4564.2007.06001.x.
30. Koopman LP, McCrindle BW, Slorach C, Chahal N, Hui W, Sarkola T, et al. Interaction between
myocardial and vascular changes in obese children: a pilot study. J Am Soc Echocardiogr
2012;25(401–10). DOI: 10.1016/j.echo.2011.12.018.
31. Mahajan R, Lau DH, Sanders P.Impact of obesity on cardiac metabolism, fibrosis, and function.
Trends Cardiovasc Med. 2015 Feb;25(2):119-26. doi: 10.1016/j.tcm.2014.09.005.
32. Peterson LR, Herrero P, Schechtman KB, Racette SB, Waggoner Z, Kisrieva-Ware Z, et al.
Effect of obesity and insulin resistance on myocardial substrate metabolism and efficiency in
Young women. Circulation 2004;109: 2191–6. doi: 10.1161/01.CIR.0000127959.28627.F8.
33. Rajbhandari, J.; Fernandez, C.J.; Agarwal, M.; Yeap, B.X.Y.; Pappachan, J.M. Diabetic heart
disease: A clinical update. World J. Diabetes 2021, 12, 383–406. doi: 10.4239/wjd.v12.i4.383.
34. Shah, R.V.; Murthy, V.; Abbasi, S.A.; Eng, J.; Wu, C.; Ouyang et al. Weight loss and progressive
left ventricular remodelling: The MultiEthnic Study of Atherosclerosis (MESA). Eur. J. Prev.
Cardiol. 2015, 22, 1408–1418. DOI: 10.1177/2047487314541731.
35. Soufi Taleb Bendiab, N.; Benkhedda, S.; Henaoui, L.; Tani, A.M. The Impact of Uncontrolled
Hypertension on the Longitudinal Systolic Function of the Left Ventricle. Curr. Hypertens. Rev.
2021, 17. DOI: 10.2174/1573402117666210218105338.
2. Levy D, Larson MG,Vasan RS, Kannel WB, Ho KK. The progression from hypertension
to congestive heart failure. JAMA 1996;275: 1557-62.
3. Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M, et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension 1995; 25: 305-13. DOI: 10.1161/01.hyp.25.3.305.
4. Hubert HB, Feinleib M, Mc Namara PM, Castelli WP, obesity as an independent risk factor for cardiovascular disease: a 26 year- follow-up of participants in the Framingham Heart Study. Circulation 1983; 67(5): 968-77. DOI: 10.1161/01.cir.67.5.968.
5. Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. An update of the 1997 American HeartAssociation Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition. Physical Activity, and metabolism. Circulation 2006; 113(6): 898-918. DOI: 10.1161/CIRCULATIONAHA.106.171016
6. Kenchaiah S, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, et al. Obesity and
the risk of heart failure. N Engl J Med 2002;347(5):305–13. doi: 10.1056/NEJMoa020245.
7. Leitman M, Lysyansky P, Sidenko S, Shir V, Peleg E, Binenbaum M, Kaluski E, Krakover
R, Vered Z. Two-dimensional strain a novel software for real-time quantitative
echocardiographic assessment of myocardial function. J Am Soc Echocardiogr 2004;
17:1021-9. DOI: 10.1016/j.echo.2004.06.019.
8. Lancellotti P, Cosyns B, Zacharakis D, Attena E, Van Camp G, Gach O, et al. Importance of
left ventricular longitudinal function and functional reserve in patients with degenerative
mitralregurgitation: assessment by two-dimensional speckle tracking. J Am Soc Echocardiogr
2008; 21:1331–6. DOI: 10.1016/j.echo.2008.09.023.
9. European Society of Hypertension and European Society of Cardiology. Guidelines for the
management of arterial hypertension. European Society of Hypertension and European
Society of Cardiology. J Hypertens 2007; 25: 1105–1187.
10. National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure. The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003 ; 289 :
2560– 2572.
11. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification : a
Report from the American Society of Echocardiography’s guidelines and chamber
quantification writing group, developed in conjunction with the European Association of
Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr
2005; 18: 1440–1463. doi: 10.1016/j.echo.2005.10.005.
12. De Simone G, Daniels SR, Devereux RB, et al. Left ventricular mass and body size in
Normotensive children and adults: assessment of allometric relations and impact of
overweight. J Am Coll Cardiol 1992; 20: 1251–1260. DOI: 10.1016/0735-1097(92)90385-z.
13. Monsuez JJ, Kesse-Guyot E, Fezeu L, et al. Impact of 6-year body weight change on cardiac
geometry and function in ageing adults: the SU.VI.MAX 2 cardiovascular ultrasound
substudy. J Hypertens 2010 ; 28 : 2309–2315. DOI: 10.1097/HJH.0b013e32833d4576.
14. Gosse P, Jullien V, Jarnier P, et al. Echocardiographic definition of left ventricular
hypertrophy in the hypertensive: which method of indexation of left ventricular mass? J Hum
Hypertens 1999 ; 13 : 505–509. DOI : 10.1038/sj.jhh.1000885.
15. Ganau A, Devereux RB, Roman MJ, et al. Pattern of left ventricular hypertrophy and
geometric remodeling in essential hypertension. J Am Coll Cardiol 1992; 19: 1550–1558.DOI: 10.1016/0735-1097(92)90617-v.
16. Nagueh SF, Appleton CP, Gillebert TC, et al. Recommendations for the evaluation of left
Ventricular diastolic function by echocardiography. Eur J Echocardiogr 2009 ; 10: 165–193.
DOI: 10.1016/j.echo.2008.11.023.
17. Paulus WJ, Tschope C, Sanderson JE, et al. How to diagnose diastolic heart failure: a
consensus statement on the diagnosis of heart failure with normal left ventricular ejection
fraction by the Heart Failure and Echocardiography Associations of the European Society of
Cardiology. Eur Heart J 2007; 28: 2539–2550. DOI: 10.1093/eurheartj/ehm037.
18. Zocalo Y, Guevara E, Bia D, et al. A reduction in the magnitude and velocity of left ventricular
torsion may be associated with increased left ventricular efficiency: Evaluation by speckle-
tracking echocardiography. Rev Esp Cardiol 2008; 61: 705–713.
19. Soufi Taleb Bendiab, N. ; Meziane-Tani, A. ; Ouabdesselam, S. ; Methia, N. ; Latreche, S. ;
Henaoui, L.; Benkhedda, S. Factors associated with global longitudinal strain decline in
hypertensive patients with normal left ventricular ejection fraction. Eur. J. Prev. Cardiol.
2017, 14, 1133–1135. doi: 10.1177/2047487317721644.
20. Di Bello V, Santini F, Di Cori A, Pucci A, Palagi C, Delle Donne MG, et al. Obesity
cardiomyopathy: is it a reality? An ultrasonic tissue characterization study. J Am Soc
Echocardiogr: official publication of the American Society of Echocardiography 2006; 19:1063–
71. DOI: 10.1016/j.echo.2006.03.033.
21. Barbosa JA, Mota CC, Simo ̃ es E, Silva AC, Nunes Mdo C, Barbosa MM. Assessing pre-clinical
ventricular dysfunction in obese children and adolescents: the value of speckle tracking imaging.
Eur Heart J – Cardiovasc Imaging September 2013;14(9):882–9. DOI: 10.1093/ehjci/jes294.
22. Drabik WK, Chrzanowski L, Kapusta A, Uznan ́ska-Loch B, Pon ́ska E, Krzemin ́ska-Pakua M,
et al. Severe obesity impairs systolic and diastolic heart function - the significance of pulsed
tissue Doppler, strain, and strain rate parameters. Echocardiography September 2013;30(8):904–
11. DOI: 10.1111/echo.12164.
23. Di Salvo G, Pacileo G, Del Giudice E, Natale F, Limongelli G, Verrengia M, et al. Abnormal
myocardial deformation properties in obese, non-hypertensive children: an ambulatory blood
pressure monitoring, standard echocardiographic, and strain rate imaging study. Eur Heart J
2006; 27:2689–95. doi: 10.1093/eurheartj/ehl163.
24. Dhuper S, Abdullah RA, Weichbrod L, Mahdi E, Cohen HW. Association of obesity and
hypertension with left ventricular. geometry and function in children and adolescents. Obesity
2011;19: 128–33. DOI: 10.1038/oby.2010.134.
25. Abel E, Litwin S, Sweeney G. Cardiac remodeling in obesity. Physiol Rev 2008;88: 389–419. doi:
10.1152/physrev.00017.2007.
26. Di Bello V, Santini F, Di Cori A, Pucc A. Relationship between preclinical abnormalities of
global and regional left ventricular function and insulin resistance in severe obesity: a Color
Doppler Imaging Study. Int J Obes 2006 ;30 : 948–56. DOI : 10.1038/sj.ijo.0803206.27. Saltijeral A, Isla LP, Pe ́rez-Rodrı ́guez O, Rueda S, Fernandez- Golfin C, Almeria C, et al. Early
myocardial deformation changes associated to isolated obesity: a study based on 3D-wall motion
tracking analysis. Obesity 2011;19: 2268–73. DOI: 10.1038/oby.2011.157.
28. Tumuklu MM, Etikan I, Kisacik B, Kayikcioglu M. Effect of obesity on left ventricular structure
and myocardial systolic function: assessment by tissue Doppler imaging and strain/strain rate
imaging. Echocardiography 2007;24(8):802–9. DOI: 10.1111/j.1540-8175.2007.00484.x.
29. Lorch S, Sharkey A. Myocardial velocity, strain, and strain rate abnormalities in healthy obese
children. J Cardiometab Syndr 2007;2: 30–4. DOI : 10.1111/j.1559-4564.2007.06001.x.
30. Koopman LP, McCrindle BW, Slorach C, Chahal N, Hui W, Sarkola T, et al. Interaction between
myocardial and vascular changes in obese children: a pilot study. J Am Soc Echocardiogr
2012;25(401–10). DOI: 10.1016/j.echo.2011.12.018.
31. Mahajan R, Lau DH, Sanders P.Impact of obesity on cardiac metabolism, fibrosis, and function.
Trends Cardiovasc Med. 2015 Feb;25(2):119-26. doi: 10.1016/j.tcm.2014.09.005.
32. Peterson LR, Herrero P, Schechtman KB, Racette SB, Waggoner Z, Kisrieva-Ware Z, et al.
Effect of obesity and insulin resistance on myocardial substrate metabolism and efficiency in
Young women. Circulation 2004;109: 2191–6. doi: 10.1161/01.CIR.0000127959.28627.F8.
33. Rajbhandari, J.; Fernandez, C.J.; Agarwal, M.; Yeap, B.X.Y.; Pappachan, J.M. Diabetic heart
disease: A clinical update. World J. Diabetes 2021, 12, 383–406. doi: 10.4239/wjd.v12.i4.383.
34. Shah, R.V.; Murthy, V.; Abbasi, S.A.; Eng, J.; Wu, C.; Ouyang et al. Weight loss and progressive
left ventricular remodelling: The MultiEthnic Study of Atherosclerosis (MESA). Eur. J. Prev.
Cardiol. 2015, 22, 1408–1418. DOI: 10.1177/2047487314541731.
35. Soufi Taleb Bendiab, N.; Benkhedda, S.; Henaoui, L.; Tani, A.M. The Impact of Uncontrolled
Hypertension on the Longitudinal Systolic Function of the Left Ventricle. Curr. Hypertens. Rev.
2021, 17. DOI: 10.2174/1573402117666210218105338.
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