Arterial stiffness as a factor of structural and functional cardiac remodeling in obesity

Aim. To analyze the association of parameters characterizing the degree of arterial stiffness and echocardiographic criteria for cardiac remodeling in patients with abdominal obesity.

Material and methods. The study included 194 patients (men aged 46 to 55 years (49,0±2,3 years)), without hypertension (24-hour average blood pressure (BP) 117,5±5,5/73,0±4,1 mmHg), diabetes and cardiovascular diseases, with abdominal obesity (waist circumference >94 cm, body mass index 31,3±3,5 kg/m²). Lipids and glucose concentrations were evaluated, and glomerular filtration rate was estimated using the CKD-EPI equation. We conducted 24-hour monitoring of blood pressure and arterial stiffness parameters (aortic pulse wave velocity (PWV), augmentation index (AIx) and systolic BP in the aorta), and echocardiography.

Results. Left ventricular (LV) hypertrophy was detected in 14 (7,2%) patients, LV diastolic dysfunction — in 36 (18,6%) patients. The correlation of the average aortic PWV and the AIx with the LV mass index and the left atrial volume was shown. Patients with a high aortic PWV exceeding the 75th percentile of distribution (8,2 m/s) were characterized by a higher incidence of hypertrophy (18,8% vs 4,9%,

p<0,01) and LV diastolic dysfunction (50,0% vs 12,3%, p<0,001). Patients with/with-out LV hypertrophy and diastolic dysfunction were characterized by higher values of average 24-hour aortic PWV, AIx and systolic BP in the aorta. According to the regression analysis, the predictors of LV diastolic dysfunction were age, waist circumference, aortic PWV, and AIx.

Conclusion. The relationship of parameters characterizing the degree of arterial stiffness, primarily, aortic PWV and echocardiographic parameters of the structural and functional cardiac remodeling in obese patients was revealed. Patients with a high aortic PWV (>8,2 m/s for men aged 46-55 years) are characterized by a higher prevalence of LV hypertrophy and diastolic dysfunction, as well as left atrial dilatation. This association is probably a reflection of one of the many pathogenesis links of HF and supraventricular cardiac arrhythmias in obese patients.

1. Chumakova GA, Veselovskaya NG, Kozarenko AA, et al. Heart morphology, structure, and function in obesity. Russian Journal of Cardiology. 2012;4:93-9. (In Russ.) doi:10.15829/1560-4071-2012-4-93-99.

2. Neeland I, Gupta S, Ayers C, et al. Relation of regional fat distribution to left ventricular structure and function. Circ Cardiovasc Imaging. 2013;6(5):800-7. doi:10.1161/ CIRCIMAGING.113.000532.

3. Gritsenko OV, Chumakova GA, Shevlyakov IV, et al. The mechanisms of heart failure development in obesity. Russian Journal of Cardiology. 2018;(5):81-6. (In Russ.) doi:10.15829/1560-4071-2018-5-81-86.

4. Faulkner J, Bruder-Nascimento T, Belin de Chantemele E. The regulation of aldosterone secretion by leptin: implications in obesity-related cardiovascular disease. Curr Opin Nephrol Hypertens. 2018;27(2):63-9. doi:10.1097/MNH.0000000000000384.

5. Packer M. Leptin-Aldosterone-Neprilysin Axis Identification of Its Distinctive Role in the Pathogenesis of the Three Phenotypes of Heart Failure in People With Obesity. Circulation. 2018;137(15):1614-31. doi:10.1161/CIRCULATIONAHA.117.032474.

6. Engin A. Adiponectin-resistance in obesity. Adv Exp Med Biol. 2017;960:415-41. doi:10.1007/978-3-319-48382-5_18.

7. Nilsson P. Hemodynamic Aging as the Consequence of Structural Changes Associated with Early Vascular Aging. Aging Dis. 2014:5(2):109-13. doi:10.14336/AD.2014.0500109.

8. Lacolley P, Regnault V, Avolio A. Smooth muscle cell and arterial aging: basic and clinical aspects. Cardiovascular Research. 2018;114(4):513-28. doi:10.1093/cvr/cvy009.

9. Van Bortel L, Laurent S, Boutouyrie P, et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. Hypertension. 2012;30(3):445-8. doi:10.1097/HJH.0b013e32834fa8b0.

10. Posokhov I. Pulse wave velocity 24-hour monitoring with one-site measurements by oscillometry. Medical Devices: Evidence and Research. 2013;6:11-5. doi:10.2147/MDER.S42082.

11. Vasyuk YuA, Ivanova SV, Shkolnik EL, et al. Consensus of Russian experts on the evaluation of arterial stiffness in clinical practice. Cardiovascular Therapy and Prevention. 2016; 15(2):4-19. (In Russ.) doi:10.15829/1728-8800-2016-2-4-19.

12. Perez L, Pareja-Galeano H, Sanchis-Gomar F et al. Adipaging': ageing and obesity share biological hallmarks related to a dysfunctional adipose tissue. J Physiol. 2016;594(12):3187-207. doi:10.1113/JP271691.

13. Druzhilov MA, Kuznetsova TYu. Visceral obesity as risk factor of early vascular aging. Cardiologiia. 2016;2(56):52-6. (In Russ.) doi:10.18565/cardio.2016.2.52-56.

14. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. doi:10.1093/eurheartj/ehy339.

15. Nagueh SF, Smiseth OA, Appleton CP et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277-314. doi:10.1016/j.echo.2016.01.011.