肥胖对左心室的影响：动脉粥样硬化多民族研究（MESA）
The impact of obesity on the left ventricle: the Multi-Ethnic Study of Atherosclerosis (MESA).
作者信息
Turkbey Evrim B, McClelland Robyn L, Kronmal Richard A, Burke Gregory L, Bild Diane E, Tracy Russell P, Arai Andrew E, Lima João A C, Bluemke David A
机构信息
Radiology and Imaging Sciences, National Institutes of Health/Clinical Center, Bethesda, Maryland 20892, USA.
出版信息
JACC Cardiovasc Imaging. 2010 Mar;3(3):266-74. doi: 10.1016/j.jcmg.2009.10.012.
OBJECTIVES
The purpose of this study was to evaluate the relationship of left ventricular (LV) remodeling assessed by cardiac magnetic resonance to various measures of obesity in a large population-based study.
BACKGROUND
Obesity is a well-known risk factor for cardiovascular disease, yet its relationship with LV size and function is poorly understood.
METHODS
A total of 5,098 participants (age 45 to 84 years; 48% men) in the Multi-Ethnic Study of Atherosclerosis who were free of clinically apparent cardiovascular disease underwent cardiac magnetic resonance to assess LV size and function as well as measures of obesity, including body mass index, waist-to-hip ratio and waist circumference, and cardiovascular risk factors. Fat mass (FM) was estimated based on height-weight models derived from bioelectrical impedance studies. The associations of obesity measures with LV size and function were evaluated using linear spline regression models for body mass index and multivariable regression models for other measures of obesity; they were displayed graphically using generalized additive models.
RESULTS
LV mass and end-diastolic volume were positively associated with measures of obesity in both sexes after adjustment for risk factors (e.g., 5.7-g and 6.9-g increase in LV mass per 10-kg increase in FM in women and men, respectively [p < 0.001]). LV mass-to-volume ratio was positively associated with increased body mass index, waist-to-hip ratio, waist circumference, and estimated FM (e.g., 0.02-g/ml and 0.06-g/ml increase in mass-to-volume ratio per 10-kg increase in FM in women and men, respectively [p < 0.001]). The increased mass-to-volume ratio was due to a greater increase in LV mass relative to LV end-diastolic volume. All associations were stronger for men than for women. Ejection fraction showed no significant association with measures of obesity.
CONCLUSIONS
Obesity was associated with concentric LV remodeling without change in ejection fraction in a large, multiethnic cohort study.
目的
在一项基于大规模人群的研究中，评估通过心脏磁共振评估的左心室（LV）重构与各种肥胖指标之间的关系。
背景
肥胖是心血管疾病的一个众所周知的危险因素，但其与左心室大小和功能的关系却知之甚少。
方法
动脉粥样硬化多族裔研究中共有5098名参与者（年龄45至84岁；48%为男性），他们没有明显的临床心血管疾病，接受了心脏磁共振检查，以评估左心室大小和功能以及肥胖指标，包括体重指数、腰臀比和腰围，以及心血管危险因素。根据生物电阻抗研究得出的身高体重模型估算脂肪量（FM）。使用体重指数的线性样条回归模型和其他肥胖指标的多变量回归模型评估肥胖指标与左心室大小和功能之间的关联；使用广义相加模型以图形方式展示这些关联。
结果
在调整危险因素后，男女的左心室质量和舒张末期容积均与肥胖指标呈正相关（例如，女性和男性的脂肪量每增加10 kg，左心室质量分别增加5.7 g和6.9 g [p < 0.001]）。左心室质量与容积比与体重指数增加、腰臀比增加、腰围增加和估算的脂肪量呈正相关（例如，女性和男性的脂肪量每增加10 kg，质量与容积比分别增加0.02 g/ml和0.06 g/ml [p < 0.001]）。质量与容积比增加是由于左心室质量相对于左心室舒张末期容积增加得更多。所有关联男性比女性更强。射血分数与肥胖指标无显著关联。
结论
在一项大型多族裔队列研究中，肥胖与左心室向心性重构相关，而射血分数无变化。
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