BACKGROUND It is unknown that dysglycemia in obese adolescents has effects on myocardial deformation that are more pronounced when compared to obesity alone. We hypothesized that obesity associated abnormal glucose tolerance (dysglycemia) would have adverse effects on two-dimensional speckle tracking echocardiography derived longitudinal, radial and circumferential strain (LS, RS, CS) compared to age and gender lean controls. We also examined if changes in deformation would be reflected in abnormal ventricular vascular coupling indices (VVI). METHODS In a prospective cross-sectional design 39 obese adolescents (15.9 ± 1.7 years; 101.5 ± 39 kg; female - 58%) were compared to age and gender matched lean controls (15.7 ± 1.8 yrs, 60 ± 12.8 kg). Based on results from an oral glucose tolerance test (OGTT), obese adolescents were categorized as obese normoglycemic (ONG, n = 25) or obese dysglycemic (ODG, n = 14). Left ventricular (LV) global and average LS, CS, RS and strain rate were measured. LV ejection fraction and mass index were measured and VVI approximated as ratio of arterial elasticity (Ea) and end-systolic elastance (Ees). RESULTS Adolescents with ODG had significantly (P = 0.005) impaired global LS (- 20.98% ± 2.8%) compared to controls (- 23.01% ± 2.3%). A similar (P = 0.0027) reduction was observed in average LS for adolescents with ODG (18.87% ± 2.5%) compared to controls (20.49% ± 2%). Global CS was also decreased (P = 0.03) in ODG (- 23.95%) compared to ONG (- 25.80). A similar trend was observed in average CS after multivariate regression for BMI and blood pressure. CS correlated with HbA1c in both groups (P = 0.05). VVI had a negative correlation with both LS (r = - 0.4, P = 0.025) and CS rate (r = - 0.36, P = 0.04). CONCLUSIONS Myocardial strain and strain rate were significantly altered in obese adolescents. Unfavorable subclinical reductions in global and average CS were more pronounced in adolescents with dysglycemia compared to obese adolescents with normoglycemia and controls. These data indicate progressive worsening of subendocardial function across the spectrum of glucose tolerance. Strain rate was predictive of VVI in obese adolescents, suggesting strain rate may be a sensitive marker for cardiac remodeling in abnormal glucose homeostasis states.

中文翻译：

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患有血糖异常的肥胖青少年的心肌变形和心室血管耦合受损。

背景 与单纯肥胖相比，肥胖青少年的血糖异常对心肌变形的影响更为明显，这一点尚不清楚。我们假设与年龄和性别的瘦对照相比，肥胖相关的异常葡萄糖耐量（血糖异常）将对二维斑点追踪超声心动图衍生的纵向、径向和周向应变（LS、RS、CS）产生不利影响。我们还检查了变形的变化是否会反映在异常的心室血管耦合指数 (VVI) 中。方法 在前瞻性横断面设计中，将 39 名肥胖青少年（15.9 ± 1.7 岁；101.5 ± 39 kg；女性 - 58%）与年龄和性别匹配的瘦对照（15.7 ± 1.8 岁，60 ± 12.8 kg）进行比较。根据口服葡萄糖耐量试验 (OGTT) 的结果，肥胖的青少年被归类为肥胖的血糖正常（ONG，n = 25）或肥胖的血糖异常（ODG，n = 14）。测量左心室 (LV) 全局和平均 LS、CS、RS 和应变率。测量 LV 射血分数和质量指数，并将 VVI 近似为动脉弹性 (Ea) 和收缩末期弹性 (Ees) 的比率。结果 与对照组 (- 23.01% ± 2.3%) 相比，患有 ODG 的青少年显着 (P = 0.005) 受损的整体 LS (- 20.98% ± 2.8%)。与对照组 (20.49% ± 2%) 相比，ODG (18.87% ± 2.5%) 青少年的平均 LS 有类似的降低 (P = 0.0027)。与 ONG (- 25.80) 相比，ODG (- 23.95%) 的全球 CS 也有所下降 (P = 0.03)。在对 BMI 和血压进行多变量回归后，在平均 CS 中观察到了类似的趋势。两组中 CS 与 HbA1c 相关（P = 0.05）。VVI 与 LS (r = - 0.4, P = 0.025) 和 CS 率 (r = - 0.36, P = 0.04) 呈负相关。结论 肥胖青少年的心肌应变和应变率显着改变。与血糖正常的肥胖青少年和对照组相比，血糖异常青少年的总体和平均 CS 的不利亚临床降低更为明显。这些数据表明在葡萄糖耐量范围内心内膜下功能逐渐恶化。应变率可预测肥胖青少年的 VVI，表明应变率可能是异常葡萄糖稳态状态下心脏重塑的敏感标志。与血糖正常的肥胖青少年和对照组相比，血糖异常青少年的总体和平均 CS 的不利亚临床降低更为明显。这些数据表明在葡萄糖耐量范围内心内膜下功能逐渐恶化。应变率可预测肥胖青少年的 VVI，表明应变率可能是异常葡萄糖稳态状态下心脏重塑的敏感标志。与血糖正常的肥胖青少年和对照组相比，血糖异常青少年的总体和平均 CS 的不利亚临床降低更为明显。这些数据表明在葡萄糖耐量范围内心内膜下功能逐渐恶化。应变率可预测肥胖青少年的 VVI，表明应变率可能是异常葡萄糖稳态状态下心脏重塑的敏感标志。