CARDIAC MORPHOLOGY AND LEFT-VENTRICULAR FUNCTION IN NORMOTENSIVE MORBIDLY OBESE PATIENTS WITH AND WITHOUT CONGESTIVE-HEART-FAILURE, AND EFFECT OF WEIGHT-LOSS

To assess cardiac morphology and left ventricular (LV) function in nor motensive morbidly obese patients with and without congestive heart fa ilure (CHF) we performed a physical examination and obtained a transth oracic echocardiogram and cardiac Doppler studies before and after sub stantial weight loss in patients whose actual body weight was initiall y equal to or more than twice their ideal body weight and who were fre e from systemic hypertension and underlying organic heart disease. The re were 24 patients with CHF, 14 of whom were studied after weight los s. There were 50 patients without CHF, 39 of whom were studied after w eight loss. Compared to patients without CHF, those with CHF had signi ficantly greater mean LV internal dimension in diastole, LV end-systol ic wall stress, LV mass/height index values, left atrial dimension and right ventricular internal dimension values, significantly lower mean LV fractional shortening, and transmitral Doppler E/A ratio values, a nd significantly longer mean transmitral E-wave deceleration time and duration of morbid obesity than patients without CHF. Substantial weig ht loss in those with and without CHF produced comparable reductions i n mean LV internal dimension in diastole, LV end-systolic wall stress, LV mass/height index, transmitral Doppler E-wave deceleration time, a nd left atrial dimension, and comparable increases in LV fractional sh ortening and transmitral Doppler E/A ratio. Linear regression analysis identified duration of morbid obesity as the strongest predictor of C HF (p <0.00000002). Thus, LV mass is greater and LV systolic function and diastolic filling are more impaired in normotensive morbidly obese subjects with CHF than in those without CHF. Duration of morbid obesi ty is the strongest predictor of CHF among the variables studied. Subs tantial weight loss produces comparable changes in cardiac morphology and function in those with and without CHF. (C) 1997 by Excerpta Medic a, Inc.