The DOI matches its Crossref record; 44 of the 45 references it cites were found in a registry or an index.
Left Ventricular Hypertrophy in Severe Obesity: Interactions Among Blood Pressure, Nocturnal Hypoxemia, and Body Mass
Abstract
Obese subjects have a high prevalence of left ventricular (LV) hypertrophy. It is unclear to what extent LV hypertrophy results directly from obesity or from associated conditions, such as hypertension, impaired glucose homeostasis, or obstructive sleep apnea. We tested the hypothesis that LV hypertrophy in severe obesity is associated with additive effects from each of the major comorbidities. Echocardiography and laboratory testing were performed in 455 severely obese subjects with body mass index 35 to 92 kg/m 2 and 59 nonobese reference subjects. LV hypertrophy, defined by allometrically corrected (LV mass/height 2.7 ), gender-specific criteria, was present in 78% of the obese subjects. Multivariable regression analyses showed that average nocturnal oxygen saturation <85% was the strongest independent predictor of LV hypertrophy ( P <0.001), followed by systolic blood pressure ( P <0.015) and then body mass index ( P <0.05). With regard to LV mass, there were synergistic effects between hypertension and body mass index ( P interaction <0.001) and between hypertension and reduced nocturnal oxygen saturation. Severely obese subjects had normal LV endocardial fractional shortening (35±6% versus 35±6%) but mildly decreased midwall fractional shortening (15±2% versus 17±2%; P <0.001), indicating subtle myocardial dysfunction. In conclusion, more severe nocturnal hypoxemia, increasing systolic blood pressure, and body mass index are all independently associated with increased LV mass. The effects of increased blood pressure seem to amplify those of sleep apnea and more severe obesity.
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In the citing paper
“In addition, the results indicate that both LV cavity size and wall thickness are increased in obese subjects compared with age-matched controls (22, 134, 151, 156, 242, 279, 377).”
From Cardiac remodeling in obesity (2008) · cites this paper as [22]
In the citing paper
“Many published studies have concluded that obesity is independently associated with LV hypertrophy (22, 28, 63, 72, 116, 235, 242, 266, 279, 284, 377).”
From Cardiac remodeling in obesity (2008) · cites this paper as [22]
In the citing paper
“The more recent data confirm the increased prevalence of LV hypertrophy in obese subjects.”
From Cardiac remodeling in obesity (2008) · cites this paper as [22]
In the citing paper
“Many studies have shown increased LA dimensions in obese subjects compared with normal-weight control subjects (16, 17, 22, 140, 274, 371, 375).”
From Cardiac remodeling in obesity (2008) · cites this paper as [22]
In the citing paper
“Various authors have reported depressed LV ejection fraction (EF) (15, 68, 100), normal EF (22, 111, 116, 191, 242, 266, 279, 377), and supernormal EF (28, 155, 274, 375) in obese subjects.”
From Cardiac remodeling in obesity (2008) · cites this paper as [22]
In the citing paper
“More recently, however, several studies have found that LV ejection fraction is normal or even supranormal in the majority of obese subjects, even those with severe obesity (22, 28, 155, 191, 242, 274, 279, 375, 377).”
From Cardiac remodeling in obesity (2008) · cites this paper as [22]
In the citing paper
“Indeed, obese subjects have generally been found to have subclinical contractile abnormalities when assessed with the aforementioned techniques (21, 22, 71, 279, 377).”
From Cardiac remodeling in obesity (2008) · cites this paper as [22]
In the citing paper
“Unfortunately, this relatively straightforward and logical hypothesis is complicated by the fact that multiple recent studies have shown a predominance of concentric geometry in obese patients (22, 63, 72, 279, 377).”
From Cardiac remodeling in obesity (2008) · cites this paper as [22]
In the citing paper
“Higher systolic blood pressures, even if they are not in the hypertensive range, are associated with a greater extent of LV hypertrophy in obesity (22).”
From Cardiac remodeling in obesity (2008) · cites this paper as [22]
In the citing paper
“The presence of diabetes, or measures of insulin resistance, was not predictive of LV mass in the mainly Caucasian, middle-aged women studies by Avelar et al. (22).”
From Cardiac remodeling in obesity (2008) · cites this paper as [22]
In the citing paper
“Several studies have shown synergistic effects between increasing BMI and increasing systolic blood pressure (22, 72).”
From Cardiac remodeling in obesity (2008) · cites this paper as [22]
In the citing paper
“Although some studies have failed to show a relationship between sleep apnea and LV hypertrophy, the majority do support such an association (18, 22, 69, 250, 256–258, 284, 287, 331, 373).”
From Cardiac remodeling in obesity (2008) · cites this paper as [22]
In the citing paper
“Rather, growing data suggest that nocturnal oxygen de-saturation may be the true culprit (22, 69).”
From Cardiac remodeling in obesity (2008) · cites this paper as [22]
In the citing paper
“Avelar et al. (22) reported that in a predominantly Caucasian female population with severe obesity, the degree of LV hypertrophy was related to BMI, systolic blood pressure, and the severity of nocturnal hypoxemia (22).”
From Cardiac remodeling in obesity (2008) · cites this paper as [22]
In the citing paper
“In this study, a diagnosis of hypertension or an average nocturnal O2 saturation <85% each had synergistic interactions with increasing BMI.”
From Cardiac remodeling in obesity (2008) · cites this paper as [22]
Citations
Cites
Lang, R. M., Bierig, M., Devereux, R. B., Flachskampf, F. A., Foster, E., Pellikka, P. A., Picard, M. H., Roman, M. J., Seward, J., Shanewise, J. S., et al. (2005) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2005.10.005 · Cited by 11,318
The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults
Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., & Badr, S. (1993) · New England Journal of Medicine · doi:10.1056/nejm199304293281704 · Cited by 10,183
Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings
Devereux, R. B., Alonso, D. R., Lutas, E. M., Gottlieb, G. J., Campo, E., Sachs, I., & Reichek, N. (1986) · The American Journal of Cardiology · doi:10.1016/0002-9149(86)90771-x · Cited by 6,226
Levy, D., Garrison, R. J., Savage, D. D., Kannel, W. B., & Castelli, W. P. (1990) · New England Journal of Medicine · doi:10.1056/nejm199005313222203 · Cited by 5,699
Prospective Study of the Association between Sleep-Disordered Breathing and Hypertension
Peppard, P. E., Young, T., Palta, M., & Skatrud, J. (2000) · New England Journal of Medicine · doi:10.1056/nejm200005113421901 · Cited by 4,973
McNicholas, W. T., Strohl, K. P., White, D. P., Levy, P. A., Schmidt, W., Wheatley, J. R., Redline, S. S., Carley, D. W., Buysse, D. J., Young, T. B., et al. (1999) · PubMed · Cited by 3,665
Body-Mass Index and Mortality in a Prospective Cohort of U.S. Adults
Calle, E. E., Thun, M. J., Petrelli, J. M., Rodriguez, C., & Heath, C. W. (1999) · New England Journal of Medicine · doi:10.1056/nejm199910073411501 · Cited by 3,643
Obesity and the risk of heart failure
Kenchaiah, S., Evans, J. C., Levy, D., Wilson, P. W. F., Benjamin, E. J., Larson, M. G., Kannel, W. B., & Vasan, R. S. (2002) · New England Journal of Medicine · doi:10.1056/nejmoa020245 · Cited by 3,093
Sleep-disordered Breathing and Cardiovascular Disease
SHAHAR, E., WHITNEY, C. W., REDLINE, S., LEE, E. T., NEWMAN, A. B., JAVIER NIETO, F., O'CONNOR, G. T., BOLAND, L. L., SCHWARTZ, J. E., & SAMET, J. M. (2001) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.163.1.2001008 · Cited by 2,901
Bonora, E., Targher, G., Alberiche, M., Bonadonna, R. C., Saggiani, F., Zenere, M. B., Monauni, T., & Muggeo, M. (2000) · Diabetes Care · doi:10.2337/diacare.23.1.57 · Cited by 2,456
SIMONE, G. D., Daniels, S. R., Devereux, R. B., Meyer, R. A., Roman, M. J., DIVITIIS, O. D., & Alderman, M. H. (1992) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(92)90385-z · Cited by 1,727
Medical Consequences of Obesity
Bray, G. A. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-0535 · Cited by 1,614
Kaneko, Y., Floras, J. S., Usui, K., Plante, J., Tkacova, R., Kubo, T., Ando, S.-I., & Bradley, T. D. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa022479 · Cited by 1,051
Impact of Diabetes on Cardiac Structure and Function
Devereux, R. B., Roman, M. J., Paranicas, M., O’Grady, M. J., Lee, E. T., Welty, T. K., Fabsitz, R. R., Robbins, D. C., Rhoades, E. R., & Howard, B. V. (2000) · Circulation · doi:10.1161/01.cir.101.19.2271 · Cited by 943
American Society of Echocardiography recommendations for use of echocardiography in clinical trials
Gottdiener, J. S., Bednarz, J. E., Devereux, R. B., Gardin, J. M., Klein, A. L., Manning, W. J., Morehead, A. J., Kitzman, D. W., Oh, J. K., Quiñones, M. A., et al. (2004) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2004.07.013 · Cited by 925
Alterations of Left Ventricular Myocardial Characteristics Associated With Obesity
Wong, C. Y., O’Moore-Sullivan, T., Leano, R., Byrne, N., Beller, E., & Marwick, T. H. (2004) · Circulation · doi:10.1161/01.cir.0000147184.13872.0f · Cited by 713
SIMONE, G. D., Devereux, R. B., Roman, M. J., Ganau, A., Saba, P. S., Alderman, M. H., & Laragh, J. H. (1994) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(94)90390-5 · Cited by 604
The Impact of Obesity on Left Ventricular Mass and Geometry
Lauer, M. S. (1991) · JAMA · doi:10.1001/jama.266.2.231 · Cited by 561
Rutter, M. K., Parise, H., Benjamin, E. J., Levy, D., Larson, M. G., Meigs, J. B., Nesto, R. W., Wilson, P. W. F., & Vasan, R. S. (2003) · Circulation · doi:10.1161/01.cir.0000045671.62860.98 · Cited by 511
Alterations in left ventricular structure and function in young healthy obese women
Peterson, L. R., Waggoner, A. D., Schechtman, K. B., Meyer, T., Gropler, R. J., Barzilai, B., & Dávila-Román, V. G. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.10.062 · Cited by 449
de Simone, G., Devereux, R. B., Roman, M. J., Alderman, M. H., & Laragh, J. H. (1994) · Hypertension · doi:10.1161/01.hyp.23.5.600 · Cited by 391
Barouch, L. A., Berkowitz, D. E., Harrison, R. W., O’Donnell, C. P., & Hare, J. M. (2003) · Circulation · doi:10.1161/01.cir.0000083716.82622.fd · Cited by 341
Dimorphic Cardiac Adaptation to Obesity and Arterial Hypertension
Messerli, F. H., SUNDGAARD-RIISE, K., REISIN, E. D., DRESLINSKI, G. R., Ventura, H. O., OIGMAN, W., FROHLICH, E. D., & DUNN, F. G. (1983) · Annals of Internal Medicine · doi:10.7326/0003-4819-99-6-757 · Cited by 336
Reliability of echocardiographic assessment of left ventricular structure and function
Palmieri, V., Dahlöf, B., DeQuattro, V. L., Sharpe, N., Bella, J. N., SIMONE, G. D., Paranicas, M., Fishman, D., & Devereux, R. B. (1999) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(99)00396-4 · Cited by 303
Alpert, M. A., Lambert, C. R., Panayiotou, H., Terry, B. E., Cohen, M. V., Massey, C. V., Hashimi, M. W., & Mukerji, V. (1995) · The American Journal of Cardiology · doi:10.1016/s0002-9149(99)80338-5 · Cited by 292
Left ventricular hypertrophy independent of hypertension in patients with obstructive sleep apnoea
Hedner, J. A., Ejnell, H., & Caidahl, K. (1990) · Journal of Hypertension · doi:10.1097/00004872-199010000-00009 · Cited by 250
The Obesity-Associated Peptide Leptin Induces Hypertrophy in Neonatal Rat Ventricular Myocytes
Rajapurohitam, V., Gan, X. T., Kirshenbaum, L. A., & Karmazyn, M. (2003) · Circulation Research · doi:10.1161/01.res.0000089255.37804.72 · Cited by 248
The impact of obesity on left ventricular mass and geometry
Lauer, M. S., Andsrson, K. M., Kannel, W. B., & Levy, D. A. (1991) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(91)92139-d · Cited by 237
CARDIOVASCULAR EFFECTS OF OBESITY AND HYPERTENSION
Messerli, F. (1982) · The Lancet · doi:10.1016/s0140-6736(82)92234-6 · Cited by 235
DESIMONE, G., KIZER, J., CHINALI, M., ROMAN, M., BELLA, J., BEST, L., LEE, E., & DEVEREUX, R. (2005) · American Journal of Hypertension · doi:10.1016/j.amjhyper.2004.08.032 · Cited by 233
Childhood Adiposity as a Predictor of Cardiac Mass in Adulthood
Li, X., Li, S., Ulusoy, E., Chen, W., Srinivasan, S. R., & Berenson, G. S. (2004) · Circulation · doi:10.1161/01.cir.0000149713.48317.27 · Cited by 218
Lauer, M. S., Anderson, K. M., & Levy, D. A. (1992) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(92)90063-s · Cited by 174
Cloward, T. V., Walker, J. M., Farney, R. J., & Anderson, J. L. (2003) · Chest · doi:10.1378/chest.124.2.594 · Cited by 166
Self-citationChinali, M., Devereux, R. B., Howard, B. V., Roman, M. J., Bella, J. N., Liu, J. E., Resnick, H. E., Lee, E. T., Best, L. G., & de Simone, G. (2004) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2003.09.009 · Cited by 157
Impact of Obstructive Sleep Apnea on Left Ventricular Mass and Diastolic Function
NIROUMAND, M., KUPERSTEIN, R., SASSON, Z., & HANLY, P. J. (2001) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.163.7.2007014 · Cited by 156
Cardiac Hypertrophy in Obstructive Sleep Apnea Syndrome
Noda, A., Okada, T., Yasuma, F., Nakashima, N., & Yokota, M. (1995) · Chest · doi:10.1378/chest.107.6.1538 · Cited by 155
Echocardiographic Abnormalities in Normotensive Obese Patients: Relationship with Visceral Fat
Morricone, L., Malavazos, A. E., Coman, C., Donati, C., Hassan, T., & Caviezel, F. (2002) · Obesity Research · doi:10.1038/oby.2002.67 · Cited by 104
Kraiczi, H., Peker, Y., Caidahl, K., Samuelsson, A., & Hedner, J. A. (2001) · Journal of Hypertension · doi:10.1097/00004872-200111000-00019 · Cited by 68
Relation of insulin resistance to left ventricular hypertrophy and diastolic dysfunction in obesity
Mureddu, G., Greco, R., Rosato, G., Cella, A., Vaccaro, O., Contaldo, F., & SIMONE, G. D. (1998) · International Journal of Obesity · doi:10.1038/sj.ijo.0800596 · Cited by 58
Adams, T. D., Avelar, E., Cloward, T. V., Crosby, R. D., Farney, R. J., Gress, R. E., Halverson, R. L., Hopkins, P. N., Kolotkin, R. L., LaMonte, M. J., et al. (2005) · Contemporary Clinical Trials · doi:10.1016/j.cct.2005.05.003 · Cited by 56
Self-citationVetta, F. (1998) · European Heart Journal · doi:10.1053/euhj.1997.0731 · Cited by 44
Ventricular mass in hypertensive and normotensive obese subjects.
de la Maza, M. P., Estévez, A. F., Bunout, D. C., Klenner, C., Miguel Oyonarte, G., & Hirsch, S. (1994) · PubMed · Cited by 35
Overweight and Obesity as Determinants of Cardiovascular Risk: The Framingham Experience
Wilson, P. W. F., D'Agostino, R. B., Sullivan, L., Parise, H., & Kannel, W. B. (2002) · Archives of Internal Medicine · doi:10.1001/archinte.162.16.1867 · Cited by 22
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The Progression of Hypertensive Heart Disease
Drazner, M. H. (2011) · Circulation · doi:10.1161/circulationaha.108.845792 · Cited by 844
Abel, E. D., Litwin, S. E., & Sweeney, G. (2008) · Physiological Reviews · doi:10.1152/physrev.00017.2007 · Cited by 736
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Metadata
- Authors
- Avelar, E., Cloward, T. V., Walker, J. M., Farney, R. J., Strong, M., Pendleton, R. C., Segerson, N., Adams, T. D., Gress, R. E., Hunt, S. C., & Litwin, S. E.
- Affiliations
- Intermountain Healthcare (US)
- Venue
- Hypertension
- Published
- 2007-01
- Volume
- 49
- Issue
- 1
- Pages
- 34-39
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2154952676
- Cited by
- 228
- References
- 45
- Citations by year
- 2026: 3 · 2025: 12 · 2024: 10 · 2023: 8 · 2022: 11 · 2021: 12 · 2020: 17 · 2019: 10 · 2018: 7 · 2017: 16 · 2016: 13 · 2015: 9 · 2014: 16 · 2013: 21 · 2012: 6
- FWCI
- 7.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (T32-HL-7576, T32HL007576)
- National Institute of Diabetes and Digestive and Kidney Diseases (5R01DK0550006-05, R01DK055006)
- National Center for Research Resources (M01-RR 00064, M01RR000064)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Keywords
- left ventricular hypertrophy, morbid obesity, nocturnal hypoxemia, obstructive sleep apnea, body mass index, left ventricular mass, fractional shortening, cardiac dysfunction, comorbidities
- MeSH terms
- Adult, Hypoxia, Blood Pressure, Body Weight, Circadian Rhythm, Echocardiography, Female, Heart, Humans, Male, Middle Aged, Obesity, Morbid, Prognosis, Sleep Apnea Syndromes, Systole, Hypertrophy, Left Ventricular
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