Cardiac Diastolic Dysfunction and Regional Body Fat Distribution in Insulin Resistant Peripubertal Obese Males.

BACKGROUND: To evaluate presence of diastolic dysfunction in obese peripubertal males (8-18 years of age). To correlate diastolic dysfunction with insulin resistance, insulin levels and omental and epicardial fat.

METHODS: Obese males (n=46) and age matched healthy lean controls (n=50) in the age group of 8-18 years were included in this study. Anthropometric measurements were recorded. Investigations done: Fasting blood sugar and serum insulin levels, lipid profile, 2-D Echocardiography to assess left ventricular diastolic function and epicardial fat, abdominal CT scan to measure omental fat and ultrasound for NAFLD.

RESULTS: Isovolumetric relaxation time (IVRT) above 100 msec seen in 18/46, E/A ratio of 0.75 seen in 4/46 cases. Left ventricular mass > 125gm seen in 10/46 cases. All the left ventricular diastolic function parameters were within normal range in controls. Significant difference in LVM (p=0.00099), LVPW(d) (p=0.0018), IVS(d) (p=0.007), E/A ratio (p=0.043), epicardial fat (p=0.0000) were seen in cases as compared to controls. Correlation of visceral fat with HOMA-IR, insulin levels and left ventricular diastolic parameters in cases was as follows HOMA vs omental fat (p=0.0008), Insulin vs omental fat (p=0.0015), E/A vs omental fat (p=0.015), LVM vs omental fat (p=0.0000), IVRT vs omental fat (p-=0.005). HOMA vs epicardial fat (p=0.0000), insulin vs epicardial fat (p=0.0000), E/A vs epicardial fat (p=0.09), LVM vs epicardial fat (p=0.006), IVRT vs epicardial fat (p=0.011).

CONCLUSIONS: Left ventricular hypertrophy and diastolic derangements start early in obese peripubertal males with positive correlation between left ventricular diastolic dysfunction and HOMA-IR and insulin levels. Epicardial fat mass and visceral fat show positive correlation with diastolic dysfunction.