Subclinical myocardial dysfunction and cardiac autonomic dysregulation are closely associated in obese children and adolescents: The potential role of insulin resistance

Domenico Cozzolino, Anna Grandone, Antonio Cittadini, Giuseppe Palmiero, Giovanni Esposito, Annamaria De Bellis, Raffaello Furlan, Silverio Perrotta, Laura Perrone, Daniele Torella, Emanuele Miraglia Del Giudice

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Abstract

Background: The prevalence of obesity is increasing among children/adolescents. Subtle cardiovascular abnormalities, responsible for a higher mortality later in life, have been reported in obese children/adolescents. The aims of the study were to evaluate cardiovascular autonomic regulation, by means of spectrum analysis of R-R interval variability, and myocardial function, by means of standard and tissue Doppler echocardiography, in a group of non-hypertensive asymptomatic obese children and adolescents; furthermore, the influence of insulin resistance was tested. Subjects and Methods: R-R interval variability was analyzed during both the 70° head-up tilt and 24-hour electrocardiographic holter monitoring. Spectrum analysis of R-R interval variability provided the indices of sympathetic (low frequency [LFRR]) and vagal (high frequency [HFRR]) modulation of the sinoatrial node. Homeostasis model assessment of insulin resistance (HOMA-IR) was used to classify obese children/adolescents (n=72) as insulin resistant (n=37) and noninsulin resistant (n=35). Results: In obese subjects: a) left ventricular mass was significantly (pRR/HFRR ratio was higher; c) during tilting, magnitude of tilt-induced inhibition of HFRR was lower; d) during 24-hour electrocardiographic holter monitoring, LFRR and the LFRR/HFRR ratio were higher, whereas HFRR was lower; e) HOMA-IR inversely correlated with both the e'/a' ratio (r=-0.655; pRR/HFRR ratio (r=-0.933; pRR/HFRR ratio (r=0.501; pRR reduction, and the e'/a' ratio in insulin resistant obese children/adolescents were markedly lower when compared with the remaining subjects. Conclusions: Subclinical abnormalities of myocardial function and of cardiac autonomic regulation were closely associated in obese children/adolescents and both correlated with the degree of insulin resistance.

Original languageEnglish
Article numbere0123916
JournalPLoS One
Volume10
Issue number4
DOIs
Publication statusPublished - Apr 23 2015

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ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Cozzolino, D., Grandone, A., Cittadini, A., Palmiero, G., Esposito, G., De Bellis, A., Furlan, R., Perrotta, S., Perrone, L., Torella, D., & Miraglia Del Giudice, E. (2015). Subclinical myocardial dysfunction and cardiac autonomic dysregulation are closely associated in obese children and adolescents: The potential role of insulin resistance. PLoS One, 10(4), [e0123916]. https://doi.org/10.1371/journal.pone.0123916