Obesity Surgery

, Volume 28, Issue 4, pp 1047–1054 | Cite as

Cardiac Remodeling Patterns in Severe Obesity According to Arterial Hypertension Grade

  • Roberto de Cleva
  • Victor Arrais Araujo
  • Carla Cristina Ornelas Buchalla
  • Fabio de Oliveira Costa
  • Acácio Fernandes Cardoso
  • Denis Pajecki
  • Marco Aurelio Santo
Original Contributions



The purpose of this study is to correlate the left ventricular hypertrophy (LVH) patterns according to severe obesity and arterial hypertension (AHT) grades.


A cross-sectional prospective study was conducted in 379 patients with severe obesity. Obesity was classified according to the BMI in the following: morbidly obese (MO; 40 < BMI < 50 kg/m2) and super obese (SO; BMI > 50 kg/m2). The AHT was classified into classes 1 and 2 according to American Heart Association. The presence of LVH and the pattern of cardiac remodeling were determined by transthoracic echocardiography.


LVH was present in 58.6% of patients. Obesity and AHT had additive effects in LVH prevalence. LVH was found in 32.9 and 46.7% of MO with AHT grades 1 and 2, respectively. LVH was diagnosed in 39.1% in SO with AHT grade 1 and in 50% of AHT grade 2. Patients with AHT presented a significantly higher risk of developing LVH (OR 1.97; p = 0.003). Hypertension grade was also a determinant variable in the development of LVH. Patients with AHT 2 had 4.31-fold greater risk (p < 0.001) when compared to normotensive patients. BMI was only considered an independent risk factor for LVH in patients with BMI greater than 47.17 kg/m2 (OR 1.62; p = 0.023).


AHT is a stronger predictive factor of LVH than obesity grade.


Severe obesity Hypertension Left ventricular hypertrophy 


Contribution of Each Author

Authors RC and MAS were responsible for conception and design and also performed drafting and critical revision of the manuscript. Authors VAA, CCOB, FOC, AFC, and DP were responsible for data review and calculations of ventricular mass in all patients. All authors participated of the analysis and interpretation of data. All authors contributed to and have approved the final manuscript. All authors take public responsibility for its content.

Funding information

The study was supported by São Paulo Research Foundation (FAPESP), grant 2015/12265-4.

Compliance with Ethical Standards

The current study was performed according to the ethical recommendations of the Declaration of Helsinki, and it was approved by the Hospital das Clinicas Ethical Committee. Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Ford ES, Mokdad AH. Epidemiology of obesity in the Western Hemisphere. J Clin Endocrinol Metab. 2008;93:S1–8. Scholar
  2. 2.
    Centers for Disease Control and Prevention. Overweight and obesity. U.S. obesity trends.
  3. 3.
    Giampaoli S, Stamler J, Donfrancesco C, et al. The metabolic syndrome: a critical appraisal based on the CUORE epidemiologic study. Prev Med. 2009;8:525–31. CrossRefGoogle Scholar
  4. 4.
    Kotchen TA. Obesity-related hypertension: epidemiology, pathophysiology, and clinical management. Am J Hypertens. 2010;23:1170–8. Scholar
  5. 5.
    Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52. PMID 14656957.CrossRefPubMedGoogle Scholar
  6. 6.
    Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347:305–13.CrossRefPubMedGoogle Scholar
  7. 7.
    Calle EE, Thun MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1993;41:1097–105.Google Scholar
  8. 8.
    Wilson PW, D’Agostino RB, Sullivan L, et al. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med. 2002;162:1867–72.CrossRefPubMedGoogle Scholar
  9. 9.
    Bray GA. Medical consequences of obesity. J Clin Endocrinol Metab. 2004;89:2583–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Wong CY, O’Moore-Sullivan T, Leano R, et al. Alterations of left ventricular myocardial characteristics associated with obesity. Circulation. 2004;110:3081–7. CrossRefPubMedGoogle Scholar
  11. 11.
    Peterson LR, Waggoner AD, Schechtman KB, et al. Alterations in left ventricular structure and function in young healthy obese women: assessment by echocardiography and tissue Doppler imaging. J Am Coll Cardiol. 2004;43:1399–404. Scholar
  12. 12.
    Li X, Li S, Ulusoy E, et al. Childhood adiposity as a predictor of cardiac mass in adulthood: the Bogalusa Heart Study. Circulation. 2004;110:3488–92.CrossRefPubMedGoogle Scholar
  13. 13.
    Alpert MA, Lambert CR, Panayiotou H, et al. Relation of duration of morbid obesity to left ventricular mass, systolic function, and diastolic filling, and effect of weight loss. Am J Cardiol. 1995;76:1194–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Lauer MS, Anderson KM, Kannel WB, et al. The impact of obesity on left ventricular mass and geometry. The Framingham Heart Study. JAMA. 1991;266:231–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Levy D, Garrison RJ, Savage DD, et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322:1561–6.CrossRefPubMedGoogle Scholar
  16. 16.
    de la Maza MP, Estevez A, Bunout D, et al. Ventricular mass in hypertensive and normotensive obese subjects. Int J Obes Relat Metab Disord. 1994;18:193–7.PubMedGoogle Scholar
  17. 17.
    Lauer MS, Anderson KM, Levy D. Separate and joint influences of obesity and mild hypertension on left ventricular mass and geometry: the Framingham Heart Study. J Am Coll Cardiol. 1992;19:130–4. CrossRefPubMedGoogle Scholar
  18. 18.
    Bombelli M, Facchetti R, Carugo S, et al. Left ventricular hypertrophy increases cardiovascular risk independently of in-office and out-of-office blood pressure values. J Hypertens. 2009;27(12):458–64. Scholar
  19. 19.
    Levy D, Garrison RJ, Savage DD, et al. Left ventricular mass and incidence of coronary heart disease in an elderly cohort. Ann Intern Med. 1989;110:101–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Avelar E, Cloward TV, Walker JM, et al. Hypertrophy in severe obesity: interactions among blood pressure, nocturnal hypoxemia, and body mass. Hypertension. 2007;49:34–9. Scholar
  21. 21.
    Sturm R. Increases in morbid obesity in the USA: 2000–2005. Public Health. 2007;121(7):492–6. Scholar
  22. 22.
    Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–63. Scholar
  23. 23.
    Le Jemtel TH, Samson R, Jaiswal A, et al. Regression of left ventricular mass after bariatric surgery. Curr Hypertens Rep. 2017;19(9):68. Scholar
  24. 24.
    Ganau A, Devereux RB, Roman MJ, et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol. 1992;19:1550–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Gerdts E, Wachtell K, Omvik P, et al. Left atrial size and risk of major cardiovascular events during antihypertensive treatment: losartan intervention for endpoint reduction in hypertension trial. Hypertension. 2007;49:311–6. Scholar
  26. 26.
    Melenovsky V, Borlaug BA, Rosen B, et al. Cardiovascular features of heart failure with preserved ejection fraction versus nonfailing hypertensive left ventricular hypertrophy in the urban Baltimore community: the role of atrial remodeling/dysfunction. J Am Coll Cardiol. 2007;49:198–207. Scholar
  27. 27.
    Frohlich ED. Preview of hemodynamic and nonhemodynamic factors associated with left ventricular hypertrophy. J Mol Cell Cardiol. 1989;21:3–10.CrossRefPubMedGoogle Scholar
  28. 28.
    de Simone G, Pasanisi F, Contaldo F. Link of nonhemodynamic factors to hemodynamic determinants of left ventricular hypertrophy. Hypertension. 2001;38(1):13–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Harmond IW, Devereux RB, Alderman MH. The prevalence and correlates of echocardiographic left ventricular hypertrophy among employed patients with uncomplicated hypertension. J Am Coll Cardiol. 1986;7:639–50.CrossRefGoogle Scholar
  30. 30.
    Grossman W, Loner D, McLaurin LP. Wall stress and patterns of hypertrophy in the human left ventricle. J Clin Invest. 1975;56:56–64. Scholar
  31. 31.
    Campus S, Malavasi A, Genau A. Systolic function of the hypertrophied left ventricle. J Clin Hypertens. 1987;3:79–87.PubMedGoogle Scholar
  32. 32.
    Messerli FH, Sundgaard-Riise K, Reisin ED, et al. Dimorphic cardiac adaptation to obesity and arterial hypertension. Ann Intern Med. 1983;99:757–61.CrossRefPubMedGoogle Scholar
  33. 33.
    Messerli FH. Cardiovascular effects of obesity and hypertension. Lancet. 1982;1:1165–8.CrossRefPubMedGoogle Scholar
  34. 34.
    de Simone G, Devereux RB, Roman MJ, et al. Relation of obesity and gender to left ventricular hypertrophy in normotensive and hypertensive adults. Hypertension. 1994;23:600–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Kronmal RA. Spurious correlation and the fallacy of the ratio standard revisited. J Royal Slat Soc A. 1993;156:379–92.CrossRefGoogle Scholar
  36. 36.
    Ganau A, Ami A, Saba PS, et al. Stroke volume and left heart anatomy in relation to plasma volume in essential hypertension. J Hypertens. 1991;9(suppl 6):sl50–1.Google Scholar
  37. 37.
    Ganau A, Devereux RB, Pickering TG, et al. Relation of left ventricular hemodynamic load and contractile performance to left ventricular mass in hypertension. Circulation. 1990;81:25–36.CrossRefPubMedGoogle Scholar
  38. 38.
    Aurigemma GP, Devereux RB, de Simone G, et al. Myocardial function and geometry in hypertensive subjects with low levels of afterload. Am Heart J. 2002;143:546–51.CrossRefPubMedGoogle Scholar
  39. 39.
    Verdecchia P, Schillaci G, Borgioni C, et al. Prognostic significance of serial changes in left ventricular mass in essential hypertension. Circulation. 1998;97:48–54.CrossRefPubMedGoogle Scholar
  40. 40.
    Beinart R, Boyko V, Schwammenthal E, et al. Long-term prognostic significance of left atrial volume in acute myocardial infarction. J Am Coll Cardiol. 2004;44:327–34. Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Roberto de Cleva
    • 1
    • 2
  • Victor Arrais Araujo
    • 1
  • Carla Cristina Ornelas Buchalla
    • 1
  • Fabio de Oliveira Costa
    • 1
  • Acácio Fernandes Cardoso
    • 1
  • Denis Pajecki
    • 1
  • Marco Aurelio Santo
    • 1
  1. 1.Hospital das Clínicas, Gastroenterology DepartmentUniversity of São Paulo Medical SchoolSão PauloBrazil
  2. 2.São PauloBrazil

Personalised recommendations