Diastolic function and cardiovascular risk among patients with severe obesity referred to a lifestyle-program – a pilot study

Figures & data

Figure 1. Flow-chart of patient recruitment to follow-up.

Table 1. Socio-demographic data and comorbidities at baseline.

	Total sample (n = 56)	Men (n = 22)	Women (n = 34)
Age (years), mean (SD)	45.1 ± 11.6	44.5	45.4 ± 11.5
BMI (kg/m^2) at referral, mean (SD)	41.9 ± 6.0	43 ± 7.4	41.1 ± 4.9
Years with obesity (years), mean (SD)	26.9 ± 14.1 (n = 51)	26.8 ± (n = 20)	27 ± 15.1 (n = 31)
Marital status
Married/cohabitant, n (%)	45 (80.4)	18 (81.8)	27 (79.4)
Single, n (%)	11 (19.6)	4 (18.2)	7 (20.5)
Highest completed education
Primary school, n (%)	7 (12.5)	3 (13.6)	4 (11.6)
Secondary school, n (%)	28 (50)	12 (54.5)	16 (47.1)
College/University, n (%)	21 (37.5)	7 (31.8)	14 (41.2)
Work status
Employed, n (%)	35 (62.5)	11 (50)	24 (70.6)
Student, n (%)	3 (5.4)	2 (9.1)	1 (2.9)
Unemployed/job seeker, n (%)	2 (3.6)	1 (4.5)	1 (2.9)
Sick-leave/work assessment allowance (AAP), n (%)	11 (19.7)	5 (22.7)	6 (17.7)
Other pension or benefit, n (%)	4 (7.2)	2 (9.1)	2 (5.9)
Comorbidities (ICD-10-diagnosis)
Type II diabetes, n (%)	14 (25)	6 (27.3)	8 (23.5)
Sleep apnoea, n (%)	21 (37.5)	10 (54.5)	11 (32.4)
Hyperlipidaemia, n (%)	17 (30)	7 (32)	10 (29)
Hypertension, n (%)	25 (44.6)	13 (59.1)	12 (35.3)
Arthrosis, n (%)	11 (19.6)	4 (18.2)	7 (20.6)
Musculoskeletal pain, n (%)	27 (48.2)	8 (36.4)	19 (55.9)
Smoking habits
Never, n (%)	16 (28.6)	6 (27.3)	10 (29.4)
Previous smoker, n (%)	29 (51.8)	10 (45.5)	19 (55.9)
Smoking, n (%)	6 (10.7)	4 (18.2)	2 (5.9)

Table 2. Clinical examination among all at baseline (n = 56).

BP, sys, mmHg	126 ± 10
BP, dias, mmHg	80 ± 6
Blood tests
Fasting glucose
mmol/L	5.8 ± 1.2
mg/dL	104 ± 22
HbA1c
%	5.8 ± 0.9
mmol/mol	40 ± 10
Total cholesterol mmol/L	4.6 ± 0.9
HDL-cholesterol mmol/L	1.2 ± 0.3
LDL-cholesterol mmol/L	2.9 ± 0.9
Triglycerides mmol/L	1.4 ± 0.4
Hb g/L	142 ± 11
CRP mg/L	11.0 ± 15.9
NT-proBNP ng/L	60.1 ± 70.8
NORRISK 2, %	2.3 ± 2.1
Self-reported physical activity
PAQ frequency	1.4 ± 1.2
PAQ intensity	1.7 ± 0.5
PAQ duration	0.6 ± 0.3
PA Index	1.7 ± 1.9
CR exercise testing	(n = 50)
VO2peak
mL/kg min	25.1 ± 4.5
L/min	3.0 ±  0.8
RER	1.1 ± 0.1
Peak heart rate beats/min	172 ± 16
HADS total	12.2 ± 6.9

BP, blood pressure; chol, cholesterol; CRP, C-reactive protein; VO₂, oxygen uptake; RER, respiratory exchange ratio; HADS, hospital anxiety and depression scale.

Table 3. Echocardiographic parameters among subjects with severe obesity at T1 and T2.

	T1 (n = 46–56)	T2 (n = 33–41)
BSA, cm^2	2.41 ± 0.25	2.35 ± 0.25
LVEF, %	59 ± 8	64 ± 5
LVEDV, mL	105.1.2 ± 28.4	101.4 ± 29.1
LVSV, mL	43.6 ± 15.7	36.0 ± 11.9
LVIDd, cm	5.2 ± 0.4	5.0 ± 0.5
IVSd, cm	1.0 ± 0.1	0.9 ± 0.1
LVPWd, cm	0.9 ± 0.1	0.9 ± 0.1
LVMI, g/m^2.7	41.4 ± 8.1	40.0 ± 8.6
RWT	0.36 ± 0.06	0.37 ± 0.05
LA diam, cm	3.4 ± 0.6	3.5 ± 0.5
E wave, cm/s	7.5 ± 1.7	7.8 ± 1.8
E/A ratio	1.1 ± 0.3	1.1 ± 0.4
MDT, ms	235 ± 55	218 ± 53
e′, cm/s	10.9 ± 4.5	10.0 ± 2.7
E/e′ ratio	7.2 ± 1.8	8.3 ± 3.1

Values are mean ± SD; BSA, body surface area; LVEF, left ventricle ejection fraction; LVEDV, LV end diastolic volume; LVSV, LV systolic volume; LVIDd, LV internal diameter in diastole; IVSd, interventricular septum in diastole; LVPWd, LV posterior wall thickness in diastole; LVMI, LV mass index relative to BSA (g/cm²) and height in obesity (g/m^2.7); RWT, relative wall thickness; LA, left atrium; E, maximum early diastolic E wave velocity at transmitral blood flow Doppler; A, maximum late diastolic A wave velocity at transmitral blood flow Doppler; MDT, mitral deceleration time; e′, maximum E wave velocity from tissue Doppler imaging.

Table 4. Diastolic assessments in six subjects at T1 and five subjects at T2 with diastolic dysfunction (three out of four parameters).

	E/A ratio	T1	n = 6	E/e′ ratio		T2	n = 5
Age, years (sex)		MDT msec	e′ cm/sec		E/A	MDT	e′	E/e′	CM
66 (man)	0.72	264	6	8	0.80	209	6	7	HT
59 (woman)	0.76	256	7	9					HT, DM
57 (woman)	0.68	272	7	9	0.64	313	5	12	HT
58 (woman)	0.63	183	7	8					HT, DM
56 (woman)	0.68	264	7	9	0.77	222	7	10
53 (woman)	0.74	235	8	8					DM
39 (woman)					0.78	326	5	9	DM
53 (woman)					0.74	230	11	6
All	0.72	261	7	8	0.82	273	8	8

E, maximum early diastolic E wave velocity at transmitral blood flow Doppler; A, maximum late diastolic A wave velocity at transmitral blood flow Doppler; MDT, mitral deceleration time; e′, maximum E wave velocity from tissue Doppler imaging; CM, co-morbidities; DM, type 2 diabetes mellitus, HT, hypertension.

Table 5. Linear Mixed Model (LMM) results of level and changes in diastolic echocardiographic data and ventricular function and geometry from T1 to T2.

		Baseline		Change
	N	Mean	SD	Mean	P
E/A Ratio	53	1.12	0.29	0.12	.005
MDT, ms	52	235.40	38.19	–20.81	.014
e′, cm/s	54	0.11	0.03	–0.01	.189
E/e′ Ratio	53	7.42	2.19	0.79	.023
EF Biplan	47	58.57	3.29	5.46	<.001
LVIDd	51	5.17	0.30	–0.13	.092
RWT	51	0.36	0.02	0.01	.359
LVMI-Obese	51	41.37	5.22	–1.39	.366

E, maximum early diastolic E wave velocity at transmitral blood flow Doppler; A, maximum late diastolic A wave velocity at transmitral blood flow Doppler; MDT, mitral deceleration time; e′, maximum E wave velocity from tissue Doppler imaging; EF, ejection fraction; LVIDd, left ventricular internal diameter in diastole; RWT, left ventricular relative wall thickness; LVMI-Obese, left ventricular mass index in obese subjects.

Table 6. Linear Mixed Model (LMM) results of level and changes in body weight, physical fitness and activity, and cardiovascular risk profile from T1 to T2 and from T2 to T3.

		Baseline (T1)		Change T1–T2		Change T2–T3
	N	Mean	SD	Mean	p	Mean	p
Weight (kg)	56	121.68	21.61	–5.26	<.001	–0.43	.666
BMI	56	40.48	5.52	–1.77	<.001	–0.11	.731
VO2peak (mL/kg min^))	53	25.03	3.15	1.61	.026	–0.64	.437
PA Index	56	1.76	1.30	1.69	<.001	–0.69	.061
NORRISK 2(%)	55	2.27	2.15	0.20	.090	–0.04	.720

BMI: Body mass index; VO_2peak: peak oxygen uptake; PA Index: physical activity index; NORRISK2: cardiovascular risk profile.