Early myocardial deformation changes in hypercholesterolemic and obese children and adolescents: a 2D and 3D speckle tracking echo study

Background. Dyslipidemia and obesity are considered strong risk factors for premature atherosclerotic cardiovascular disease and increased morbidity and mortality and may have an adverse effect on left ventricular (LV) performance. Objective. Our purpose was to assess the presence of early myocardial deformation abnormalities in dyslipidemic children free from other cardiovascular risk factors using two-dimensional (2DSTE) and three-dimensional (3DSTE) speckle tracking echocardiography. Methods. We studied eighty consecutive nonselected patients (6-18 years of age) with hypercholesterolemia (low-density lipoprotein -LDL- cholesterol levels above the 95th percentile for age and gender). Fourty of them had normal weight and 40 were obese (body mass index >95th percentile for age and gender). Fourty healthy age-matched children were selected as controls. Left ventricular (LV) global longitudinal, circumferential and radial strains were calculated by 2DSTE and 3DSTE. Global area strain (GAS) was calculated by 3DSTE as percentage variation in surface area defined by the longitudinal and circumferential strain vectors. Right ventricular (RV) global and free-wall longitudinal strain and LV and RV diastolic strain rate parameters were obtained. Data analysis was performed offline. Results. LV global longitudinal strain and GAS were lower in normal weight and obese dyslipidemic children compared to normal controls and reduced in obese patients compared to normal weight dyslipidemic children. LV early diastolic strain rate was lower compared to normals. RV global and free-wall longitudinal strain was significantly reduced in obese patients when compared with the control group. A significant inverse correlation was found between LV strain, LDL cholesterol levels, and body mass index. Conclusions. 2DSTE and 3DSTE show LV longitudinal strain and GAS changes in dyslipidemic children and adolescents free from other cardiovascular risk factors or structural cardiac abnormalities. Obesity causes an additive adverse effect on LV strain parameters and RV strain impairment.