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Overweight and Sudden Death: Increased Ventricular Ectopy in Cardiopathy of Obesity

Overweight and Sudden Death: Increased Ventricular Ectopy in Cardiopathy of Obesity Abstract • Obesity has been documented to be an independent risk factor for sudden death and other cardiovascular mortality. The present study was designed to monitor and quantify cardiac arrhythmias in obese subjects with and without eccentric left ventricular hypertrophy, who were matched with regard to arterial pressure, age, sex, and height with lean subjects. Prevalence of premature ventricular (but not atrial) contractions was 30 times higher in obese patients with eccentric left ventricular hypertrophy compared with lean subjects. Similarly, obese patients with left ventricular hypertrophy scored higher with regard to the classification of Lown and Wolf than those without left ventricular hypertrophy and lean subjects having the same level of arterial pressure. Patients' class in the Lown and Wolf system correlated with ventricular diastolic diameter and left ventricular mass. Thus, heart enlargement of the eccentric type as a consequence of obesity predisposes to excessive ventricular ectopy. Echocardiographic assessment and electrocardiographic monitoring allow us to identify the patients who are at highest risk of more serious arrhythmias or possibly sudden death and to subject them to the most specific preventive and therapeutic measures. (Arch Intern Med 1987;147:1725-1728) References 1. Chadwick J, Mann WN: Medical works of Hippocrates . Boston, Black-well Scientific Publications Inc, 1950, p 154. 2. Smith HL, Willius FA: Adiposity of the heart: A clinical and pathologic study of 136 obese patients. Arch Intern Med 1933;52:910-931.Crossref 3. Messerli FH: Cardiopathy of obesity: A not-so-victorian disease. N Engl J Med 1986;314:378-380.Crossref 4. Messerli FH: Cardiovascular effects of obesity and hypertension. Lancet 1982;1:1165-1168.Crossref 5. Messerli FH, Sungaard-Riise K, Reisin E, et al: Dimorphic cardiac adaptation to obesity and essential hypertension. Ann Intern Med 1983;99: 757-761.Crossref 6. Dunn FG, Chandraratna PAN, DeCarvalho JFG, et al: Pathophysiological assessment of hypertensive heart disease with echocardiography. Am J Cardiol 1977;39:789-795.Crossref 7. Savage DD, Drayer JIM, Henry WL: Echocardiographic assessment of cardiac anatomy and function in hypertensive patients. Circulation 1979;59:623-632.Crossref 8. Devereux RB, Savage DD, Sach I, et al: Relation of hemodynamic load to left ventricular hypertrophy and performance in hypertension. Am J Cardiol 1983;51:171-176.Crossref 9. Messerli FH, Ventura HO, Elizardi DJ, et al: Hypertension and sudden death: Increased ventricular ectopic activity in left ventricular hypertrophy. Am J Med 1984;77:18-22.Crossref 10. Loadi A, Pepi M, Agostini PG, et al: Cardiac rhythm in hypertension assessed through 24-hour ambulatory electrocardiographic monitoring effects of load manipulation with atenolol, verapamil, and nifedipine. Br Heart J 1983;50:118-126.Crossref 11. Levy D, Savage DD, Garrison RJ, et al: The association of left ventricular hypertrophy with ventricular arrhythmias: The Framingham Heart study, abstracted. Circulation 1985;72:46.Crossref 12. Kannel WB, Gordon T, Olf TD: Left ventricular hypertrophy by electrocardiogram: Prevalence, incidence and mortality in the Framingham Study. Ann Intern Med 1969;71:89-109.Crossref 13. Gordon T, Kannel WB: Obesity and cardiovascular disease: The Framingham Study. Clin Endocrinol Metab 1976;5:367-374.Crossref 14. Hubert HB, Feinleib M, Menamacre PM, et al: Obesity as an independent risk factor for cardiovascular disease: A 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983;67:968-977.Crossref 15. New Weight Standards For Men and Women : Stat Bull Metrop Insur Co 1959;40:1-10. 16. Messerli FH, Glade LB, Ventura HO: Diurnal variations of cardiac rhythm, arterial pressure and urinary catecholamines. Am Heart J 1982;104:109-114.Crossref 17. Bennett DH, Evans DW: Correlation of left ventricular mass determined by echocardiography with vectocardiographic and electrocardiographic measurements. Br Heart J 1974;36:981-987.Crossref 18. Snedecor GW, Cochram WG: Statistical Methods , ed 6. Ames, Iowa, Iowa State University Press, 1967. 19. Toyoshima H, Park YG, Ishikawa Y, et al: Effect of ventricular hypertrophy on conduction velocity of activation front in the ventricular myocardium. Am J Cardiol 1982;49:1938-1945.Crossref 20. Cameron JS, Myerburg RJ, Wong SS, et al: Electrophysiologic consequences of chronic experimentally induced left ventricular pressure overload. J Am Coll Cardiol 1983;2:481-487.Crossref 21. White CW, Mirro MJ, Lund DD, et al: Alterations in ventricular excitability in conscious dogs during development of chronic heart failure. Am J Physiol 1986;250:H1022-H1029. 22. Janse MJ, Kleber A: Electrophysiological changes and ventricular arrhythmias in the elderly phase of regional myocardial ischemia. Circ Res 1981;49:1069-1081.Crossref 23. Strauer BE: Hypertensive Heart Disease . New York, Springer-Verlag NY Inc, 1980, pp 23-36. 24. Marcus ML, Mueller TM, Gascho JA, et al: Effects of cardiac hypertrophy secondary to hypertension on coronary circulation. Am J Cardiol 1979;44:1023-1028.Crossref 25. Marcus ML, Mueller TM, Eastham CHL: Effects of short- and long-term left ventricular hypertrophy on coronary circulation. Am J Physiol 1981;24:H358-H362. 26. Isner JM, Sours HE, Paris AL, et al: Sudden, unexpected death in avid dieters using the liquid protein modified fast diet: Observations in 17 patients and the role of prolonged Q-T interval. Circulation 1979;60: 1401-1412.Crossref 27. Lantigua RA, Amatruda JM, Biddle TH, et al: Cardiac arrhythmias associated with a liquid protein diet for the treatment of obesity. N Engl J Med 1980;303:735-738.Crossref 28. Alpert MA, Terry BE, Kelly DL: Effect of weight loss on cardiac chamber size, wall thickness and left ventricular function in morbid obesity. Am J Cardiol 1985;55:783-786.Crossref 29. MacMahon SW, Wilcken DEL, MacDonald GJ: The effect of weight reduction on left mass: A randomized controlled trial in young, overweight hypertensive patients. N Engl J Med 1986;314:334-339.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Overweight and Sudden Death: Increased Ventricular Ectopy in Cardiopathy of Obesity

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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1987.00370100039008
Publisher site
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Abstract

Abstract • Obesity has been documented to be an independent risk factor for sudden death and other cardiovascular mortality. The present study was designed to monitor and quantify cardiac arrhythmias in obese subjects with and without eccentric left ventricular hypertrophy, who were matched with regard to arterial pressure, age, sex, and height with lean subjects. Prevalence of premature ventricular (but not atrial) contractions was 30 times higher in obese patients with eccentric left ventricular hypertrophy compared with lean subjects. Similarly, obese patients with left ventricular hypertrophy scored higher with regard to the classification of Lown and Wolf than those without left ventricular hypertrophy and lean subjects having the same level of arterial pressure. Patients' class in the Lown and Wolf system correlated with ventricular diastolic diameter and left ventricular mass. Thus, heart enlargement of the eccentric type as a consequence of obesity predisposes to excessive ventricular ectopy. Echocardiographic assessment and electrocardiographic monitoring allow us to identify the patients who are at highest risk of more serious arrhythmias or possibly sudden death and to subject them to the most specific preventive and therapeutic measures. (Arch Intern Med 1987;147:1725-1728) References 1. Chadwick J, Mann WN: Medical works of Hippocrates . Boston, Black-well Scientific Publications Inc, 1950, p 154. 2. Smith HL, Willius FA: Adiposity of the heart: A clinical and pathologic study of 136 obese patients. Arch Intern Med 1933;52:910-931.Crossref 3. Messerli FH: Cardiopathy of obesity: A not-so-victorian disease. N Engl J Med 1986;314:378-380.Crossref 4. Messerli FH: Cardiovascular effects of obesity and hypertension. Lancet 1982;1:1165-1168.Crossref 5. Messerli FH, Sungaard-Riise K, Reisin E, et al: Dimorphic cardiac adaptation to obesity and essential hypertension. Ann Intern Med 1983;99: 757-761.Crossref 6. Dunn FG, Chandraratna PAN, DeCarvalho JFG, et al: Pathophysiological assessment of hypertensive heart disease with echocardiography. Am J Cardiol 1977;39:789-795.Crossref 7. Savage DD, Drayer JIM, Henry WL: Echocardiographic assessment of cardiac anatomy and function in hypertensive patients. Circulation 1979;59:623-632.Crossref 8. Devereux RB, Savage DD, Sach I, et al: Relation of hemodynamic load to left ventricular hypertrophy and performance in hypertension. Am J Cardiol 1983;51:171-176.Crossref 9. Messerli FH, Ventura HO, Elizardi DJ, et al: Hypertension and sudden death: Increased ventricular ectopic activity in left ventricular hypertrophy. Am J Med 1984;77:18-22.Crossref 10. Loadi A, Pepi M, Agostini PG, et al: Cardiac rhythm in hypertension assessed through 24-hour ambulatory electrocardiographic monitoring effects of load manipulation with atenolol, verapamil, and nifedipine. Br Heart J 1983;50:118-126.Crossref 11. Levy D, Savage DD, Garrison RJ, et al: The association of left ventricular hypertrophy with ventricular arrhythmias: The Framingham Heart study, abstracted. Circulation 1985;72:46.Crossref 12. Kannel WB, Gordon T, Olf TD: Left ventricular hypertrophy by electrocardiogram: Prevalence, incidence and mortality in the Framingham Study. Ann Intern Med 1969;71:89-109.Crossref 13. Gordon T, Kannel WB: Obesity and cardiovascular disease: The Framingham Study. Clin Endocrinol Metab 1976;5:367-374.Crossref 14. Hubert HB, Feinleib M, Menamacre PM, et al: Obesity as an independent risk factor for cardiovascular disease: A 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983;67:968-977.Crossref 15. New Weight Standards For Men and Women : Stat Bull Metrop Insur Co 1959;40:1-10. 16. Messerli FH, Glade LB, Ventura HO: Diurnal variations of cardiac rhythm, arterial pressure and urinary catecholamines. Am Heart J 1982;104:109-114.Crossref 17. Bennett DH, Evans DW: Correlation of left ventricular mass determined by echocardiography with vectocardiographic and electrocardiographic measurements. Br Heart J 1974;36:981-987.Crossref 18. Snedecor GW, Cochram WG: Statistical Methods , ed 6. Ames, Iowa, Iowa State University Press, 1967. 19. Toyoshima H, Park YG, Ishikawa Y, et al: Effect of ventricular hypertrophy on conduction velocity of activation front in the ventricular myocardium. Am J Cardiol 1982;49:1938-1945.Crossref 20. Cameron JS, Myerburg RJ, Wong SS, et al: Electrophysiologic consequences of chronic experimentally induced left ventricular pressure overload. J Am Coll Cardiol 1983;2:481-487.Crossref 21. White CW, Mirro MJ, Lund DD, et al: Alterations in ventricular excitability in conscious dogs during development of chronic heart failure. Am J Physiol 1986;250:H1022-H1029. 22. Janse MJ, Kleber A: Electrophysiological changes and ventricular arrhythmias in the elderly phase of regional myocardial ischemia. Circ Res 1981;49:1069-1081.Crossref 23. Strauer BE: Hypertensive Heart Disease . New York, Springer-Verlag NY Inc, 1980, pp 23-36. 24. Marcus ML, Mueller TM, Gascho JA, et al: Effects of cardiac hypertrophy secondary to hypertension on coronary circulation. Am J Cardiol 1979;44:1023-1028.Crossref 25. Marcus ML, Mueller TM, Eastham CHL: Effects of short- and long-term left ventricular hypertrophy on coronary circulation. Am J Physiol 1981;24:H358-H362. 26. Isner JM, Sours HE, Paris AL, et al: Sudden, unexpected death in avid dieters using the liquid protein modified fast diet: Observations in 17 patients and the role of prolonged Q-T interval. Circulation 1979;60: 1401-1412.Crossref 27. Lantigua RA, Amatruda JM, Biddle TH, et al: Cardiac arrhythmias associated with a liquid protein diet for the treatment of obesity. N Engl J Med 1980;303:735-738.Crossref 28. Alpert MA, Terry BE, Kelly DL: Effect of weight loss on cardiac chamber size, wall thickness and left ventricular function in morbid obesity. Am J Cardiol 1985;55:783-786.Crossref 29. MacMahon SW, Wilcken DEL, MacDonald GJ: The effect of weight reduction on left mass: A randomized controlled trial in young, overweight hypertensive patients. N Engl J Med 1986;314:334-339.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1987

References