Impact of body mass index on worsening of diastolic function and impairment of left atrial strain in the general female urban population: a subanalysis of the Berlin female risk evaluation echocardiography follow-up study

Elena Romero Dorta; Adrian Wolf; Anne Hübscher; Daniela Blaschke-Waluga; Ute Seeland; Claudia Crayen; Sven Bischoff; Isabel Mattig; Henryk Dreger; Karl Stangl; Vera Regitz-Zagrosek; Ulf Landmesser; Fabian Knebel; Verena Stangl; Anna Brand

doi:10.3389/fcvm.2023.1242805

Impact of body mass index on worsening of diastolic function and impairment of left atrial strain in the general female urban population: a subanalysis of the Berlin female risk evaluation echocardiography follow-up study

Front Cardiovasc Med. 2023 Sep 20:10:1242805. doi: 10.3389/fcvm.2023.1242805. eCollection 2023.

Authors

Elena Romero Dorta^{1

2}, Adrian Wolf^{1

2}, Anne Hübscher^{1

2}, Daniela Blaschke-Waluga¹, Ute Seeland^{2

3

4}, Claudia Crayen⁵, Sven Bischoff¹, Isabel Mattig^{1

2

3

6}, Henryk Dreger^{1

2

3}, Karl Stangl^{1

2

3}, Vera Regitz-Zagrosek^{3

7

8}, Ulf Landmesser^{2

3

9}, Fabian Knebel^{1

3

10}, Verena Stangl^{1

2

3}, Anna Brand^{1

2

3

9}

Affiliations

¹ Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Mitte, Berlin, Germany.
² Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
³ DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany.
⁴ Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
⁵ Freie Universität Berlin, Department of Education and Psychology, Berlin, Germany.
⁶ Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany.
⁷ Charité-Universitätsmedizin Berlin, Institute of Gender in Medicine, Berlin, Germany.
⁸ Department of Cardiology, University Hospital ZüRich, University of ZüRich, Switzerland.
⁹ Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany.
¹⁰ Clinical Department of Cardiology, Internal Medicine II, Sana Klinikum Berlin-Lichtenberg, Germany.

Abstract

Background: The association of body mass index (BMI) with diastolic dysfunction (DD) is well described in the literature. However, there is conflicting evidence and long-term follow-up data regarding effects of BMI on preclinical DD and left atrial (LA) function are scarce, highlighting the importance of early detection tools, such as myocardial strain.

Purpose: The aim of our study was to prospectively analyze the impact of clinical and demographic parameters, especially of BMI, on worsening of diastolic function and left atrial strain (LAS) in an urban population of women with a low prevalence of cardiovascular risk factors.

Methods and results: An extensive clinical and echocardiographic assessment comprising the analysis of phasic LAS using two-dimensional speckle-tracking echocardiography (2D STE) was performed in 258 participants of the Berlin Female Risk Evaluation (BEFRI) trial between October 2019 and December 2020 after a mean follow-up period of 6.8 years. We compared clinical and echocardiographic parameters stratifying women by BMI < or ≥25 kg/m², and we analyzed the impact of demographic characteristics on the worsening of DD and LA mechanics in the longer-term follow-up using univariate and multivariate regression analyses. 248 women were suitable for echocardiographic analysis of LAS using 2D STE. After a mean follow-up time of 6.8 years, LA reservoir strain (LASr) and LA conduit strain (LAScd) were significantly reduced in participants with a BMI ≥25 kg/m² compared with women with a BMI <25 kg/m² at baseline (30 ± 8% vs. 38 ± 9%, p < 0.0001; -14 ± 7% vs. -22 ± 8%, p < 0.0001). 28% of the overweighted women presented a deterioration of diastolic function at the time of follow-up in contrast with only 7% of the group with a BMI <25 kg/m² (p < 0.0001). BMI remained significantly associated with LAS reductions after adjustment for other risk factors in multivariate regression analyses.

Conclusion: Overweight and obesity are related to impaired LAS and to a worsening of diastolic function after a long-term follow-up in a cohort of randomly selected women.

Keywords: BEFRI; body mass index; diastolic dysfunction; left atrial strain; left atrium.

Grants and funding

Supported by the DZHK (German Centre for Cardiovascular Research) and by the BMBF (German Ministry of Education and Research). Grant number 81Z0100211. We acknowledge financial support from the Open Access Publication Fund of Charité – Universitätsmedizin Berlin and the German Research Foundation (DFG).