Effect of Left Ventricular Diastolic Function on Exercise Capacity in Hypertensive Patients with Obesity

비만을 동반한 고혈압 환자의 좌심실 이완기 기능이 운동능력에 미치는 영향

  • Shin, Kyung-A (Dept. of Clinical Laboratory Science, Shinsung University)
  • 신경아 (신성대학교 임상병리과)
  • Received : 2020.06.04
  • Accepted : 2020.08.20
  • Published : 2020.08.28


The purpose of this study was to investigate the effect of left ventricular diastolic function on exercise capacity in hypertensive patients with obesity compared to the obese group. Adults who visited a general hospital in Gyeonggi-do from 2016 to 2019(man: 308, women: 192) were divided into 4 groups according to hypertension and obesity. In the hypertensive obesity group(IV), the A wave and E/E' wave were significantly higher than the normotensive obesity group(II), and the E' wave was significantly lower(respectively p<0.001). The group IV had significantly lower METS(metabolic equivalents) and exercise duration than the group II(respectively p<0.001). In group IV, E/A ratio was positively correlated with METS(p=0.025) and exercise duration(p=0.026). In contrast, E/E' wave in these groups showed a negative correlation with the exercise duration(p=0.046).

이 연구는 비만군과 비교해 비만을 동반한 고혈압 환자에서 좌심실 이완기 기능 및 운동능력의 차이를 평가하고 좌심실 이완기 기능이 운동능력에 미치는 영향을 알아보고자 하였다. 2016년 1월부터 2019년 8월까지 경기도 지역종합병원을 내원한 남성 308명, 여성 197명을 대상으로 하였다. 고혈압과 비만 유무에 따라 대상자를 4그룹으로 나누었다. 비만 단독환자보다 비만을 동반한 고혈압 환자에서 이완기 기능을 나타내는 A파와 E/E'파는 높았으며, E'파는 낮았다(각각 p<0.001). 운동능력은 비만군보다 비만을 동반한 고혈압 환자에서 대사당량과 운동지속시간이 낮았다(각각 p<0.001). 비만을 동반한 고혈압 환자에서 E/A 비율은 대사당량에 정적인 영향을 미쳤다(p=0.025). 또한 E/A 비율은 운동지속시간에 정적인 영향을 미치며(p=0.026), E/E'파는 부적인 영향을 미치는 것으로 나타났다(p=0.046).



  1. E. E. Calle, M. J. Thun, J. M. Petrelli, C. Rodriguez & C. W. Heath. (1999). Body-mass index and mortality in a prospective cohort of U.S. adults. The New England Journal of Medicine, 341(15), 1097-1105. DOI : 10.1056/NEJM199910073411501
  2. D. Levy, R. J. Garrison, D. D. Savage, W. B. Kannel & W. P. Castelli. (1990). Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. The New England Journal of Medicine, 322(22), 1561-1566. DOI : 10.1056/NEJM199005313222203
  3. L. A. Barouch, D. E. Berkowitz, R. W. Harrison, C. P. O'Donnell & J. M. Hare. (2003). Disruption of leptin signaling contributes to cardiac hypertrophy independently of body weight in mice. Circulation, 108(6), 754-759. DOI : 10.1161/01.CIR.0000083716.82622.FD
  4. M. A. Alpert. (2001). Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. The American Journal of the Medical Sciences, 321(4), 225-236. DOI : 10.1097/00000441-200104000-00003
  5. H. A. Al Otair et al. (2018). Left ventricular diastolic dysfunction in patients with obesity hypoventilation syndrome. Journal of Thoracic Disease, 10(10), 5747-5754. DOI : 10.21037/jtd.2018.09.74
  6. S. L. Hummel & D. W. Kitzman. (2013). Update on heart failure with preserved ejection fraction. Current Cardiovascular Risk Reports, 7(6), 495-502. DOI : 10.1007/s12170-013-0350-9.
  7. D. Levy, M. G. Larson, R. S. Vasan, W. B. Kannel & K. K. Ho. (1996). The progression from hypertension to congestive heart failure. The Journal of the American Medical Association, 275(20), 1557-1562. DOI : 10.1001/jama.275.20.1557
  8. S. K. Ryu, J. W. Choi & Y. B. Cho. (2008). The early change of left ventricular function in overweight and obese patients: analysis with tissue doppler echocardiography. Korean Circulation Journal, 38(5), 270-275. DOI : 10.4070/kcj.2008.38.5.270
  9. F. H. Messerli et al. (1983). Dimorphic cardiac adaptation to obesity and arterial hypertension. Annals of Internal Medicine, 99(6), 757-761. DOI : 10.7326/0003-4819-99-6-757
  10. A. Chockalingam, M. A. Linden, M. Del Rosario, G. Govindarajan, K. C. Dellsperger & T. R. Thomas. (2010). Exercise and weight loss improve exercise capacity independent of cardiac function in metabolic syndrome. Angiology, 61(2), 192-197. DOI : 10.1177/0003319709336418
  11. H. K. Kim, Y. J. Kim, J. W. Chung, D. W. Sohn, Y. B. Park & Y. S. Choi. (2004). Impact of left ventricular diastolic function on exercise capacity in patients with chronic mitral regurgitation: an exercise echocardiography study. Clinical Cardiology, 27(11), 624-628. DOI : 10.1002/clc.4960271109
  12. S. F. Nagueh et al. (2009). Recommendations for the evaluation of left ventricular diastolic function by echocardiography. European Journal of Echocardiography, 10(2), 165-193. DOI : 10.1093/ejechocard/jep007
  13. A. F. Leite-Moreira. (2006). Current perspectives in diastolic dysfunction and diastolic heart failure. Heart, 92(5), 712-718. DOI : 10.1136/hrt.2005.062950
  14. R. Fontes-Carvalho et al. (2015). Left ventricular diastolic dysfunction and E/E' ratio as the strongest echocardiographic predictors of reduced exercise capacity after acute myocardial infarction. Clinical Cardiology, 38(4), 222-229. DOI : 10.1002/clc.22378
  15. M. Canepa et al. (2013). Comparison of clinical presentation, left ventricular morphology, hemodynamics, and exercise tolerance in obese versus nonobese patients with hypertrophic cardiomyopathy. American Journal of Cardiology, 112(8), 1182-1189. DOI : 10.1016/j.amjcard.2013.05.070
  16. K. A. Shin, H. Y. Kim & N. J. Kim. (2013). Association between exercise capacity and cardiovascular risk factors among obesity types in adult man. The Korean Journal of Clinical Laboratory Science, 45(3), 96-101.
  17. American College of Sports Medicine. (2009). ACSM's Guidelines for exercise testing and prescription. 8th ed. Philadelphia, PA : Lippincott Williams & Wilkins.
  18. P. N. Casale et al. (1986). Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men. Annals of Internal Medicine, 105(25), 173-178. DOI : 10.7326/0003-4819-105-2-173
  19. M. M. Redfield, S. J. Jacobsen, J. C. Burnett, D. W. Mahoney, K. R. Bailey & R. J. Rodeheffer. (2003). Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. The Journal of the American Medical Association, 289(2), 194-202. DOI : 10.1001/jama.289.2.194
  20. S. Y. Kim et al. (2006). Differences of the exercise capacity according to left ventricular geometrical changes and its associated factors in hypertensive patients with isolated diastolic dysfunction. Journal of Cardiovascular Ultrasound, 14(2), 53-59. DOI : 10.4250/jcu.2006.14.2.53
  21. C. Dugo, M. Rigolli, A. Rossi & G. A. Whalley. (2016). Assessment and impact of diastolic function by echocardiography in elderly patients. The American Journal of Geriatric Cardiology, 13(3), 252-260. DOI : 10.11909/j.issn.1671-5411.2016.03.008
  22. J. Kim et al. (2016). Obesity and hypertension in association with diastolic dysfunction could reduce exercise capacity. Korean Circulation Journal, 46(3), 394-401. DOI : 10.4070/kcj.2016.46.3.394
  23. L. Rodriguez, M. Garcia, M. Ares, B. P. Griffin, S. Nakatani & J. D. Thomas. (1996). Assessment of mitral annular dynamics during diastole by Doppler tissue imaging: comparison with mitral Doppler inflow in subjects without heart disease and in patients with left ventricular hypertrophy. American Heart Journal, 131(5), 982-987. DOI : 10.1016/s0002-8703(96)90183-0
  24. Y. J. Cho & G. H. Lee. (2016). Relation between body mass index, waist circumference, and echocardiographic index of left ventricular diastolic function. The Korean Journal of Obesity, 25(2), 84-91. DOI : 10.7570/kjo.2016.25.2.84
  25. H. Dokainish et al. (2004). Optimal noninvasive assessment of left ventricular filling pressures: a comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters. Circulation, 109(20), 2432-2439. DOI : 10.1016/j.accreview.2004.08.100
  26. A. S. Sharp et al. (2010). Tissue Doppler E/E' ratio is a powerful predictor of primary cardiac events in a hypertensive population: an ASCOT substudy. European Heart Journal, 31(6), 747-752. DOI : 10.1093/eurheartj/ehp498
  27. S. R. Ommen et al. (2000). Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation, 102(15), 1788-1794. DOI : 10.1161/01.cir.102.15.1788
  28. E. Y. Cho et al. (2018). Impacts of diastolic function on clinical outcomes in young patients with acute myocardial infarction. Korean Journal of Internal Medicine, 93(6), 538-547. DOI:
  29. L. R. Peterson et al. (2004). Alterations in left ventricular structure and function in young healthy obese women: assessment by echocardiography and tissue Doppler imaging. Journal of the American College of Cardiology, 43(8), 1399-1404. DOI : 10.1016/j.jacc.2003.10.062
  30. C. Y. Wong, T. O'Moore-Sullivan, R. Leano, N. Byrne, E. Beller & T. H. Marwick. (2004). Alterations of left ventricular myocardial characteristics associated with obesity. Circulation, 110(19), 3081-3087. DOI : 10.1161/01.cir.0000147184.13872.0f
  31. J. Grewal, R. B. McCully, G. C. Kane, C. Lam & P. A. Pellikka. (2009). Left ventricular function and exercise capacity. The Journal of the American Medical Association, 301(3), 286-294. DOI : 10.1001/jama.2008.1022
  32. P. Podolec, P. Rubis, L. Tomkiewicz-Pajak, G. Kopec & W. Tracz. (2008). Usefulness of the evaluation of left ventricular diastolic function changes during stress echocardiography in predicting exercise capacity in patients with ischemic heart failure. Journal of the American Society of Echocardiography, 21(7), 834-840. DOI : 10.1016/j.echo.2007.12.008
  33. P. DasGupta, E. Ramhanmdany, G. Brigden, A. Lahiri, I. M. Baird & E. B. Raftery. (1992). Improvement in left ventricular function after rapid weight loss in obesity. European Heart Journal, 13(8), 1060-1066. DOI : 10.1093/oxfordjournals.eurheartj.a060314
  34. H. J. Willens et al. (2005). Effects of weight loss after gastric bypass on right and left ventricular function assessed by tissue Doppler imaging. American Journal of Cardiology, 95(12), 1521-1524. DOI : 10.1016/j.amjcard.2005.02.029