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Paediatrica Indonesiana

VOLUME 50 November ‡ NUMBER 6

Original Article

Relationship between obesity and left ventricular


hypertrophy in children
Johnny Rompis, Erling David Kaunang

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Abstract EHVLW\ZKLFKEHFRPLQJDJOREDOHSLGHPLF
Background Obesity is a chronic metabolic disorder associated is an independent risk factor for
with cardiovascular disease (CVD) increasing morbidity-mortality cardiovascular diseases such as arterial
UDWHV,WLVDSSDUHQWWKDWDYDULHW\RIDGDSWDWLRQVDOWHUDWLRQVLQ K\SHUWHQVLRQ FRQJHVWLYH KHDUW IDLOXUH
cardiac structure and function occurs as excessive adipose tissue
DFFXPXODWHV 7KLV OHDGV WR D GHFUHDVH LQ GLDVWROLF FRPSOLDQFH
DQGLVFKDHPLFKHDUWGLVHDVHDQGKDVEHHQSURSRVHG
eventually resulting in an increase in left ventricular filling as a risk factor for ventricular arrhythmias and sudden
pressure and left ventricular enlargement. death. Obesity is a chronic metabolic disorder
Objective To evaluate left ventricular hypertrophy (LVH) among associated with cardiovascular disease (CVD) and
obese using electrocardiographic (ECG) criteria. increases morbidity and mortality rates. It is apparent
Methods A cross-sectional study was conducted on 74 children WKDW D YDULHW\ RI DGDSWDWLRQVDOWHUDWLRQV LQ FDUGLDF
DJHG  \HDUV IURP )HEUXDU\  WR 2FWREHU  7KH
VXEMHFWV ZHUH GLYLGHG LQWR REHVH DQG FRQWURO JURXSV 3K\VLFDO structure and function occurs as excessive adipose
H[DPLQDWLRQ DQG VWDQGDUG  OHDG HOHFWURFDUGLRJUDSK\ (&*  WLVVXHDFFXPXODWHVHYHQLQWKHDEVHQFHRIV\VWHPLF
were done in both groups. hypertension or underlying organic heart disease.
Results 2IREHVHFKLOGUHQ/9+ZHUHIHDWXUHGLQVXEMHFWV 7R PHHW LQFUHDVHG PHWDEROLF QHHGV FLUFXODWLQJ
ZKLOHLQFRQWUROJURXSRQO\FKLOGKDG/9+ 3  :H
EORRG YROXPH SODVPD YROXPH DQG FDUGLDF RXWSXW
IRXQGWKDWPHDQ59LQREHVHDQGFRQWUROJURXSZHUH
6' DQG 6' UHVSHFWLYHO\ 3   all increase. The increase in blood volume in turn
$VDQDGGLWLRQDOILQGLQJVZHIRXQGWKDWELUWKZHLJKWZDVUHODWHG increases venous return to the right and the left
to obesity in children. YHQWULFOHV HYHQWXDOO\ SURGXFLQJ GLODWDWLRQ RI WKHVH
Conclusion There is no relation between obesity and left FDUGLDF FDYLWLHV LQFUHDVLQJ ZDOO WHQVLRQ 7KLV OHDGV
YHQWULFXODUXVLQJ(&*FULWHULDLQREHVHFKLOGUHQDJHG²\HDUV
WR OHIW YHQWULFXODU K\SHUWURSK\ /9+  ZKLFK LV
[Paediatr Indones. 2010;50:331-5].
accompanied by a decrease in diastolic chamber
FRPSOLDQFH HYHQWXDOO\ UHVXOWLQJ LQ DQ LQFUHDVH LQ
Keywords: left ventricular hypertrophy,
electrocardiography left ventricular filling pressure and left ventricular
enlargement.

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Indonesia. E-mail: albmalon@yahoo.com

Paediatr Indones, Vol. 50, No. 6, November 2010‡331


Johnny Rompis et al: Relationship between obesity and left ventricular hypertrophy

Left ventricular hypertrophy takes weeks GLVHDVHVPHWDEROLFGLVRUGHUVDQGOHIWEXQGOHEUDQFK


even months to years to develop. It has been block (LBBB). Informed consent was obtained from
proposed that a cardiac renin-angiotensin system their parents or caretakers.
and angiotensin converting enzyme activity may Physical examination was following information
be an important determinant of the hypertrophic LQFOXGLQJJHQGHUDJHDWWKHWLPHRIGLDJQRVLVZHLJKW
response. There are two predominant types of KHLJKWFDOFXODWHGERG\PDVVLQGH[ %0, DQGELUWK
K\SHUWURSK\FRQFHQWULFDQGGLODWDWLRQ,QFRQFHQWULF weight. The children were categorized obese if BMI
W\SH ZDOO WKLFNQHVV LV LQFUHDVHG UHODWLYHO\ WR ZDV WK SHUFHQWLOH DFFRUGLQJ WR WKH :+2 DQG
FDYLW\ GLPHQVLRQV VR WKH HQODUJHPHQW KDSSHQV Center for Disease Control and Prevention (CDC)
to be eccentric. While dilatation means there is 
an increase in muscle mass so that ratio between $UHVWLQJOHDG(&*ZDVREWDLQHGIURPHDFK
wall thickness and ventricular cavity size remains VXEMHFWRQDGPLVVLRQDFFRUGLQJWRVWDQGDUGSURFH-
relatively constant. /LNHSK\VLFDOHYDOXDWLRQWKH GXUHWKHQHYDOXDWHGE\DXWKRU:HXVHG&DUGLPD[
ECG is influenced by morphological changes induced );IRUHOHFWURFDUGLRJUDKLFH[DPLQDWLRQ(YHU\
E\REHVLW\VXFKDV  GLVSODFHPHQWRIWKHKHDUWE\ ECG data was examined by two observers. ECG
DQ HOHYDWHG GLDSKUDJP LQ WKH VXSLQH SRVLWLRQ   criteria for LVH used standard pediatric criteria
increased cardiac workload with associated cardiac IRU/9+DQG6RNRORZ/\RQFULWHULD 6LQ95
K\SHUWURSK\   LQFUHDVHG GLVWDQFH EHWZHHQ WKH LQ9RU9 !PP 7KHVWDQGDUGSHGLDWULF
heart and the recording electrodes induced by the criteria for LVH were based on one of the following
accumulation of adipose tissue in the subcutaneous (&*FULWHULDLQFOXGHGKLJK5ZDYHLQ9FKDQJHV
tissue of the chest wall (and possibly increased LQ7ZDYHLQ9DQG95LQ9DQG9KLJKHU
HSLFDUGLDO IDW  DQG   WKH SRWHQWLDO DVVRFLDWHG WKDQ PD[LPXP 6 LQ 9 KLJKHU WKDQ PD[LPXP
FKURQLFOXQJGLVHDVHVHFRQGDU\WRWKHVOHHSDSQHD 56UDWLRLQ9OHVVWKDQPLQLPXPGHHS4ZDYHLQ
hypoventilation syndrome. The ECG is a useful 9DQG9DQG9$7OHIWSUHFRUGLXPKLJKHUWKDQ
but imperfect tool for detecting LVH. The utility of maximum.
the ECG related to its being relatively inexpensive All analyses were performed using the
DQGZLGHO\DYDLODEOHEXWWKHVHQVLWLYLW\RUVSHFLILFLW\ VWDWLVWLFCSURJUDP  6366 YHUVLRQ  'DWD ZHUH
depending upon which of the many proposed sets of SUHVHQWHGDVPHDQ 6' 7WHVWZHUHXVHGWRDVVHVV
FULWHULDDUHDSSOLHG+RZHYHUWKH(&*PD\EHXVHG the differences between the variables in patients
in poor resource countries where echocardiography ZLWK REHVH DQG FRQWURO VXEMHFWV 'LIIHUHQFHV ZHUH
is unavailable or too expensive. considered significant at a probability value of P <
Early detection and treatment of LVH in obese 0.05.
children may prevent cardiovascular risk later in adult.
The aim of this study was to evaluate the prevalence
of obesity in left ventricular hypertrophy using ECG Results
criteria.
Data from obese and non-obese children were
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Methods data of obese children and healthy controls are
summarized in Table 1 :HLJKW ELUWK ZHLJKW DQG
This cross-sectional study was conducted at five body mass index were significantly smaller in control
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2FWREHU  (WKLFDO DSSURYDO ZDV REWDLQHG IURP 7KHUHZHUHREHVHFKLOGUHQDQGKHDOWK\
WKH0HGLFDO(WKLFV&RPPLWWHH0HGLFDO6FKRRO6DP QRUPDOZHLJKWFKLOGUHQDVFRQWURO2XWRIREHVH
5DWXODQJL 8QLYHUVLW\ :H LQFOXGHG ² \HDU ROG VXEMHFWVSDUWLFLSDWLQJLQWKHVWXG\ZHUHPDOHVDQG
children with obesity and employed healthy-normal ZHUHIHPDOHV0RVWRIWKHVXEMHFWVZHUHWR
weight children as control. We excluded children with \HDUVRIDJH  0HDQ%0,IRUDJHZHUH
FOLQLFDOVLJQVRIFDUGLDFG\VIXQFWLRQFRQJHQLWDOKHDUW 6' LQREHVHDQG 6' LQFRQWURO

332‡Paediatr Indones, Vol. 50, No. 6, November 2010


Johnny Rompis et al: Relationship between obesity and left ventricular hypertrophy

VXEMHFWV 0HDQ ERG\ ZHLJKW LQ REHVH FKLOGUHQ ZDV Discussion


 6' NJFRPSDUHGWRFRQWURO 6'
 NJ0HDQERG\ZHLJKWDWELUWKZDV 6' 2XUVWXG\IRXQGREHVLW\LVPRUHIUHTXHQWLQFKLOGUHQ
 JLQREHVHFKLOGUHQDQG 6' JLQ who were born with heavier birth weight. Mean
FRQWUROVXEMHFWV 3  ERG\ZHLJKWDWELUWKZDV 6' LQREHVH
Left ventricular hypertrophy were featured FKLOGUHQDQG 6' LQFRQWUROVXEMHFWV
ZLWK(&*LQREHVHFKLOGUHQDQGFKLOGLQFRQWURO 3 7KHVHLQGLFDWHWKDWWKHKHDYLHUWKHELUWK
VXEMHFWV 3  Table 2 %DVHGRQ6RNRORZ ZHLJKWWKHPRUHULVNWREHFRPHREHVH7KHVHUHVXOWV
/\RQFULWHULDLQREHVHFKLOGUHQWKHORZHVW69ZDV are similar with those found by Danielzik ZKR
 PP DQG WKH KLJKHVW ZDV  PP ZLWK PHDQ studied obese children aged 5–7 years (P= 0.005).
69PP,QREHVHFKLOGUHQJURXSWKHORZHVW Maternal obesity and maternal diabetes were possibly
59ZDVPPDQGWKHKLJKHVWZDVPPZLWK factors responsible in this mechanisms.
PHDQ59PPORZHVW59ZDVPPDQG 2QHVXEMHFWRIFRQWUROJURXSKDG/9+EDVHGRQ
WKH KLJKHVW ZDV  PP ZLWK PHDQ 59  (&*EXWKLVEORRGSUHVVXUHZDVDERYHDYHUDJHQRUPDO
PP7KHUHIRUHWKHORZHVW6959RU59ZDV OLPLWV+\SHUWHQVLRQLVWKHPDLQFDXVHRI/9+LWPDNHV
PPDQGWKHKLJKHVWZDVPPZLWKPHDQ myocardium contraction in left ventricular strengthen
6959RU59PPTable 3 shows that WREDODQFHWKHLQFUHDVLQJSUHVVXUH)LQDOO\LWEHFRPHV
PHDQ59IURP(&*LQREHVHFKLOGUHQZDV ventricular dilatation because of increased circulation
6' DQGPHDQ59IURP(&*LQFRQWURO resistance. The hypertrophy muscle fibers become
FKLOGUHQZDV 6'  3 3KL WKLFNHUDQGVKRUWHUVRWKH\ORVHWKHLUDELOLW\WRUHOD[
correlation failed to show significant correlation influencing cardiac output. We suggest further
EHWZHHQREHVHDQGQRQREHVHFKLOGUHQ U¡  examination on this child to make sure the cause of
DQG3   hypertrophy then perform early treatment.

Table 1. Anthropometrics data of obese children and control


Variabel Control Obesity P*
(n=37) (n=37)
Mean SD Mean SD
Birth weight (g) 2989.2 283.4 3537.8 608.3 <0.001
Height (cm) 144.86 7.285 149.70 7.371 0.006
Weight (kg) 33.97 5.331 73.46 8.815 <0.001
BMI (kg/m2) 18.19 1.660 32.07 2.135 <0.001
*T test mean in 2 pair group

Tabel 2. LVH featured in ECG ,hj


ECG Featured Group Total
Control Obese
Normal 36 34 70
LVH 1 3 4
Total 37 37 74
X2 = 1.057 db = 1 P = 0.307

Tabel 3. ECG feature using Sokolow-Lyon criteria.


Control Obese P*
(n=37) (n=37)
Mean SD Mean SD
SV1 (mm) 8.0608 3.6488 8.7230 4.1218 0.234
RV5 (mm) 13.6284 4.9633 14.9730 4.6606 0.117
RV6 (mm) 9.8446 3.5854 11.9662 3.2857 0.005
SV1 + RV5 or RV6 (mm) 21.7432 7.4142 23.9865 6.4410 0.085
*T test mean in 2 pair group

Paediatr Indones, Vol. 50, No. 6, November 2010‡333


Johnny Rompis et al: Relationship between obesity and left ventricular hypertrophy

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chronic. T test showed significant different in RV6  /HY\'*DUULVRQ5-6DYDJH''.DQQHO:%&DVWHOOL:3
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further investigation. Increasing LVH is associated -0HG²
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criteria for ECG reading that has better sensitivity and 
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cannot be done as a comparison to ECG because 
the tools is not available in this study. Despite  7KDOHU 06 6DWXVDWXQ\D EXNX (.* \DQJ DQGD SHUOXNDQ
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echocardiography is unavailable or too expensive. Cunha CLP. An analysis of electrocardiographic criteria for
,Q FRQFOXVLRQ WKHUH LV QR UHODWLRQ EHWZHHQ REHVLW\ GHWHUPLQLQJOHIWYHQWULFXODUK\SHUWURSK\$UT%UDV&DUGLRO
and left ventricular hypertrophy in obese children 
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obesity in children. 7XPEXKNHPEDQJDQDNVWHG-DNDUWD(*&S

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334‡Paediatr Indones, Vol. 50, No. 6, November 2010


Johnny Rompis et al: Relationship between obesity and left ventricular hypertrophy

 ecocardiográfica no diagnóstico da hipertrofia ventricular


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affecting left ventricular mass in childhood: the muscatine  %URZQ':*LOHV:+&URIW-%/HIWYHQWULFXODUK\SHUWURSK\
VWXG\3HGLDWULFV as a predictor of coronary heart disease mortality and the
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Paediatr Indones, Vol. 50, No. 6, November 2010‡335

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