الفهرس 
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Abstract
SUMMARY
Obesity is a chronic medical problem, with dramatically rising trends in
its prevalence worldwide, to an extent that it is now recognized as a
global epidemic.
It is associated with multiple metabolic disturbances leading to increased
morbidity and mortality for cardiovascular diseases.
Diabetes mellitus, hypertension and hyperlipidemia are among the major
causes of obesity-related cardiac disease.
Conventional noninvasive imaging modalities are often suboptimal for
detailed evaluation of cardiac structures and for detection of subtle
functional changes associated with obesity.
Newer echocardiographic techniques such as tissue Doppler imaging
(TDI) and TDI-derived techniques; strain imaging/strain rate imaging
(SRI), could better characterize these possible cardiac abnormalities
associated with obesity.
In particular, SRI is relatively load independent, and this characteristic is
very relevant in the obese population, in which a cardiac volume overload
exists.
The study was conducted on 45 selected obese patients with obesity
defined as BMI ≥ 30, presented to Obesity outpatient clinic in Menoufia
University Hospital from September 2012 to February 2013 and 20 age
and sex comparable healthy control group with BMI < 30.
Patients were enrolled in the study after their informed consent, and
approval of ethics committee of Menoufia University Hospitals was
obtained.
Subjects with congestive heart failure, history of coronary artery disease,
cardiomyopathies (hypertrophic, dilated & restrictive), pericardial
diseases, hypertension, diabetes mellitus, chest disease (COPD, IPF),
thyroid disease, renal diseases, hepatic diseases, pregnancy in females,
significant valvular lesion and poor image quality on echocardiography
were excluded from the study.
All patients were subjected to:
1. Full history taking.
2. Thorough physical examination.
3. 12-lead resting electrocardiogram.
4. Each subject’s height was determined while subject standing
without shoes and weight was determined by using a mechanical
scale.
5. The body mass index (BMI) was calculated as weight in
kilograms divided by the square of height in meters.
6. The waist circumference was measured at the part of the trunk
located midway between the lower costal margin, and the iliac
crest at the end of expiration while the person is standing with
feet about 25–30 cm apart.
7. Standard transthoracic echocardiogram (TTE).
8. Left ventricular longitudinal strain and strain rate imaging.
Data collected from the study population were statistically studied
showing that obese subjects had significantly increased left atrial
diameter, aortic diameter, septal wall thickness, left ventricular posterior
wall thickness and LV mass.
On the contrary, there was no significant difference between obese
patients and control subjects regarding left ventricular diameter in
diastole and systole, ejection fraction, fractional shortening, left
ventricular mass index and mitral inflow velocity indices (E, A and E/A
ratio).
Analysis of Left ventricular two dimensional longitudinal strain and
strain rate parameters of different LV walls shows significant decrease in
global LV longitudinal strain in almost all walls of the LV in obese
patients with more significant decrease in class III obesity.
The early diastolic wave (E) measured by strain rate was significantly
lower in almost all walls of LV in obese patients with more significant
decrease in class III obesity, conversely the peak systolic wave (S)
measured by strain rate was decreased only in the lateral wall of the LV
of obese patients. The late diastolic wave (A) measured by strain rate
wasn’t affected in any class of obesity and its values was similar in obese
and control subjects.