Baseline cardiovascular characteristics and longitudinal changes following weight
loss surgery (WLS) in adolescents are not well defined. Recent data suggest that the
use of transthoracic echocardiography (TTE) for preoperative cardiac assessment may
provide suboptimal imaging fidelity secondary to excessive upper body adiposity. High
fidelity imaging using cardiac magnetic resonance (CMR) is an extremely useful diagnostic
tool. We report the use of CMR in a cohort of extremely obese adolescents undergoing
A retrospective analysis of adolescent WLS patients at a single institution was conducted.
Data collection included mean age, sex, body mass index (BMI), and CMR measurements
of left ventricular (LV) mass, LV end-diastolic volume (LVEDV), ejection fraction
(EF), and myocardial perfusion reserve index (MPRI). Comparison of CMR results to
normative data derived from lean subjects was performed.
Ten subjects (9 female), with a mean age and BMI of 17.4±1.9 years and 50.33±10.21 kg/m2 respectively, were studied. When compared to age, gender, and height matched normal
weight (NW) controls, the obese (OB) subjects had evidence of increased LV mass (122±25 g vs. 101±10 g, OB vs. NW respectively, p<0.05), and increased LVEDV (156±25 mL vs. 109±9 mL, p<0.05), with an average EF of 61.5%±5% (range 52% to 67% vs. 71% to 74% expected EF for males and females, respectively,
p=0.003). In addition, 60% of the OB subjects (6/10) demonstrated adenosine-induced
sub-endocardial ischemia at baseline, the majority of whom underwent WLS (n=5) resulting in complete normalization of ischemia in 60% (3/5) and partial improvement
in 40% (2/5). A reduction in mean LV mass (range 2 to 12 g) following WLS was observed.
Extreme adolescent obesity is associated with significant cardiovascular abnormalities
that include LV hypertrophy (i.e. increased LV mass) and LV dilatation. These findings,
considered to be well-recognized cardiovascular disease risk factors in adults, were
shown to be reversible after WLS in the small group of subjects studied here. Additional
large-scale investigations designed to examine obesity-related cardiovascular disease
in severely obese adolescents are required.