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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Right heart hemodynamic and endomyocardial biopsy abnormalities associated with marked obesity were characterized in 43 obese patients who presented with symptoms of congestive heart failure. Marked obesity was defined as a body mass index greater than or equal to 35 kg/m2. They were compared to a group of 409 patients with similar presentations but normal body mass. Analysis of the 519 patients showed that body mass index was positively correlated with right heart pressures and cardiac output (p less than or equal to 0.0001), pulmonary vascular resistance index (p less than or equal to 0.003) and systolic blood pressure (p less than or equal to 0.0006). Obese patients had elevated right heart pressures, cardiac output (p less than or equal to 0.0001) and pulmonary vascular resistance index (p less than or equal to 0.02) when compared with a group of lean patients with a similar degree of cardiomyopathy. After evaluation, a significantly higher percentage of obese patients were found to have idiopathic dilated cardiomyopathy compared with lean patients. A specific etiology was found in 264 (64.5%) of the 409 lean patients compared with 10 (23.3%) of the obese patients (p less than or equal to 0.0001). The most common finding on endomyocardial biopsy in the obese group was mild myocyte hypertrophy (67%). These data suggest that the cardiomyopathy of obesity exists and may play an important role in a population referred for the evaluation of heart failure.
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PMID:Cardiomyopathy of obesity: a clinicopathologic evaluation of 43 obese patients with heart failure. 152 47

We conducted an epidemiologic study to examine the extent to which differences in purported risk factors account for black-white differences in risk of idiopathic dilated cardiomyopathy. We examined associations with race and other factors by comparing newly diagnosed cases (N = 122), ascertained from five Washington DC area hospitals, with neighborhood controls (N = 234) identified using a random digit dialing technique. We matched the cases and controls on sex and 5-year age intervals and analyzed the data using conditional logistic regression methods. We found that blacks were at increased risk for idiopathic dilated cardiomyopathy (relative odds = 2.6, 95% confidence interval = 1.6-4.3). The increased risk for blacks could not be explained by income, educational attainment, alcohol consumption, cigarette smoking, or history of hypertension, obesity, diabetes, or asthma. We also observed a possible interactive effect between black race and hypertension.
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PMID:Black-white differences in idiopathic dilated cardiomyopathy: the Washington DC dilated Cardiomyopathy Study. 803 60

To learn more about the dilated form of cardiomyopathy associated with obesity, we conducted a pooled analysis of data from two case-control studies of idiopathic dilated cardiomyopathy. Up to two controls of the same sex and approximate age (+/- 5 years) had been selected for each case using random digit dialing. The subjects had been interviewed by telephone. We compared the cases (N = 224) and controls (N = 353) using conditional logistic regression. We defined severe obesity using national criteria for severely elevated body mass index. We found little association with severe obesity in multivariate analysis (relative odds = 1.1; 95% confidence interval = 0.7-1.9).
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PMID:Obesity and idiopathic dilated cardiomyopathy. 889 90

AIM OF THE STUDY: Heart failure is the final clinical presentation of a variety of cardiovascular diseases, such as coronary artery disease, hypertensive, toxic, and inflammatory heart disease. However, the cellular mechanisms responsible for the progressive deterioration of myocardial function observed in heart failure remain unclear and may result from cell death (programmed or not) and from an increase in number of nuclei and in the degree of their ploidy. METHODS: We examined thirty-eight explanted hearts obtained during transplantation for DNA content in the myocytic population. All thirty-eight patients had severe chronic heart failure: 23 had idiopathic dilated cardiomyopathy, and 15 had ischemic cardiomyopathy. Ten hearts of people whose death was not due to primary heart disease or as a consequence of major risk factors of coronary artery disease, including hypertension, diabetes, obesity, or severe atherosclerosis, were used as controls. DNA content in the myocytic population was evaluated using Image Cytometry. RESULTS: The DNA content per nucleus and per myocyte in cardiomyopathic hearts are characterized by: a) a decrease of the diploid DNA content of myocytic nuclei; b) an increase of DNA ploidies higher than 4c; c) a decrease in mononucleated myocytes; d) an increase in binucleated and multinucleated myocytes. The changes are more prominent in dilated cardiomyopathy. e) The total ploidy index, used to calculate the total DNA content, is related to heart weight and ventricular weight. CONCLUSIONS: Ischemic and dilated cardiomyopathies result in reduction of ventricular mass-to-chamber volume ratio and in discrete foci of myocyte cell death, leading to an elevation in systolic and diastolic stress on the remaining viable cells. Therefore mechanical stimuli generated by global and local loading abnormalities associated with end-stage failure may contribute to activate genes implicated in cell proliferation. Observations in this investigation are consistent with recent results documenting that in the presence of overload conditions the myocytes may retain their capacity to proliferate throughout life and this growth reserve mechanism may become operative in response to severe myocardial dysfuntion and overt failure. Polyploidization and multinucleation are prominent phenomena in the end-stage of ischemic and dilated cardiomyopathy in humans.
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PMID:DNA Content in End-Stage Heart Failure. 1035 69

Obesity is associated with an increased risk of development of chronic heart failure, but recent epidemiological studies indicate that a higher body mass index (BMI) is associated with a better survival rate. This is described as the 'obesity paradox' or 'reverse epidemiology'. A 42-year-old male was admitted because of recurrent episodes of decompensated heart failure, and the diagnosis was idiopathic dilated cardiomyopathy complicated with severe obesity (BMI 46.0), nonsustained ventricular tachycardia, and central type sleep apnea syndrome. Combined therapy with weight loss (BMI 46.0 to 30.8) and amiodarone (200 mg/day) was instituted in addition to the previous regimen including angiotensin converting enzyme inhibitor, beta blocker, diuretics and pimobendan, improved cardiac function, exercise tolerance, and cardiac sympathetic nerve activity evaluated by cardiac 123I-metaiodobenzylguanidine scintigraphy. Furthermore, we succeeded in uptitration of carvedilol(5 to 10mg/day). This case highlights the possible beneficial effect of weight loss in patients with chronic heart failure complicated with obesity, and the resultant improvement of cardiac sympathetic nerve activity suggests that weight loss may partially mimic beta blocker effects in patients with systolic heart failure.
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PMID:[Combined therapy with weight loss and amiodarone improved cardiac function in a patient with idiopathic dilated cardiomyopathy complicated with severe obesity: a case report]. 1780 98

Bariatric surgery may be an effective treatment for obese heart failure patients, enabling access to cardiac transplantation and/or improvement of symptoms. We report the outcomes of two morbidly obese patients with end-stage heart failure, where obesity precluded cardiac transplantation and underwent laparoscopic gastric banding. A 42 year-old male with idiopathic dilated cardiomyopathy weighing 124.4 kg (BMI 42 kg/m(2)) lost 34 kg and was successfully transplanted 11 months later. A 40 year-old woman with familial dilated cardiomyopathy weighing 105 kg (BMI 40 kg/m(2)) lost 14 kg with sufficient symptomatic resolution to no longer require cardiac transplantation. In selected patients with severe heart failure and concomitant morbid obesity, bariatric surgery may be a reasonable treatment option.
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PMID:Take heart: bariatric surgery in obese patients with severe heart failure. Two case reports. 2274 91

Heart failure (HF) data in Latin America (LA) were reviewed to guide health service planning in the prevention and treatment of HF. The HF epidemiology and the adequacy of relevant health service provision related to HF in LA are not well delineated. A systematic search of the electronic databases and the World Health Organization website was undertaken for HF in LA. LA countries have reduced gross income and lower total expenditure on health per capita. LA is a heterogeneous region with HF risk factors of developed and nondeveloped countries, including lower risk of raised blood glucose levels, obesity, tobacco, and aging, whereas systemic hypertension (SH), rheumatic fever, and Chagas' disease (C'D) are higher in LA. Main etiologies of HF in LA are idiopathic dilated cardiomyopathy (from 1.3% to 37%), C'D (from 1.3% to 21%), ischemic (from 68% to 17%), SH (from 14% to 76%), valvular (from 3% to 22%), and alcohol related (from 1.1% to 8%). The prognosis of C'D HF is worse than for other etiologies. Chronic HF is the cause of death in 6.3% of cases. Decompensated HF is the main cause of cardiovascular hospitalization. The prevalence of systolic HF varies from 64% to 69%. LA is under the awful paradox of having the HF risk factors and HF epidemiology of developed countries with the added factors of SH, C'D, and rheumatic fever. Overall, in the scenario of lower total expenditure on health per capita and lower gross national income per capita, new strategies are essential for prevention and treatment of HF in LA.
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PMID:The reality of heart failure in Latin America. 2385 Sep 10