International journal of hypertension
From Adiposity to Diastolic Dysfunction: The Integrated Role of Epicardial Fat, Autonomic Dysregulation, and Morning Blood Pressure Surge in Obesity
By Cosgun A and Oren H.
Abstract
Objective
Although the association between obesity and left ventricular diastolic dysfunction (LVDD) is well established, the concurrent associations of epicardial adipose tissue (EAT), sleep-trough (prewaking) morning blood pressure surge (MBPS), and autonomic imbalance with LVDD have not been fully elucidated. This study aimed to evaluate the associations of EAT thickness, MBPS, and heart rate variability (HRV) parameters with LVDD in obese adults and to assess the cross-sectional discriminatory performance of these multimodal markers.
Methods
This cross-sectional study included 240 individuals, comprising 120 obese participants (body mass index ≥ 30 kg/m2) and 120 age- and sex-matched normal-weight controls (body mass index 18.5-24.9 kg/m2). All participants underwent transthoracic echocardiography, 24-h ambulatory blood pressure monitoring, and 24-h Holter electrocardiographic analysis, with HRV data available for the entire cohort (n = 240). EAT thickness was measured echocardiographically, and LVDD was classified using contemporary guideline-based echocardiographic criteria. SDNN was predefined as the primary autonomic marker, while RMSSD and the LF/HF ratio were reported as supportive indices. Associations with LVDD (≥ Grade I) were evaluated using correlation analysis, multivariable logistic regression, and receiver operating characteristic analyses. Cross-sectional discrimination analysis and performance assessment were performed within the obese subgroup (n = 120).