Ventricular Remodeling and Subclinical Dysfunction in Pediatric Obesity: Echocardiographic Links to Weight and Abdominal Fat

Obesity is linked to early cardiovascular alterations, including subclinical myocardial dysfunction in adults. However evidence in adolescents remains limited. Our aim was to identify early subclinical cardiac changes and their association with weight status in adolescents. Cross-sectional observational study evaluating cardiac structure and function in adolescents from the Obemat2.0 trial, two years after finalizing a multicomponent intervention for obesity. Participants underwent echocardiography to assess ventricular dimensions, cardiac mass, and systolic and diastolic function. Anthropometry and blood pressure were also assessed. A total of 135 adolescents (14.4 ± 1.5 years; 61% male) were evaluated. Current weight status and abdominal obesity were associated with differences in several echocardiographic parameters (including increased septal and posterior wall thickness, indexed left ventricular mass, as well as diastolic functional indices). Adolesencents with severe obesity showed alterations in tissue doppler velocities and higher E/e' ratios. In addition, those with central fat accumulation, also showed early diastolic dysfunction by alterated atrial strain. Children with normal weight had more favourable structural and functional cardiac profiles. Obesity in adolescents is associated with subclinical cardiac remodeling and dysfunction, absent in those who have recovered normal weight. Abdominal obesity may identify a subgroup with a more adverse cardiovascular phenotype, characterized by greater structural changes and early diastolic dysfunction. These findings support the need for early cardiovascular monitoring and further longitudinal studies to clarify the clinical relevance and the ponential reversibility of these alterations.