Effect of Weight Loss on Cardiac Synchronization and Proinflammatory Cytokines in Premenopausal Obese Women

  1. Raffaele Marfella, MD, PHD12,
  2. Katherine Esposito, MD12,
  3. Mario Siniscalchi, MD, PHD1,
  4. Federico Cacciapuoti, MD1,
  5. Francesco Giugliano1,
  6. Domenico Labriola, MD3,
  7. Myriam Ciotola1,
  8. Carmen Di Palo1,
  9. Lucio Misso, MD1 and
  10. Dario Giugliano, MD, PHD12
  1. 1Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy
  2. 2Cardiovascular Research Center, Second University of Naples, Naples, Italy
  3. 3Department of Gynecology, Obstetrics and Neonatology, Second University of Naples, Naples, Italy
  1. Address correspondence and reprint requests to Raffaele Marfella, MD, Via Emilio Scaglione, 141 I-80145 Naples, Italy. E-mail: raffaele.marfella{at}unina2.it


OBJECTIVE—Obesity is an important risk factor for heart failure in both women and men. Dyssynchrony between right and left ventricular contraction and relaxation has been identified as an independent predictor of heart failure. We examined the relationship of ventricular synchronization abnormalities with the concentration of proinflammatory cytokines in obese women at baseline and after sustained weight loss.

RESEARCH DESIGN AND METHODS—Echocardiographic parameters of ventricular dyssynchrony, circulating levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-18, and C-reactive protein (CRP) were investigated in 67 healthy, premenopausal obese women and 40 age-matched normal-weight women.

RESULTS—Compared with nonobese women, obese women had increased concentrations of CRP (P < 0.01), TNF-α (P < 0.01), IL-6 (P < 0.01), and IL-18 (P < 0.01). Moreover, obese women had a higher myocardial performance index (P < 0.02) and lower transmitral Doppler flow (P < 0.05), pulmonary venous flow analysis (P < 0.02), and ejection fraction (P < 0.05), indicating ventricular dyssynchrony. Concentrations of CRP, TNF-α, and IL-6 were related to anthropometric indexes of obesity and to echocardiographic parameters of ventricular dyssynchrony. After 1 year of a multidisciplinary program of weight reduction, obese women lost at least 10% of their original weight. This was associated with reduction of cytokine (P < 0.01) and CRP (P < 0.02) concentrations and with improvement of echocardiographic parameters of ventricular dyssynchrony, which correlated with changes in adiposity, particularly visceral adiposity.

CONCLUSIONS—In obese women, ventricular dyssynchrony correlates with body fat, possibly through inappropriate secretion of cytokines. Weight loss represents a safe method for downregulating the inflammatory state and ameliorating cardiac function in obese women.


  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted October 10, 2003.
    • Received July 14, 2003.
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