Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Original Article

Volume 10, Number 3, June 2019, pages 165-171

Patients With Obesity Exhibit a Plateau Pattern of the Right Ventricular Waveform

Figure 1. Measurement of the EAT using echocardiography. EAT was detected as an echo-free space between the outer wall of the right ventricle and visceral layer of the pericardium during the end-diastolic cardiac cycle (double arrow). Ao: aorta; EAT: epicardial adipose tissue; LA: left atrium; LV: left ventricle; RV: right ventricle.

Figure 3. (a) The EAT values in the patients who exhibited a plateau pattern (w/plateau) are significantly higher than those in the patients who did not (w/o plateau). (b) The mean BMI values are higher in the patients with a plateau than in those without it. (c) Scatter plots between the EAT and BMI. BMI: body mass index; EAT: epicardial adipose tissue.

Figure 4. (a) The TG levels in the patients who exhibited a plateau pattern (w/plateau) are significantly higher than in those who did not (w/o plateau). (b) The LDL-C levels in the patients with a plateau are significantly higher than those in the patients without a plateau. (c) Scatter plots between the TG level and EAT. (d) Scatter plots between the TG level and BMI. BMI: body mass index; EAT: epicardial adipose tissue; LDL-C: low-density lipoprotein cholesterol; TG: triglyceride.

Figure 5. (a) The left atrial diameter is significantly larger in the patients with a plateau pattern (w/plateau) than in those without it (w/o plateau). (b) The left atrial volume index is significantly higher in the patients with a plateau pattern than in those without it.

**Table 1.** Comparison of the Clinical and Laboratory Characteristics of Patients Without and With a Plateau Pattern
	Without a plateau (n = 49)	With a plateau (n = 11)	P value
Data are expressed as the mean ± SD or n (%). BMI: body mass index; BP: blood pressure; EAT: epicardial adipose tissue; HbA1c: glycated hemoglobin; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; PPG: postprandial plasma glucose; TC: total cholesterol; TG: triglyceride.
Age (years)	69.3 ± 13.4	69.9 ± 16.8	0.90
Male	28 (57%)	5 (45%)	0.52
Weight (kg)	55.5 ± 12.2	69.0 ± 14.2	< 0.01
Height (m)	1.58 ± 0.09	1.59 ± 0.08	0.89
BMI (kg/m²)	21.8 ± 3.6	27.2 ± 5.7	< 0.001
EAT (mm)	2.19 ± 1.97	4.26 ± 3.13	< 0.01
Systolic BP (mm Hg)	129.2 ± 23.5	133.2 ± 23.0	0.61
Diastolic BP (mm Hg)	67.7 ± 13.6	76.7 ± 16.0	0.06
Heart rate (beats/min)	70.8 ± 14.3	73.6 ± 15.1	0.56
TC (mg/dL)	170.3 ± 42.2	196.2 ± 47.9	0.08
HDL-C (mg/dL)	57.7 ± 18.5	51.1 ± 27.3	0.34
LDL-C (mg/dL)	95.8 ± 34.1	121.8 ± 35.6	< 0.05
TG (mg/dL)	100.2 ± 67.9	150.4 ± 82.6	< 0.05
HbA1c (%)	6.4 ± 1.59	6.2 ± 0.77	0.75
PPG (mg/dL)	126 ± 62.8	120 ± 27.9	0.79

Table 1. Comparison of the Clinical and Laboratory Characteristics of Patients Without and With a Plateau Pattern

Without a plateau (n = 49)

With a plateau (n = 11)

P value

Data are expressed as the mean ± SD or n (%). BMI: body mass index; BP: blood pressure; EAT: epicardial adipose tissue; HbA1c: glycated hemoglobin; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; PPG: postprandial plasma glucose; TC: total cholesterol; TG: triglyceride.

Age (years)

69.3 ± 13.4

69.9 ± 16.8

0.90

Male

28 (57%)

5 (45%)

0.52

Weight (kg)

55.5 ± 12.2

69.0 ± 14.2

< 0.01

Height (m)

1.58 ± 0.09

1.59 ± 0.08

0.89

BMI (kg/m²)

21.8 ± 3.6

27.2 ± 5.7

< 0.001

EAT (mm)

2.19 ± 1.97

4.26 ± 3.13

< 0.01

Systolic BP (mm Hg)

129.2 ± 23.5

133.2 ± 23.0

0.61

Diastolic BP (mm Hg)

67.7 ± 13.6

76.7 ± 16.0

0.06

Heart rate (beats/min)

70.8 ± 14.3

73.6 ± 15.1

0.56

TC (mg/dL)

170.3 ± 42.2

196.2 ± 47.9

0.08

HDL-C (mg/dL)

57.7 ± 18.5

51.1 ± 27.3

0.34

LDL-C (mg/dL)

95.8 ± 34.1

121.8 ± 35.6

< 0.05

TG (mg/dL)

100.2 ± 67.9

150.4 ± 82.6

< 0.05

HbA1c (%)

6.4 ± 1.59

6.2 ± 0.77

0.75

PPG (mg/dL)

126 ± 62.8

120 ± 27.9

0.79

**Table 2.** Comparison of the Right Cardiac Catheterization Characteristics of Patients Without and With a Plateau Pattern
	Without a plateau (n = 49)	With a plateau (n = 11)	P value
Data are expressed as the mean ± SD. PA: pulmonary artery; PCWP: pulmonary capillary wedge pressure; RA: right atrium; RV: right ventricle.
Cardiac output (L/min)	4.93 ± 1.37	5.18 ± 1.73	0.61
Cardiac index (L/min/m²)	3.21 ± 0.94	2.97 ± 0.82	0.46
Main PA systolic pressure (mm Hg)	33.5 ± 12.8	35.7 ± 10.1	0.63
Main PA diastolic pressure (mm Hg)	15.9 ± 7.19	16.3 ± 6.5	0.88
Main PA mean pressure (mm Hg)	23.0 ± 9.51	23.8 ± 9.11	0.81
Right PA systolic pressure (mm Hg)	33.3 ± 12.4	35.7 ± 10.0	0.56
Right PA diastolic pressure (mm Hg)	16.4 ± 7.11	15.7 ± 6.88	0.75
Right PA mean pressure (mm Hg)	22.9 ± 9.39	23.7 ± 9.18	0.79
Mean PCWP (mm Hg)	14.4 ± 7.61	14.3 ± 6.63	0.96
RV systolic pressure (mm Hg)	33.0 ± 11.7	33.2 ± 10.9	0.94
RV diastolic pressure (mm Hg)	5.67 ± 4.39	4.54 ± 2.20	0.41
RV end-diastolic pressure (mm Hg)	9.00 ± 4.07	9.18 ± 3.68	0.89
Mean RA (mm Hg)	6.59 ± 3.85	6.81 ± 3.06	0.85

Table 2. Comparison of the Right Cardiac Catheterization Characteristics of Patients Without and With a Plateau Pattern

Without a plateau (n = 49)

With a plateau (n = 11)

P value

Data are expressed as the mean ± SD. PA: pulmonary artery; PCWP: pulmonary capillary wedge pressure; RA: right atrium; RV: right ventricle.

Cardiac output (L/min)

4.93 ± 1.37

5.18 ± 1.73

0.61

Cardiac index (L/min/m²)

3.21 ± 0.94

2.97 ± 0.82

0.46

Main PA systolic pressure (mm Hg)

33.5 ± 12.8

35.7 ± 10.1

0.63

Main PA diastolic pressure (mm Hg)

15.9 ± 7.19

16.3 ± 6.5

0.88

Main PA mean pressure (mm Hg)

23.0 ± 9.51

23.8 ± 9.11

0.81

Right PA systolic pressure (mm Hg)

33.3 ± 12.4

35.7 ± 10.0

0.56

Right PA diastolic pressure (mm Hg)

16.4 ± 7.11

15.7 ± 6.88

0.75

Right PA mean pressure (mm Hg)

22.9 ± 9.39

23.7 ± 9.18

0.79

Mean PCWP (mm Hg)

14.4 ± 7.61

14.3 ± 6.63

0.96

RV systolic pressure (mm Hg)

33.0 ± 11.7

33.2 ± 10.9

0.94

RV diastolic pressure (mm Hg)

5.67 ± 4.39

4.54 ± 2.20

0.41

RV end-diastolic pressure (mm Hg)

9.00 ± 4.07

9.18 ± 3.68

0.89

Mean RA (mm Hg)

6.59 ± 3.85

6.81 ± 3.06

0.85

**Table 3.** Comparison of the Echocardiographic Characteristics of Patients Without and With a Plateau Pattern
	Without a plateau (n = 49)	With a plateau (n = 11)	P value
Data are expressed as the mean ± SD. DT: mitral deceleration time; e’: mitral annulus early peak velocity; EF: ejection fraction; IVC ex: inferior vena cava expiration; IVC in: inferior vena cava inspiration; IVCCI: IVC collapsibility index; IVSd: interventricular septum diameter; LAD: left atrial diameter; LAVI: left atrial volume index; LVDd: left ventricular end-diastolic diameter; LVDs: left ventricular end-systolic diameter; LVMI: left ventricular mass index; PWd: posterior wall diameter; RWT: relative wall thickness.
LVDd (mm)	51.2 ± 9.87	48.5 ± 8.53	0.40
LVDs (mm)	37.8 ± 12.2	35.0 ± 10.6	0.48
IVSd (mm)	10.9 ± 2.16	11.4 ± 1.17	0.42
PWd (mm)	10.4 ± 1.92	11.1 ± 0.50	0.27
EF (%)	49.4 ± 20.5	50.1 ± 19.5	0.91
LVMI (g/m²)	141.4 ± 70.6	115.7 ± 32.9	0.26
RWT	0.435 ± 0.096	0.476 ± 0.069	0.21
E/A ratio	1.28 ± 0.69	1.60 ± 0.92	0.40
DT (ms)	187.5 ± 60.4	173.0 ± 48.0	0.52
e’ (cm/s)	5.66 ± 2.16	7.15 ± 1.81	0.11
E/e’ (ratio)	16.3 ± 7.95	16.5 ± 6.14	0.95
LAD (mm)	44.7 ± 8.69	52.8 ± 4.30	< 0.01
LAVI (mL/m²)	47.6 ± 14.9	58.7 ± 12.1	< 0.05
IVC ex (mm)	15.8 ± 4.68	17.8 ± 6.75	0.25
IVC in (mm)	6.87 ± 4.99	10.0 ± 8.49	0.09
IVCCI	58.9 ± 20.1	50.2 ± 24.9	0.25

Table 3. Comparison of the Echocardiographic Characteristics of Patients Without and With a Plateau Pattern

Without a plateau (n = 49)

With a plateau (n = 11)

P value

Data are expressed as the mean ± SD. DT: mitral deceleration time; e’: mitral annulus early peak velocity; EF: ejection fraction; IVC ex: inferior vena cava expiration; IVC in: inferior vena cava inspiration; IVCCI: IVC collapsibility index; IVSd: interventricular septum diameter; LAD: left atrial diameter; LAVI: left atrial volume index; LVDd: left ventricular end-diastolic diameter; LVDs: left ventricular end-systolic diameter; LVMI: left ventricular mass index; PWd: posterior wall diameter; RWT: relative wall thickness.

LVDd (mm)

51.2 ± 9.87

48.5 ± 8.53

0.40

LVDs (mm)

37.8 ± 12.2

35.0 ± 10.6

0.48

IVSd (mm)

10.9 ± 2.16

11.4 ± 1.17

0.42

PWd (mm)

10.4 ± 1.92

11.1 ± 0.50

0.27

EF (%)

49.4 ± 20.5

50.1 ± 19.5

0.91

LVMI (g/m²)

141.4 ± 70.6

115.7 ± 32.9

0.26

RWT

0.435 ± 0.096

0.476 ± 0.069

0.21

E/A ratio

1.28 ± 0.69

1.60 ± 0.92

0.40

DT (ms)

187.5 ± 60.4

173.0 ± 48.0

0.52

e’ (cm/s)

5.66 ± 2.16

7.15 ± 1.81

0.11

E/e’ (ratio)

16.3 ± 7.95

16.5 ± 6.14

0.95

LAD (mm)

44.7 ± 8.69

52.8 ± 4.30

< 0.01

LAVI (mL/m²)

47.6 ± 14.9

58.7 ± 12.1

< 0.05

IVC ex (mm)

15.8 ± 4.68

17.8 ± 6.75

0.25

IVC in (mm)

6.87 ± 4.99

10.0 ± 8.49

0.09

IVCCI

58.9 ± 20.1

50.2 ± 24.9

0.25