Role of Obesity in Cardiomyopathy and Pulmonary Hypertension

Clinics in Chest Medicine

Volumn 30, Issue 3, 2009, Pages 509-523

  Dela Cruz, Charles S ^a   Matthay, Richard A ^a  

^a YALE UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

Cardiomyopathy; Congestive heart failure; Obesity; Pulmonary hypertension; Right heart dysfunction

Indexed keywords

2,4 THIAZOLIDINEDIONE DERIVATIVE; ALDOSTERONE ANTAGONIST; AMINO TERMINAL PRO BRAIN NATRIURETIC PEPTIDE; ANGIOTENSIN RECEPTOR ANTAGONIST; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; BIOLOGICAL MARKER; BRAIN NATRIURETIC PEPTIDE; CARVEDILOL; DIGOXIN; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; DIURETIC AGENT; PLACEBO; RIMONABANT; SERTRALINE; SIBUTRAMINE; TETRAHYDROLIPSTATIN;

BARIATRIC SURGERY; BLOOD PRESSURE REGULATION; BODY MASS; CARDIOMYOPATHY; CLINICAL FEATURE; CLINICAL TRIAL; CONGESTIVE CARDIOMYOPATHY; CONGESTIVE HEART FAILURE; DIABETES MELLITUS; DIET THERAPY; DISEASE ASSOCIATION; DISEASE MARKER; DRUG MECHANISM; ECHOCARDIOGRAPHY; ELECTROCARDIOGRAM; EXERCISE; GLUCOSE METABOLISM; HEART LEFT VENTRICLE FAILURE; HEART RIGHT VENTRICLE FAILURE; HEART VENTRICLE HYPERTROPHY; HEART VENTRICLE REMODELING; HUMAN; HYPERALDOSTERONISM; LIPID METABOLISM; LUNG ARTERY PRESSURE; MORBID OBESITY; NONHUMAN; OBESITY; PATHOPHYSIOLOGY; POSITIVE END EXPIRATORY PRESSURE; PREVALENCE; PRIORITY JOURNAL; PROTEIN BLOOD LEVEL; PULMONARY HYPERTENSION; REVIEW; RISK FACTOR; SIDE EFFECT; SLEEP APNEA SYNDROME; THORAX RADIOGRAPHY; TISSUE DOPPLER IMAGING; TRACHEOSTOMY; VASOCONSTRICTION; WEIGHT GAIN; WEIGHT REDUCTION;

BODY MASS INDEX; CARDIOMYOPATHIES; CARDIOMYOPATHY, DILATED; HUMANS; HYPERTENSION, PULMONARY; OBESITY;

EID: 68949149092     PISSN: 02725231     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.ccm.2009.06.001     Document Type: Review

References (134)

1. Puska P., Nishida C., and Porter D. Obesity and overweight. In: World Health Organization: Global strategy on diet physical activity and health (2003), WHO, Geneva 1-2
2. Allison D., Fontaine K., Manson J., et al. Annual deaths attributable to obesity in the United States. JAMA 282 16 (1999) 1530-1538
3. Hunt S. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to update the 2001 guidelines for the evaluation and management of heart failure). J Am Coll Cardiol 46 6 (2005) e1-e82
4. Wong C., and Marwick T. Obesity cardiomyopathy: pathogenesis and pathophysiology. Nat Clin Pract Cardiovasc Med 4 8 (2007) 436-443
5. Wong C., and Marwick T. Obesity cardiomyopathy: diagnosis and therapeutic implications. Nat Clin Pract Cardiovasc Med 4 9 (2007) 480-490
6. Poirier P., Giles T., Bray G., et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 113 6 (2006) 898-918
7. Smith H., and Willius F. Adiposity of the heart: a clinical and pathologic study of one hundred and thirty-six obese patients. Arch Intern Med 52 (1933) 911-931
8. Kasper E., Hruban R., and Baughman K. Cardiomyopathy of obesity: a clinicopathologic evaluation of 43 obese patients with heart failure. Am J Cardiol 70 9 (1992) 921-924
9. Duflou J., Virmani R., Rabin I., et al. Sudden death as a result of heart disease in morbid obesity. Am Heart J 130 2 (1995) 306-313
10. Hubert H., Feinleib M., McNamara P., et al. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 67 5 (1983) 968-977
11. He J., Ogden L., Bazzano L., et al. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med 161 7 (2001) 996-1002
12. Murphy N., MacIntyre K., Stewart S., et al. Long-term cardiovascular consequences of obesity: 20-year follow-up of more than 15,000 middle-aged men and women (the Renfrew-Paisley study). Eur Heart J 27 1 (2006) 96-106
13. Kenchaiah S., Evans J., Levy D., et al. Obesity and the risk of heart failure. N Engl J Med 347 5 (2002) 305-313
14. Malavazos A., Ermetici F., Coman C., et al. Influence of epicardial adipose tissue and adipocytokine levels on cardiac abnormalities in visceral obesity. Int J Cardiol 121 1 (2007) 132-134
15. Alpert M., Lambert C., Panayiotou H., et al. Relation of duration of morbid obesity to left ventricular mass, systolic function, and diastolic filling, and effect of weight loss. Am J Cardiol 76 16 (1995) 1194-1197
16. Licata G., Scaglione R., Paterna S., et al. Left ventricular function response to exercise in normotensive obese subjects: influence of degree and duration of obesity. Int J Cardiol 37 2 (1992) 223-230
17. Alpert M., Terry B., Mulekar M., et al. Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss. Am J Cardiol 80 6 (1997) 736-740
18. Karason K., Wallentin I., Larsson B., et al. Effects of obesity and weight loss on left ventricular mass and relative wall thickness: survey and intervention study. BMJ 315 7113 (1997) 912-916
19. Lauer M., Anderson K., Kannel W., et al. The impact of obesity on left ventricular mass and geometry. The Framingham Heart Study. JAMA 266 2 (1991) 231-236
20. Alaud-din A., Meterissian S., Lisbona R., et al. Assessment of cardiac function in patients who were morbidly obese. Surgery 108 4 (1990) 809-818 [discussion: 818-20]
21. Nakajima T., Fujioka S., Tokunaga K., et al. Noninvasive study of left ventricular performance in obese patients: influence of duration of obesity. Circulation 71 3 (1985) 481-486
22. Amad K., Brennan J., and Alexander J. The cardiac pathology of chronic exogenous obesity. Circulation 32 5 (1965) 740-745
23. Wong C., O'Moore-Sullivan T., Leano R., et al. Association of subclinical right ventricular dysfunction with obesity. J Am Coll Cardiol 47 3 (2006) 611-616
24. Wong C., Byrne N., O'Moore-Sullivan T., et al. Effect of weight loss due to lifestyle intervention on subclinical cardiovascular dysfunction in obesity (body mass index >30 kg/m2). Am J Cardiol 98 12 (2006) 1593-1598
25. Warnes C., and Roberts W. The heart in massive (more than 300 pounds or 136 kilograms) obesity: analysis of 12 patients studied at necropsy. Am J Cardiol 54 8 (1984) 1087-1091
26. Cittadini A., Mantzoros C., Hampton T., et al. Cardiovascular abnormalities in transgenic mice with reduced brown fat: an animal model of human obesity. Circulation 100 21 (1999) 2177-2183
27. Mizushige K., Yao L., Noma T., et al. Alteration in left ventricular diastolic filling and accumulation of myocardial collagen at insulin-resistant prediabetic stage of a type II diabetic rat model. Circulation 101 8 (2000) 899-907
28. Powell B., Redfield M., Bybee K., et al. Association of obesity with left ventricular remodeling and diastolic dysfunction in patients without coronary artery disease. Am J Cardiol 98 1 (2006) 116-120
29. Alpert M., Lambert C., Terry B., et al. Influence of left ventricular mass on left ventricular diastolic filling in normotensive morbid obesity. Am Heart J 130 5 (1995) 1068-1073
30. Wong C., O'Moore-Sullivan T., Leano R., et al. Alterations of left ventricular myocardial characteristics associated with obesity. Circulation 110 19 (2004) 3081-3087
31. Peterson L., Waggoner A., Schechtman K., et al. Alterations in left ventricular structure and function in young healthy obese women: assessment by echocardiography and tissue Doppler imaging. J Am Coll Cardiol 43 8 (2004) 1399-1404
32. Ferraro S., Perrone-Filardi P., Desiderio A., et al. Left ventricular systolic and diastolic function in severe obesity: a radionuclide study. Cardiology 87 4 (1996) 347-353
33. Lavie C., and Messerli F. Cardiovascular adaptation to obesity and hypertension. Chest 90 2 (1986) 275-279
34. Contaldo F., Pasanisi F., Finelli C., et al. Obesity, heart failure and sudden death. Nutr Metab Cardiovasc Dis 12 4 (2002) 190-197
35. Alexander J. Obesity and the heart. Heart Dis Stroke 2 4 (1993) 317-321
36. Alexander J. Obesity and coronary heart disease. Am J Med Sci 321 4 (2001) 215-224
37. Bradley T., and Floras J. Obstructive sleep apnoea and its cardiovascular consequences. Lancet 373 9657 (2009) 82-93
38. Alpert M. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci 321 4 (2001) 225-236
39. Schram K., and Sweeney G. Implications of myocardial matrix remodeling by adipokines in obesity-related heart failure. Trends Cardiovasc Med 18 6 (2008) 199-205
40. Banerjee S., and Peterson L. Myocardial metabolism and cardiac performance in obesity and insulin resistance. Curr Cardiol Rep 9 2 (2007) 143-149
41. Peterson L., Herrero P., Schechtman K., et al. Effect of obesity and insulin resistance on myocardial substrate metabolism and efficiency in young women. Circulation 109 18 (2004) 2191-2196
42. Zhou Y., Grayburn P., Karim A., et al. Lipotoxic heart disease in obese rats: implications for human obesity. Proc Natl Acad Sci U S A 97 4 (2000) 1784-1789
43. Listenberger L., and Schaffer J. Mechanisms of lipoapoptosis: implications for human heart disease. Trends Cardiovasc Med 12 3 (2002) 134-138
44. McGavock J., Victor R., Unger R., et al. Adiposity of the heart, revisited. Ann Intern Med 144 7 (2006) 517-524
45. Ren J., Samson W., and Sowers J. Insulin-like growth factor I as a cardiac hormone: physiological and pathophysiological implications in heart disease. J Mol Cell Cardiol 31 11 (1999) 2049-2061
46. Shibata R., Ouchi N., Ito M., et al. Adiponectin-mediated modulation of hypertrophic signals in the heart. Nat Med 10 12 (2004) 1384-1389
47. Nickola M., Wold L., Colligan P., et al. Leptin attenuates cardiac contraction in rat ventricular myocytes. Role of NO. Hypertension 36 4 (2000) 501-505
48. Minhas K., Khan S., Raju S., et al. Leptin repletion restores depressed {beta}-adrenergic contractility in ob/ob mice independently of cardiac hypertrophy. J Physiol 565 Pt 2 (2005) 463-474
49. Rasouli N., and Kern P. Adipocytokines and the metabolic complications of obesity. J Clin Endocrinol Metab 93 11 Suppl 1 (2008) S64-S73
50. Xu H., Barnes G., Yang Q., et al. Chronic inflammation in fat plays a crucial role in the development of obesity-related insulin resistance. J Clin Invest 112 12 (2003) 1821-1830
51. Harte A., McTernan P., Chetty R., et al. Insulin-mediated upregulation of the renin angiotensin system in human subcutaneous adipocytes is reduced by rosiglitazone. Circulation 111 15 (2005) 1954-1961
52. Brilla C., Matsubara L., and Weber K. Anti-aldosterone treatment and the prevention of myocardial fibrosis in primary and secondary hyperaldosteronism. J Mol Cell Cardiol 25 5 (1993) 563-575
53. Corry D., and Tuck M. Obesity, hypertension, and sympathetic nervous system activity. Curr Hypertens Rep 1 2 (1999) 119-126
54. Sundell J., Laine H., Luotolahti M., et al. Obesity affects myocardial vasoreactivity and coronary flow response to insulin. Obes Res 10 7 (2002) 617-624
55. Sivitz W., Wayson S., Bayless M., et al. Obesity impairs vascular relaxation in human subjects: hyperglycemia exaggerates adrenergic vasoconstriction arterial dysfunction in obesity and diabetes. J Diabetes Complications 21 3 (2007) 149-157
56. Estes E.J., Sieker H., Mcintosh H., et al. Reversible cardiopulmonary syndrome with extreme obesity. Circulation 16 2 (1957) 179-187
57. MacGregor M., Block A., and Ball W.J. Topics in clinical medicine: serious complications and sudden death in the Pickwickian syndrome. Johns Hopkins Med J 126 5 (1970) 279-295
58. Desai A., and Fang J. Heart failure with preserved ejection fraction: hypertension, diabetes, obesity/sleep apnea, and hypertrophic and infiltrative cardiomyopathy. Heart Fail Clin 4 1 (2008) 87-97
59. O'Hearn D., Gold A., Gold M., et al. Lower extremity edema and pulmonary hypertension in morbidly obese patients with obstructive sleep apnea. Sleep Breath 13 1 (2009) 25-34
60. Alpert M. Management of obesity cardiomyopathy. Am J Med Sci 321 4 (2001) 237-241
61. Drenick E., and Fisler J. Sudden cardiac arrest in morbidly obese surgical patients unexplained after autopsy. Am J Surg 155 6 (1988) 720-726
62. Bharati S., and Lev M. Cardiac conduction system involvement in sudden death of obese young people. Am Heart J 129 2 (1995) 273-281
63. Messerli F., Nunez B., Ventura H., et al. Overweight and sudden death. Increased ventricular ectopy in cardiopathy of obesity. Arch Intern Med 147 10 (1987) 1725-1728
64. Nishida N., Kudo K., Esaki R., et al. Two cases of sudden death in obese psychiatric patients with microscopic cardiopulmonary abnormalities. Fukuoka Igaku Zasshi 94 4 (2003) 66-74
65. Eisenstein I., Edelstein J., Sarma R., et al. The electrocardiogram in obesity. J Electrocardiol 15 2 (1982) 115-118
66. Okin P., Roman M., Devereux R., et al. ECG identification of left ventricular hypertrophy. Relationship of test performance to body habitus. J Electrocardiol 29 Suppl (1996) 256-261
67. Ungerleider H.E., and Clark C.P. A study of the transverse diameter of the heart silhouette with prediction based on teleroentgenogram. Am Heart J 17 (1939) 92-98
68. Garcia M., Thomas J., and Klein A. New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol 32 4 (1998) 865-875
69. Wickline S., Thomas L.R., Miller J., et al. A relationship between ultrasonic integrated backscatter and myocardial contractile function. J Clin Invest 76 6 (1985) 2151-2160
70. Lucarini A., Talarico L., Di Bello V., et al. Increased myocardial ultrasonic reflectivity is associated with extreme hypertensive left ventricular hypertrophy: a tissue characterization study in humans. Am J Hypertens 11 12 (1998) 1442-1449
71. Alpert M., Singh A., Terry B., et al. Effect of exercise and cavity size on right ventricular function in morbid obesity. Am J Cardiol 64 19 (1989) 1361-1365
72. Alpert M., Singh A., Terry B., et al. Effect of exercise on left ventricular systolic function and reserve in morbid obesity. Am J Cardiol 63 20 (1989) 1478-1482
73. Abidov A., Hachamovitch R., and Berman D. Modern nuclear cardiac imaging in diagnosis and clinical management of patients with left ventricular dysfunction. Minerva Cardioangiol 52 6 (2004) 505-519
74. Orakzai S., Orakzai R., Nasir K., et al. Assessment of cardiac function using multidetector row computed tomography. J Comput Assist Tomogr 30 4 (2006) 555-563
75. Sigurdsson G. CT for assessing ventricular remodeling: is it ready for prime time?. Curr Heart Fail Rep 5 1 (2008) 16-22
76. Epstein F. MRI of left ventricular function. J Nucl Cardiol 14 5 (2007) 729-744
77. Lainscak M., von Haehling S., and Anker S. Natriuretic peptides and other biomarkers in chronic heart failure: from BNP, NT-proBNP, and MR-proANP to routine biochemical markers. Int J Cardiol 132 3 (2009) 303-311
78. Wang T., Larson M., Levy D., et al. Impact of obesity on plasma natriuretic peptide levels. Circulation 109 5 (2004) 594-600
79. Taylor J., Christenson R., Rao K., et al. B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide are depressed in obesity despite higher left ventricular end diastolic pressures. Am Heart J 152 6 (2006) 1071-1076
80. Iwanaga Y., Kihara Y., Niizuma S., et al. BNP in overweight and obese patients with heart failure: an analysis based on the BNP-LV diastolic wall stress relationship. J Card Fail 13 8 (2007) 663-667
81. Bayes-Genis A., DeFilippi C., and Januzzi J.J. Understanding amino-terminal pro-B-type natriuretic peptide in obesity. Am J Cardiol 101 3A (2008) 89-94
82. Mertens I., and Van Gaal L. Overweight, obesity, and blood pressure: the effects of modest weight reduction. Obes Res 8 3 (2000) 270-278
83. Tuomilehto J., Lindström J., Eriksson J., et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344 18 (2001) 1343-1350
84. MacMahon S., Wilcken D., and Macdonald G. The effect of weight reduction on left ventricular mass. A randomized controlled trial in young, overweight hypertensive patients. N Engl J Med 314 6 (1986) 334-339
85. Wirth A., and Kröger H. Improvement of left ventricular morphology and function in obese subjects following a diet and exercise program. Int J Obes Relat Metab Disord 19 1 (1995) 61-66
86. Hinderliter A., Sherwood A., Gullette E., et al. Reduction of left ventricular hypertrophy after exercise and weight loss in overweight patients with mild hypertension. Arch Intern Med 162 12 (2002) 1333-1339
87. Bray G., and Ryan D. Drug treatment of the overweight patient. Gastroenterology 132 6 (2007) 2239-2252
88. Jordan J., Messerli F., Lavie C., et al. Reduction of weight and left ventricular mass with serotonin uptake inhibition in obese patients with systemic hypertension. Am J Cardiol 75 10 (1995) 743-744
89. Aronne L., and Isoldi K. Cannabinoid-1 receptor blockade in cardiometabolic risk reduction: efficacy. Am J Cardiol 100 12A (2007) 18P-26P
90. Godoy-Matos A., Carraro L., Vieira A., et al. Treatment of obese adolescents with sibutramine: a randomized, double-blind, controlled study. J Clin Endocrinol Metab 90 3 (2005) 1460-1465
91. O'Brien P., Brown W., and Dixon J. Obesity, weight loss and bariatric surgery. Med J Aust 183 6 (2005) 310-314
92. Kanoupakis E., Michaloudis D., Fraidakis O., et al. Left ventricular function and cardiopulmonary performance following surgical treatment of morbid obesity. Obes Surg 11 5 (2001) 552-558
93. Willens H., Chakko S., Byers P., et al. Effects of weight loss after gastric bypass on right and left ventricular function assessed by tissue Doppler imaging. Am J Cardiol 95 12 (2005) 1521-1524
94. Alpert M., Terry B., and Kelly D. Effect of weight loss on cardiac chamber size, wall thickness and left ventricular function in morbid obesity. Am J Cardiol 55 6 (1985) 783-786
95. Ashrafian H., le Roux C., Darzi A., et al. Effects of bariatric surgery on cardiovascular function. Circulation 118 20 (2008) 2091-2102
96. Vidal-Puig A., Considine R., Jimenez-Liñan M., et al. Peroxisome proliferator-activated receptor gene expression in human tissues. Effects of obesity, weight loss, and regulation by insulin and glucocorticoids. J Clin Invest 99 10 (1997) 2416-2422
97. Tuck M., Sowers J., Dornfeld L., et al. The effect of weight reduction on blood pressure, plasma renin activity, and plasma aldosterone levels in obese patients. N Engl J Med 304 16 (1981) 930-933
98. Bastard J., Hainque B., Dusserre E., et al. Peroxisome proliferator activated receptor-gamma, leptin and tumor necrosis factor-alpha mRNA expression during very low calorie diet in subcutaneous adipose tissue in obese women. Diabetes Metab Res Rev 15 2 (1999) 92-98
99. Barger P., and Kelly D. PPAR signaling in the control of cardiac energy metabolism. Trends Cardiovasc Med 10 6 (2000) 238-245
100. Verreth W., De Keyzer D., Pelat M., et al. Weight-loss-associated induction of peroxisome proliferator-activated receptor-alpha and peroxisome proliferator-activated receptor-gamma correlate with reduced atherosclerosis and improved cardiovascular function in obese insulin-resistant mice. Circulation 110 20 (2004) 3259-3269
101. Giese S., Bulan E., Commons G., et al. Improvements in cardiovascular risk profile with large-volume liposuction: a pilot study. Plast Reconstr Surg 108 2 (2001) 510-519 [discussion: 520-11]
102. Klein S., Fontana L., Young V., et al. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med 350 25 (2004) 2549-2557
103. Duprez D. Role of the renin-angiotensin-aldosterone system in vascular remodeling and inflammation: a clinical review. J Hypertens 24 6 (2006) 983-991
104. Satwani S., Dec G., and Narula J. Beta-adrenergic blockers in heart failure: review of mechanisms of action and clinical outcomes. J Cardiovasc Pharmacol Ther 9 4 (2004) 243-255
105. Jacob S., Rett K., and Henriksen E. Antihypertensive therapy and insulin sensitivity: do we have to redefine the role of beta-blocking agents?. Am J Hypertens 11 10 (1998) 1258-1265
106. Al-Hesayen A., Azevedo E., Floras J., et al. Selective versus nonselective beta-adrenergic receptor blockade in chronic heart failure: differential effects on myocardial energy substrate utilization. Eur J Heart Fail 7 4 (2005) 618-623
107. Raji A., Seely E., Bekins S., et al. Rosiglitazone improves insulin sensitivity and lowers blood pressure in hypertensive patients. Diabetes Care 26 1 (2003) 172-178
108. Wang T., Chen W., Lin J., et al. Effects of rosiglitazone on endothelial function, C-reactive protein, and components of the metabolic syndrome in nondiabetic patients with the metabolic syndrome. Am J Cardiol 93 3 (2004) 362-365
109. Grunstein R., Wilcox I., Yang T., et al. Snoring and sleep apnoea in men: association with central obesity and hypertension. Int J Obes Relat Metab Disord 17 9 (1993) 533-540
110. Lopez P., Stefan B., Schulman C., et al. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery. Am Surg 74 9 (2008) 834-838
111. Peppard P., Young T., Palta M., et al. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284 23 (2000) 3015-3021
112. Golbin J., Somers V., and Caples S. Obstructive sleep apnea, cardiovascular disease, and pulmonary hypertension. Proc Am Thorac Soc 5 2 (2008) 200-206
113. Voelkel N. Mechanisms of hypoxic pulmonary vasoconstriction. Am Rev Respir Dis 133 6 (1986) 1186-1195
114. Presberg K., and Dincer H. Pathophysiology of pulmonary hypertension due to lung disease. Curr Opin Pulm Med 9 2 (2003) 131-138
115. Chaouat A., Weitzenblum E., Krieger J., et al. Pulmonary hemodynamics in the obstructive sleep apnea syndrome. Results in 220 consecutive patients. Chest 109 2 (1996) 380-386
116. Somers V., White D., Amin R., et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation 118 10 (2008) 1080-1111
117. Finkelhor R., Moallem M., and Bahler R. Characteristics and impact of obesity on the outpatient echocardiography laboratory. Am J Cardiol 97 7 (2006) 1082-1084
118. McQuillan B., Picard M., Leavitt M., et al. Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects. Circulation 104 23 (2001) 2797-2802
119. Bady E., Achkar A., Pascal S., et al. Pulmonary arterial hypertension in patients with sleep apnoea syndrome. Thorax 55 11 (2000) 934-939
120. Krieger J., Sforza E., Apprill M., et al. Pulmonary hypertension, hypoxemia, and hypercapnia in obstructive sleep apnea patients. Chest 96 4 (1989) 729-737
121. Sajkov D., Cowie R., Thornton A., et al. Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome. Am J Respir Crit Care Med 149 2 Pt 1 (1994) 416-422
122. Sanner B., Doberauer C., Konermann M., et al. Pulmonary hypertension in patients with obstructive sleep apnea syndrome. Arch Intern Med 157 21 (1997) 2483-2487
123. Yamakawa H., Shiomi T., Sasanabe R., et al. Pulmonary hypertension in patients with severe obstructive sleep apnea. Psychiatry Clin Neurosci 56 3 (2002) 311-312
124. Laks L. Pulmonary arterial pressure in sleep apnea. Sleep 16 8 Suppl (1993) S41-S43
125. Motta J., Guilleminault C., Schroeder J., et al. Tracheostomy and hemodynamic changes in sleep-inducing apnea. Ann Intern Med 89 4 (1978) 454-458
126. Tilkian A., Guilleminault C., Schroeder J., et al. Hemodynamics in sleep-induced apnea. Studies during wakefulness and sleep. Ann Intern Med 85 6 (1976) 714-719
127. Alchanatis M., Tourkohoriti G., Kakouros S., et al. Daytime pulmonary hypertension in patients with obstructive sleep apnea: the effect of continuous positive airway pressure on pulmonary hemodynamics. Respiration 68 6 (2001) 566-572
128. Sajkov D., Wang T., Saunders N., et al. Continuous positive airway pressure treatment improves pulmonary hemodynamics in patients with obstructive sleep apnea. Am J Respir Crit Care Med 165 2 (2002) 152-158
129. Arias M., García-Río F., Alonso-Fernández A., et al. Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure: a randomized, controlled cross-over study. Eur Heart J 27 9 (2006) 1106-1113
130. Chaouat A., Weitzenblum E., Kessler R., et al. Five-year effects of nasal continuous positive airway pressure in obstructive sleep apnoea syndrome. Eur Respir J 10 11 (1997) 2578-2582
131. Simonneau G., Galiè N., Rubin L., et al. Clinical classification of pulmonary hypertension. J Am Coll Cardiol 43 12 Suppl S (2004) 5S-12S
132. Taraseviciute A., and Voelkel N. Severe pulmonary hypertension in postmenopausal obese women. Eur J Med Res 11 5 (2006) 198-202
133. Kramer M., and Lane D. Aminorex, dexfenfluramine, and primary pulmonary hypertension. J Clin Epidemiol 51 4 (1998) 361-364
134. Blankfield R., Tapolyai A., and Zyzanski S. Left ventricular dysfunction, pulmonary hypertension, obesity, and sleep apnea. Sleep Breath 5 2 (2001) 57-62