ABSTRACT. Cardiac morbidity and mortality come first in obese patients. Adverse consequences of obesity are based on the structural changes of the heart, as a result of a multitude of pathophysiological changes and co-morbidities. Hence, the left ventricular (LV) geometry is altered. We aimed to study the characteristics and the prevalence of LV remodeling in obese subjects and to evaluate the magnitude of the impact of hypertension. We conducted a prospective study on 343 ambulatory adult subjects, with normal LV ejection fractions and no cardiovascular complications, BMI – classified in normal weight, overweight and obese. There were 87/343 (25%) obese, 191/343 (56%) overweight and 65/343 (19%) normal weight. In the obese group the relative wall thickness and the LV mass index were significantly increased (0.44±0.06 vs 0.39±0.03, p<0.0001 for the interventricular septum, 0.42±0.06 vs 0.38±0.04, p<0.0001 for the posterior wall and 119±30 g/m2 vs 97±19 g/m2, p<0.0001 for the LV mass index). The LV geometry was abnormal in 79/87 (90.8%) of the obese. Most of the obese had concentric LV geometry: 56/87 (64.4%) had concentric hypertrophy and 16/87 (18.4%) had concentric remodeling. The prevalence of LV remodeling was significantly higher in the obese with hypertension than in the normotensive obese subgroup: 62/66 (94%) vs 17/21 (79%), p=0.0026. The prevalence of obesity in our cohort was 25%. The prevalence of LV remodeling in the obese was 91%. Obese heart change is characterized by concentric hypertrophy and remodeling. Additional hypertrophic causes must be evaluated in the obese with LV concentric remodeling. pp. 23–31

Keywords: obesity; cardiac remodeling; left ventricular hypertrophy; concentric geometry; echocardiography; hypertension