Improvement in Hypertrophic Cardiomyopathy After Significant Weight Loss: Case Report

Gabriel I. Uwaifo, MD, Erica M. Fallon, BS, Karim A. Calis, PharMD, MPh, Bart Drinkard, PT, MSPT, CCS, Jennifer R. McDuffie, PhD, Jack A. Yanovski, MD, PhD

Disclosures

South Med J. 2003;96(6) 

In This Article

Case Report

A 17-year-old, otherwise healthy black male was evaluated for possible inclusion in a randomized, double-blind, placebo-controlled trial in which a weight loss program was being conducted to evaluate the safety and efficacy of orlistat (Xenical; Roche Laboratories, Inc., Nutley, NJ). The Institutional Review Board of the National Institute of Child Health and Human Development approved the protocol, and both parental and patient consent were obtained before enrollment. The patient's medical history was significant for obesity in both parents and a half-sister. His mother had diabetes mellitus type 2 and hypertension, but there was no family history of sudden cardiac death or other cardiac problems. The patient's vital signs at the initial evaluation were within normal limits, with the exception of mild systolic hypertension (blood pressure, 147/68 mm Hg). The clinical examination was significant for widespread acanthosis nigricans and mild lipomas, as was the cardiac examination. The patient's heart sounds were normal, with a physiologic split of the second heart sound but no murmurs or other added sounds. The electrocardiogram (Fig. 1) revealed abnormalities that were diagnosed as FAHCM on the basis of further transthoracic echocardiography.

Electrocardiograms obtained before and 1 year after patient's enrollment in a weight loss program. All presented data are mean ± SD where applicable. A, baseline electrocardiograms. B, electrocardiogram obtained 1 year after patient's weight loss.

In consultation with cardiologists, it was decided to allow the patient to commence the weight loss program with strict advice to avoid competitive, exhausting, isometric, and/or isotonic exercise. The patient was treated according to the study protocol and was administered randomized medication for 6 months, followed by 6 months of open-label orlistat. Roche Pharmaceuticals, Inc., supplied orlistat and placebo under a materials transfer agreement. Echocardiography was performed with the use of the Acuson 2D Sequoia probe (Siemens AG, Mountain View, CA), and color Doppler sonography was performed in the left lateral decubitus position from the left parasternal window. Estimates of left ventricular mass (LVM) were made according to the American Society of Echocardiography standard thin-wall (after Devereux and Alonso) and thick-wall (after Devereux and Reichek) models. The various wall thicknesses were measured according to the Penn measurement conventions.[7] The LVM index (LVMI) was derived from body surface area and height indexation.[8] The left ventricular internal, external, and myocardial volume,[7] as well as cardiac output and total peripheral resistance,[9] also were estimated. The P value was computed as the ratio of left ventricular internal and external volumes and is an index of left ventricular compliance.[7] Left ventricular fractional shortening was also estimated as described previously.[9]

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