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Modified Haller index validation and correlation with left ventricular strain in a cohort of subjects with obesity and without overt heart disease

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Abstract

The present study was primarily designed to validate the modified Haller index (MHI), the ratio of chest transverse diameter over the distance between sternum and spine, measured by a ruler and transthoracic echocardiography (TTE), respectively, in a cohort of subjects with obesity, but otherwise healthy, by comparing the results to the conventional Haller index (HI) measured on chest X-ray (CXR). 100 consecutive subjects with body mass index (BMI) ≥ 30 kg/m2 and 60 matched controls with BMI < 30 kg/m2, who underwent a two-plane CXR for any clinical indication, were prospectively examined over a 6-month period. All participants underwent MHI assessment, TTE and speckle-tracking analysis of left ventricular (LV) global longitudinal strain (GLS). Bland–Altman analysis was used to compare the radiological and nonradiological techniques. Second, independent predictors of subclinical myocardial dysfunction, defined as LV-GLS less negative than − 20%, were evaluated. Bland–Altman analysis revealed a bias of − 4.91 cm for latero-lateral thoracic diameter, of − 0.74 cm for antero-posterior (A–P) thoracic diameter and of − 0.22 for HI assessment, suggesting a systematic overestimation of the nonradiological methodology in comparison to that radiological. Despite normal LV systolic function on TTE, LV-GLS resulted impaired in 76% of subjects with obesity. Waist circumference (OR 1.13, 95%CI 1.04–1.22) and nonradiological A–P thoracic diameter (OR 0.51, 95%CI 0.28–0.93) were the main independent predictors of subclinical myocardial dysfunction in subjects with obesity. The impairment in LV myocardial strain detected in subjects with obesity appears to be primarily related to extrinsic abdominal and thoracic compressive phenomena, rather than intrinsic myocardial dysfunction.

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Abbreviations

2D:

Two-dimensional

A–P:

Antero-posterior

AUC:

Area under curve

BMI:

Body mass index

CI:

Confidence interval

CO:

Cardiac output

CXR:

Chest X-ray

eGFR:

Estimated glomerular filtration rate

GLS:

Global longitudinal strain

HI:

Haller index

ICC:

Intraclass correlation coefficient

LAVi:

Left atrial volume index

LDL:

Low-density lipoprotein

L–L: latero-lateral; LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

LVMi:

Left ventricular mass index

LVOT:

Left ventricular outflow tract

MAPSE:

Mitral annular plane systolic excursion

MHI:

Modified Haller index

OR:

Odds ratio

OSAS:

Obstructive sleep apnea syndrome

P–A:

Postero-anterior

ROC:

Receiver operating characteristics

RV:

Right ventricular

RWT:

Relative wall thickness

SPAP:

Systolic pulmonary artery pressure

STE:

Speckle-tracking echocardiography

Svi:

Stroke volume index

TAPSE:

Tricuspid annular plane systolic excursion

TTE:

Transthoracic echocardiography

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Acknowledgements

This work has been supported by Italian Ministry of Health Ricerca Corrente—IRCCS MultiMedica.

Funding

This work has been supported by Italian Ministry of Health Ricerca Corrente—IRCCS MultiMedica.

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Authors and Affiliations

  1. Division of Cardiology, MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy

    Andrea Sonaglioni & Michele Lombardo

  2. Division of Cardiology, Policlinico San Giorgio, Pordenone, Italy

    Gian Luigi Nicolosi

  3. Division of Radiology, MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy

    Roberta Trevisan & Maurizio Zompatori

  4. Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini 2, Grugliasco, 10095, Turin, Italy

    Alberto Granato

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  1. Andrea Sonaglioni
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  2. Gian Luigi Nicolosi
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  4. Alberto Granato
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  5. Maurizio Zompatori
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  6. Michele Lombardo
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Contributions

AS: Conceptualization; Data curation; Investigation; Methodology; Software; Visualization; Writing—original draft. RT and AG: Conceptualization; Data curation; Methodology; Software. GLN, MZ and ML: Conceptualization; Supervision; Validation; Writing—review and editing.

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Correspondence to Andrea Sonaglioni.

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We wish to confirm that there are no conflicts of interest associated with this publication. Andrea Sonaglioni declares that he has no conflict of interest. Gian Luigi Nicolosi declares that he has no conflict of interest. Roberta Trevisan declares that she has no conflict of interest. Alberto Granato declares that he has no conflict of interest. Maurizio Zompatori declares that he has no conflict of interest. Michele Lombardo declares that he has no conflict of interest.

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Sonaglioni, A., Nicolosi, G.L., Trevisan, R. et al. Modified Haller index validation and correlation with left ventricular strain in a cohort of subjects with obesity and without overt heart disease. Intern Emerg Med 17, 1907–1919 (2022). https://doi.org/10.1007/s11739-022-03026-5

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