Obesity and Left Ventricular Mechanics in Children and Adolescents: A Systematic Review and Meta-Analysis.

Introduction: Evidence on left ventricular (LV) myocardial deformation, assessed by speckle tracking echocardiography (STE), in children and adolescents with obesity is scanty.

Aim: This meta-analysis aimed to provide a new piece of information on LV systolic function, phenotyped by global longitudinal strain (GLS) and LV ejection fraction (LVEF), in pediatric obesity.

Methods: Following the PRISMA guidelines, systematic searches were conducted in Pub-Med, OVID, EMBASE, and Cochrane Library to identify eligible studies from inception up to February 28^th 2025. Studies comparing LV mechanics in pediatric obesity and normal weight controls were included. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using random-effects models to assess differences in GLS and LVEF.

Prospero-id: 635938.

Results: Twenty-seven studies including 1398 individuals with obesity and 2376 age-matched healthy controls were considered for the analysis. Pooled average GLS values were 20±0.4% in the control group and 17±0.5% in the obese group (SMD - 1.28±0.14, CI - 1.57/- 1.0, p<0.0001). Overall, LVEF was lower in the obese group (SMD - 0.14±0.15, CI - 0.22/- 0.05, p <0.001), although this parameter, at difference from GLS, in the majority of studies did not reach the statistical significance between groups. The metaregression analysis of GLS on BMI showed a significant inverse correlation between the two parameters (coefficient= - 0.33±0.11, p=0.003), this was not the case for LVEF.

Conclusions: Our data suggest that targeting LV mechanics may more accurately assess the systolic function in pediatric obesity; implementing STE in clinical practice may be highly useful in unmasking early LV functional alterations in this setting.