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 28th 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.