Concentric Left Ventricular Geometry and Relative Wall Thickness as Echocardiographic Predictors of Metabolic Syndrome in Obese Children

Background: The association between metabolic syndrome (MetS) and left ventricular (LV) remodeling is well established both in adults and children. Objective: To evaluate whether concentric LV geometry and relative wall thickness predict the presence of metabolic syndrome in obese children. Methods: This cross-sectional study included 112 obese children who underwent comprehensive echocardiographic and metabolic evaluations. LV geometric patterns were classified as normal geometry (non-concentric) if relative wall thickness (RWT) was < 0.41 (equivalent to 41%), or concentric geometry if RWT was ³ 0.41, with or without increased LV mass index. The predictive performance of echocardiographic indices for MetS was assessed using two approaches: (1) RWT as a continuous variable (expressed as percentage); (2) RWT as a binary variable using the established pediatric cut-off of RWT ≥ 0.41 (equivalent to 41%) to define concentric geometry (LVCG). Associations were evaluated with receiver operating characteristic (ROC) analysis, chi-square tests, and odds ratios. Results: Of the 112 children, 41 (36.6%) met the diagnostic criteria for MetS while 71 (63.4 %) didn’t meet the criteria. Children with LVCG (n=36) showed a significantly higher prevalence of MetS (61.1%) compared to those with normal geometry (n=76; 25.0%; χ² = 13.727, p < 0.001; odds ratio =4.71). RWT as a continuous variable emerged as the stronger predictor (AUC 0.716), while binary LVCG demonstrated a highly significant association (p < 0.001) with more than double the prevalence of MetS. Conclusions: In obese children, LV concentric geometry assessed by echocardiography, particularly increased RWT, is independent and clinically relevant predictor of MetS. These findings may support consideration of echocardiographic assessment in high-risk obese children for early detection of their metabolic risk.