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Purpose: The relation between obesity and cardiac structure and function in children is poor documented. We used 2D speckle strain imaging to investigate whether severely overweight children without hypertension, dyslipidemia, diabetes or sleep apnea, show early cardiac abnormalities. We also investigated the relation between these myocardial features and severity of obesity, fat mass percentage, inflammation and insulin resistance index.Methods : 2D echocardiography, tissue Doppler imaging (TDI) and 2D speckle strain imaging were prospectively performed in obese children and compared them to age and sex- matched healthy control subjects. Standard echocardiographic indices of global systolic and diastolic function, early peak diastolic mitral velocity (Ea), longitudinal strain (LS), radial strain (RS) and circumferential strain (CS) were investigated. Z-score body mass index (BMI), body composition, high-sensitive C reactive protein (hs-CRP) and indices of insuline resistance (HOMA-IR) were assessed in the obese children.Results: Overall 32 consecutive obese patients (age: 12,8 [8–17] years; z-score BMI: 6,2 [3,9 – 7,4]; 15 males; HOMA-IR: 2,1 [0,6 – 5,7]) were compared to 32 nonobese patients. There was no difference beween two groups for left ventricular ejection fraction and conventionnal diastolic mitral Doppler parameters. Obese subjects showed significantly larger left ventricular wall dimensions (End diastolic diameter: 45±5 vs 43±4 mm; p < 0,05; left ventricular mass: 116±31 vs 79±19g; p<0,005) and signs of early diastolic filling abnormalities on TDI (Ea: 18,1 vs 16,9 cm/s; p=0,02). LS and CS were significantly lower in obese group (LS: -18±2% vs -20±2%; p < 0,05 – CS: -18±3% vs -20,1±2 %; p < 0,05) while RS did not differ. LS and CS were poor correlated with BMI (Respectively: r = 0,5; p < 0.05 and r = 0,3; p < 0.05). There was no correlation between strain parameters and body composition.There was no correlation between strain parameters and hs-CRP. LS was weakly correlated with HOMA-IR (r: 0, 45; p< 0, 05). After adjusting for age, mean arterial pressure, LV mass index, in a multivariate stepwise regression model, BMI remained independently related to average LV longitudinal strain (β=0.50; p<0.001)Conclusion: Children with obesity, without associated risk factors for cardiovascular disease, have significant impairment of longitudinal myocardial strain.