Introduction: Obesity is accompanied by left ventricular hypertrophy (LVH), the magnitude of this association being heterogeneously reported by previous studies. Beyond assessment of LV mass alone, LV geometry evaluation was proved to add important prognostic information regarding the long term risk of heart failure, myocardial infarction, stroke or even death, but data regarding the factors that induce a specific type of LV remodeling are scarce yet. The aim of the study was to identify the factors associated with specific LV geometry and mass changes in obese subjects. Methods: 254 obese subjects (mean age 39.5 ±12.2 years, 44.7 % men), mean body mass index (BMI) 42.8 ± 8.8 kg/m2, were studied. LV geometry was assessed by echocardiography, using LV mass/height 2.7 index in combination with relative wall thickness, with gender-specific cut-offs. LV geometry was divided into normal geometry (NG), concentric remodeling (CR), eccentric LVH (E-LHV) and concentric LVH (C-LVH). Aortic stiffness index was calculated using systolic and diastolic ascending aorta diameters. The visceral adiposity index (VAI), a parameter which was proved to be correlated with abdominal adiposity – evaluated by magnetic resonance, was calculated by Amato formula, using anthropometrical and lipid profile data. Results: LV geometry in the 254 obese subjects had the following pattern: 40.9% had NG, 0.4% had CR, 18.9% C-LVH* and 39.8% E-LVH *# (*p < 0.05 versus NG group, #p < 0.05 versus C-LVH group). Mean age was 32.8 ± 10.6 years in NG group, 50.5 ± 9.3* in C-LVH and 39.5 ± 12.2*# in E-LVH. The proportion of females was 63% in NG group, 62% in C-LVH and 44% * in ELVH. Mean BMI was 38.2 ± 5.7 kg/m2 in NG group, 4.2 ± 9* in C-LVH and 46.7 ± 9.2 *# in E-LVH. Mean VAI was 6.7 ± 2.3 m2*10 – 2/kg in NG group, 8.1 ± 4.3* in C-LVH and 7.8 ± 3.7*# in E-LVH. Systemic hypertension and diabetes mellitus prevalence was 6 and 7.8%, respectively, in NG group, 83 and 64.6% in C-LVH and 36, 38.6% in E-LVH. Aortic stiffness index was 3.9 ± 3.6 in NG group, 10.1 ± 8.2* in C-LVH and 8.5 ± 6.9*# in E-LVH. Conclusions: 1. More than half (59%) of the obese studied patients have left ventricular mass and geometry changes. 2. Eccentric left ventricular hypertrophy is the main pattern of cardiac remodeling in obese subjects, followed by concentric left ventricular hypertrophy and concentric remodeling. 3. Eccentric left ventricular hypertrophy is associated with younger ages, male gender and with advanced stages of general obesity. 4. Concentric left ventricular hypertrophy is associated with older ages, female gender, and increased visceral adiposity, with the presence of systemic hypertension and diabetes mellitus and with increased aortic stiffness.