Document Type : Original Article(s)
Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
BACKGROUND: The dramatic increase in the prevalence of metabolic syndrome is associated with more increased cardiovascular morbidity and mortality in this group. Some recent studies suggested that metabolic syndrome is associated with increased risk of subclinical left ventricular (LV) systolic dysfunction. In the present cross-sectional case–control study, the utility of two-dimensional speckle tracking echocardiography (STE) was examined to detect early LV systolic dysfunction in this population. METHODS: A total of 75 clinically asymptomatic subjects with LV ejection fraction (LVEF) ≥ 55%, 39 without metabolic syndrome and 36 with metabolic syndrome, matched for gender and age, were enrolled in this case–control study. Metabolic syndrome was diagnosed using the National Cholesterol Education Program/Adult Treatment Panel III criteria. LV systolic function was assessed by STE-derived global and segmental longitudinal strain (εLL). RESULTS: Global εLL was significantly lower in patients with metabolic syndrome compared with normal population (−18.41 ± 2.20% vs. −21.2 ± 2.1%, P < 0.001). Segmental εLL was significantly lower in patients with metabolic syndrome in comparison to control group except for basal anteroseptal (−19.95 ± 2.90% vs. −21.15 ± 3.30%, P = 0.106), basal anterolateral (−17.5 ± 5.0% vs. −18.3 ± 4.1%, P = 0.437), and basal inferolateral segments (−18.1 ± 6.3% vs. −18.9 ± 4.1%, P = 0.526). CONCLUSION: STE-derived longitudinal LV strain (εLL), a marker of subclinical cardiovascular disease, is impaired in asymptomatic individuals with metabolic syndrome and normal LVEF.
- Kim JY, Mun HS, Lee BK, Yoon SB, Choi EY, Min PK, et al. Impact of metabolic syndrome and its individual components on the presence and severity of angiographic coronary artery disease. Yonsei Med J 2010; 51(5): 676-82.
- Eckel RH, Kahn R, Robertson RM, Rizza RA. Preventing cardiovascular disease and diabetes: a call to action from the American Diabetes Association and the American Heart Association. Circulation 2006; 113(25): 2943-6.
- Levesque J, Lamarche B. The metabolic syndrome: definitions, prevalence and management. J Nutrigenet Nutrigenomics 2008; 1(3): 100-8.
- Nesbitt GC, Mankad S, Oh JK. Strain imaging in echocardiography: methods and clinical applications. Int J Cardiovasc Imaging 2009; 25(Suppl 1): 9-22.
- Imbalzano E, Zito C, Carerj S, Oreto G, Mandraffino G, Cusma-Piccione M, et al. Left ventricular function in hypertension: new insight by speckle tracking echocardiography. Echocardiography 2011; 28(6): 649-57.
- Yoon JH, Kim HJ, Lee EJ, Moon S, Lee JY, Lee JW, et al. Early left ventricular dysfunction in children after hematopoietic stem cell transplantation for acute leukemia: a case control study using speckle tracking echocardiography. Korean Circ J 2015; 45(1): 51-8.
- Voulgari C, Moyssakis I, Papazafiropoulou A, Perrea D, Kyriaki D, Katsilambros N, et al. The impact of metabolic syndrome on left ventricular myocardial performance. Diabetes Metab Res Rev 2010; 26(2): 121-7.
- Gong HP, Tan HW, Fang NN, Song T, Li SH, Zhong M, et al. Impaired left ventricular systolic and diastolic function in patients with metabolic syndrome as assessed by strain and strain rate imaging. Diabetes Res Clin Pract 2009; 83(3): 300-7.
- Almeida AL, Teixido-Tura G, Choi EY, Opdahl A, Fernandes VR, Wu CO, et al. Metabolic syndrome, strain, and reduced myocardial function: multi-ethnic study of atherosclerosis. Arq Bras Cardiol 2014; 102(4): 327-35.
- Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112(17): 2735-52.
- Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28(1): 1-39.
- Pacholczyk M, Ferenc T, Kowalski J. The metabolic syndrome. Part I: definitions and diagnostic criteria for its identification. Epidemiology and relationship with cardiovascular and type 2 diabetes risk. Postepy Hig Med Dosw (Online) 2008; 62: 530-42.
- Sreenivasa Kumar ML, Rajasekhar D, Vanajakshamma V, Latheef K. Impact of metabolic syndrome on global left ventricular function: As evaluated by the myocardial performance index. J Saudi Heart Assoc 2014; 26(3): 145-51.
- Wang Q, Sun QW, Wu D, Yang MW, Li RJ, Jiang B, et al. Early detection of regional and global left ventricular myocardial function using strain and strain-rate imaging in patients with metabolic syndrome. Chin Med J (Engl) 2015; 128(2): 226-32.
- Hanekom L, Cho GY, Leano R, Jeffriess L, Marwick TH. Comparison of two-dimensional speckle and tissue Doppler strain measurement during dobutamine stress echocardiography: an angiographic correlation. Eur Heart J 2007; 28(14): 1765-72.
- Leitman M, Lysiansky M, Lysyansky P, Friedman Z, Tyomkin V, Fuchs T, et al. Circumferential and longitudinal strain in 3 myocardial layers in normal subjects and in patients with regional left ventricular dysfunction. J Am Soc Echocardiogr 2010; 23(1): 64-70.