Do diabetes, metabolic syndrome or their association equally affect biventricular function? A tissue Doppler study

Abstract

Metabolic syndrome (MetS) and type 2 diabetes (T2DM) have been associated with an impairment of left (LV) and right ventricular (RV) function as well as an increased risk of heart failure (HF). However, it remains unclear whether these clinical entities or their associations promote a similar derangement of biventricular function. Overall, 345 patients without overt cardiovascular disease consecutively underwent routine blood chemistry including high-sensitivity C reactive protein (hs-CRP) and echocardiographical examination with conventional and tissue Doppler imaging (TDI) of both ventricles. According to the ATP III criteria and fasting glucose levels, the study population was stratified into four groups: (1) healthy controls (n=120); (2) MetS without T2DM (n=84); (3) T2DM without MetS (n=49); and (4) MetS+T2DM (n=92). The Myocardial performance index (MPI) of the RV and LV was obtained with a multi-segmental approach using TDI. Patients with MetS and T2DM exhibited a similar impairment of biventricular function compared with healthy controls, whereas a further decline was observed in patients having both MetS and T2DM. In addition to MetS markers, hs-CRP exhibited the strongest association with the MPI of both ventricles. Regression analyses indicated that individual MetS markers were inferior to MetS in identifying subtle cardiac dysfunction. Independent associations of MetS and T2DM with biventricular dysfunction were comparable, and the coexistence of MetS and T2DM exhibited the highest risk for biventricular dysfunction. Our findings emphasize the importance of MetS as an equivalent of T2DM and support a synergic effect of these clinical conditions on cardiac organ damage requiring more aggressive therapeutic strategies to prevent HF.

Right ventricle free wall mechanics in metabolic syndrome without type-2 diabetes: effects of a 3-month lifestyle intervention program

“…Most of the available studies refer to assessment of RV free wall velocities by TDI and report inconclusive results, especially for longitudinal systolic velocities [9]-[11],[20]. Our data of reduced systolic and early diastolic longitudinal velocities agree with some of these works [10],[11] but not all [9],[20]. A major limitation of TDI over speckle tracking imaging is however, its lack of sensitivity (dependency on loading conditions, tethering effect, translational cardiac movement) in detecting subtle myocardial changes [3],[37],[39].…”

Blockade of glucocorticoid receptors with RU486 attenuates cardiac damage and adipose tissue inflammation in a rat model of metabolic syndrome

“…33 These changes may thus contribute to the development of myocardial fibrosis in DS/obese rats. 34,35 RU486 attenuated macrophage infiltration into the myocardium as well as the upregulation of MCP-1, osteopontin, COX-2 and TNF-α gene expression in the heart of DS/obese rats, indicating that RU486 alleviated cardiac inflammation in these animals. These results also support the previous finding that GRs are present in inflammatory cells, including macrophages, that invade vascular lesions.…”

Asymptomatic left ventricular dysfunction and metabolic syndrome: Results from an Italian multicenter study

“…Particularly, among MS criteria, the coexistence of MS and type 2 diabetes exhibits the highest risk for biventricular dysfunction, requiring more aggressive therapeutic strategies to prevent HF. [14]…”

“…[13] Moreover, each individual marker of MS is inferior to MS itself in identifying subtle cardiac dysfunction. [14] However, the prevalence of asymptomatic LV systolic and/or diastolic dysfunction is not well established in patients with MS at stage A or B of HF.…”