Effect of lifestyle intervention plus rosiglitazone or placebo therapy on left ventricular mass assessed with cardiovascular magnetic resonance in the metabolic syndrome

Abstract

BackgroundTo evaluate the effect of lifestyle intervention in conjunction with rosiglitazone or placebo therapy on left ventricular (LV) mass, using cardiovascular magnetic resonance (CMR) in the metabolic syndrome.MethodsThe present study was a pre-specified substudy of a double-blind randomized controlled trial evaluating the effect of lifestyle intervention in conjunction with rosiglitazone or placebo therapy on carotid artery atherosclerosis in the metabolic syndrome. From this original study population, 10 subjects from the placebo group and 10 from the rosiglitazone group were randomly selected. At baseline and follow-up (52 weeks), clinical and laboratory measurements were assessed and a CMR-examination was performed to evaluate LV mass indexed for body surface area (LV mass-I). Subsequently, the effect of therapy (rosiglitazone vs. placebo) and clinical and laboratory variables on LV mass-I was evaluated.ResultsIn both groups, body mass index, waist circumference, systolic and diastolic blood pressure significantly decreased during follow-up. Interestingly, LV mass-I significantly decreased in the placebo group (48.9 ± 5.3 g/m2 vs. 44.3 ± 5.6 g/m2, p < 0.001) indicating reverse remodeling, whereas LV mass-I remained unchanged in the rosiglitazone group (54.7 ± 9.9 g/m2 vs. 53.7 ± 9.2 g/m2, p = 0.3). After correction for systolic and diastolic blood pressure and triglyceride, the kind of therapy (rosiglitazone vs. placebo) remained the only significant predictor of LV mass-I reduction.ConclusionsLifestyle intervention resulted in a reduction of LV mass-I in the metabolic syndrome, indicating reverse remodeling. However, rosiglitazone therapy may have inhibited this positive reverse remodeling.Trial registrationCurrent Controlled Trials ISRCTN54951661.

Cardiovascular Characteristics in Subjects With Increasing Levels of Abnormal Glucose Regulation

“…Thus, there is a need for early identification of individuals with glucose dysregulation to adopt appropriate preventive strategies to reduce CV risk. Promoting lifestyle intervention to reduce weight and increase muscle mass is the most effective measure to improve metabolic status, reduce progression to diabetes, and induce a favorable ventricular remodeling (40). In addition, careful attention to BP and lipid treatment and smoking cessation should be a priority for these individuals.…”

Inflammation increases plasma angiopoietin-like protein 4 in patients with the metabolic syndrome and type 2 diabetes

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Diagnostic imaging in the management of patients with metabolic syndrome

“…67 Cine imaging of the beating heart is important for functional cardiac MRI, and cine MR with steady-state free precession is widely accepted as the reference for assessment of ventricular function as well as mass, 77 and allows measurement and monitoring of LV mass index in proportion to weight reduction in MetS. 78 Three-dimensional (D) volume tracking of the mitral annulus with cine MR is useful for assessing diastolic dysfunction, yielding parameters that correlate with tissue Doppler-based variables. 79 Flow quantification using velocity sensitivity with cardiac MR is also a good technique to quantitatively assess diastolic dysfunction as well as valvular and congenital heart disease, 80 as validated with tissue Doppler imaging.…”