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

Abstract

BackgroundGrowing evidence demonstrates subtle left ventricular myocardial dysfunction in patients with metabolic syndrome (MetS), with central obesity, glucose intolerance and inflammation emerging as important contributors. Whether these results can be translated to the right ventricle (RV) is not yet fully elucidated. Furthermore, although lifestyle intervention favorably impacts MetS components and inflammatory biomarkers, its effect on RV myocardial function remains unknown today.MethodsThirty-nine MetS adults free of diabetes were enrolled in a three month lifestyle intervention program including diet and physical exercise, and compared with forty healthy controls. Blood biochemistry, echocardiography including tissue Doppler imaging (TDI), and vector velocity imaging of the RV free wall to assess global longitudinal strain (GLS) and strain rates (SR) were obtained at baseline and after the intervention.ResultsCompared with controls, MetS patients presented similar right atrial and RV morphology but reduced systolic (P = 0.04) and early diastolic (P = 0.02) velocities of the tricuspid annulus. They showed attenuated RV GLS (−21.4 ± 4.5vs-25.7 ± 4.9%, P < 0.001) as well as early diastolic (P = 0.003) and systolic (P < 0.001) SR. Multiple regression analyses revealed log PAI-1 active, (P < 0.001), log adiponectin, (P = 0.01), LV mass indexed (P = 0.004) and central fat (P = 0.03) as independent predictors of RV GLS (R2 = 0.46, P < 0.001). Biological markers of MetS and inflammation as well as RV GLS (−21.8 ± 3.8vs-24.3 ± 3.0%, P = 0.009) and systolic (P = 0.003) and early diastolic (P = 0.01) SR, but not TDI indexes, significantly improved after diet and exercise training, and vector velocity imaging data in MetS following the lifestyle intervention no longer differed from controls.ConclusionsMetS is associated with subtle impairments in both RV free wall diastolic and systolic myocardial function which could be partly related to central-obesity induced changes in pro- and anti-inflammatory cytokines and left ventricular remodeling. The favorable impact of healthy dieting and physical activity on RV free wall mechanics indicates that cellular and sub-cellular alterations responsible for the RV myocardial abnormalities are probably not permanent and modifiable throughout adequate interventional strategies.Trial registrationAmerican National Institutes of Health database NCT00917917.

Comparison of echocardiographic findings in patients with nonfunctioning adrenal incidentalomas

“…Insulin resistance is associated with early left ventricular changes [26,27]. There are reports that insulin resistance without overt diabetes can also affect right ventricular systolic and diastolic functions assessed by novel echocardiographic techniques [28–30].…”

2-Dimensional Strain Analysis of Regional Change in Right Ventricular Function after Treadmill Exercise

“… 16) 17) 18) 19) Speckle tracking echocardiography is a highly sensitive technique used to detect subtle myocardial dysfunction of systolic abnormalities. 20) 21) 22) Many studies revealed regional analysis of RV using strain analysis in patients undergoing long term exercise. 4) 5) 6) 23) Anjak et al 23) demonstrated that tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity are reliable and accurate measures of the RV response to exercise during a supine bicycle stress echocardiography protocol.…”

Holter registers and metabolic syndrome

“…There are a lot of references that describe the favorable impact of healthy dieting and physical activity in patients with MS, lifestyle intervention based on dietary management and physical exercise is a well-established approach to the management of various cardiometabolic diseases, including diabetes, obesity and MS [4]. Increasing evidence reports favorable and specific effects of lifestyle interventions on central obesity, insulin-resistance, glucose intolerance and inflammation [5][6][7].…”

“…They are frequently benign and require no treatment. However, in some cases they may be so frequent (over 15-20/minute) that they may cause the heart to beat inefficiently enough to cause symptoms which may need to be addressed [4].…”

“…Examples of these abnormal heartbeats are shown in Figs. 1 and 2, we only illustrate some abnormal heartbeats, and it is not our intention to describe all of them, see reference [4] for a detailed description. (Three or more consecutive PVCs are technically referred to as ventricular tachycardia.)…”