title: 3D echocardiography: "The most powerful predictor of masked CVD in metabolic syndrome".
abstract: AIMS & OBJECTIVE: To evaluate the impact of the Metabolic Syndrome (MetS) on various echo variables by 3D Echocardiography.
  
  
  METHODS
  100 patients of MetS from indoor and outdoor patient departments were subjected to Echocardiographic and Carotid Doppler evaluation. They were divided into three groups: Group A, Group B and Group C on the basis of age <40 yrs, 40-60 yrs and >60 yrs respectively. The echo variables included left ventricular myocardial performance index (LVMPI), left ventricular mass index (LVMi), left ventricular diastolic dysfunction (LVDD), systolic function (LVEF), left atrial volume index (LAVi) and composite common carotid intima media thickness (CCIMT).
  
  
  RESULTS
  The mean LVMPI was abnormal in all the groups and showed an increasing trend with prolonged LVMPI (> 0.4) in 74% of the total population. Prolonged LVMPI in Group A, Group B and Group C were 12.1%, 52.7% and 35.1% respectively. There was also a strong correlation between LVMPI & LVDD (p-value < 0.0001). Only 9% had systolic dysfunction (LVEF < 50%), but 68% of patients had abnormal diastolic function, of which 53% had grade I LVDD, 12% had grade II LVDD and 3% had grade III diastolic dysfunction. None of our patients had grade IV diastolic dysfunction. The mean LA Vi was normal in all the groups, but LAVi increased with worsening LVDD. The mean LVMi indexed to Body Surface Area (BSA) was normal in all the groups, but showed a statistically significant increasing trend from Group A to Group C (p-value < 0.05). Statistically significant higher LVMi values were observed for males as compared to females (p-value < 0.0001). On analysis of patients having left ventricular hypertrophy (LVH), 76% had concentric remodeling; only 11 % had concentric hypertrophy, but none had eccentric hypertrophy. Most of our patients in Group B & Group C had higher mean Composite CCIMT (0.73 +/- 0.33 & 0.84 +/- 0.42 respectively) which was statistically very significant (p-value < 0.001)
  
  
  CONCLUSIONS
  Metabolic Syndrome is associated with masked cardiovascular disease (CVD) as evident by 3D Echo in this series of patients. LVMPI was an early indicator and the most robust marker of early LVDD. Impaired relaxation was highly prevalent; while LAVi was less robust predictor of LVDD in this series of patients. Concentric left ventricular remodeling was the most common pattern of LVH. Most of our series of patients had increased Composite CCIMT. Thus 3D Echocardiography has great potential and is very useful for early detection and timely therapeutic interventions in patients with subclinical CVD in MetS.
authors.affiliation: Department of Cardiology, Moolchand Medcity, New Delhi-110024, India. drhkchopra@yahoo.com
authors.forename: H K
authors.initials: HK
authors.lastname: Chopra
authors.forename: K K
authors.initials: KK
authors.lastname: Aggarwal
authors.forename: C K
authors.initials: CK
authors.lastname: Krishna
authors.forename: Ravinder S
authors.initials: RS
authors.lastname: Sambi
authors.forename: S K
authors.initials: SK
authors.lastname: Parashar
authors.forename: Rakesh
authors.initials: R
authors.lastname: Gupta
authors.forename: R R
authors.initials: RR
authors.lastname: Kasliwal
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mittal
authors.forename: Manish
authors.initials: M
authors.lastname: Bansal
authors.forename: A K
authors.initials: AK
authors.lastname: Gaur
authors.forename: V
authors.initials: V
authors.lastname: Anand
authors.forename: A K
authors.initials: AK
authors.lastname: Bali
authors.forename: V
authors.initials: V
authors.lastname: Langer
authors.forename: A
authors.initials: A
authors.lastname: Vermani
authors.forename: K N
authors.initials: KN
authors.lastname: Jagadeesh
authors.forename: Sundeep
authors.initials: S
authors.lastname: Mishra
authors.forename: Navin C
authors.initials: NC
authors.lastname: Nanda
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology; D019560:Echocardiography, Three-Dimensional / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D024821:Metabolic Syndrome / Q000503:physiopathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013223:Statistics as Topic; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000473:pathology