title: Early change of extracellular matrix and diastolic parameters in metabolic syndrome.
abstract: BACKGROUND
  Metabolic syndrome (MS) is associated with increased cardiovascular risk. It is not clear whether myocardial changes showed in this syndrome, such as diastolic dysfunction, are due to the systemic effects of the syndrome, or to specific myocardial effects.
  
  
  OBJECTIVE
  Compare diastolic function, biomarkers representing extracellular matrix activity (ECM), inflammation and cardiac hemodynamic stress in patients with the MS and healthy controls.
  
  
  METHODS
  MS patients (n = 76) and healthy controls (n=30) were submitted to a clinical assessment, echocardiographic study, and measurement of plasma levels of metalloproteinase-9 (MMP9), tissue inhibitor of metalloproteinase-1 (TIMP1), ultrasensitive-reactive-C-Protein (us-CRP), insulin resistance (HOMA-IR) and natriuretic peptide (NT-proBNP).
  
  
  RESULTS
  MS group showed lower E' wave (10.1 ± 3.0 cm/s vs 11.9 ± 2.6 cm/s, p = 0.005), increased A wave (63.4 ± 14.1 cm/s vs. 53.1 ± 8.9 cm/s; p < 0.001), E/E' ratio (8.0 ± 2.2 vs. 6.3 ± 1.2; p < 0.001), MMP9 (502.9 ± 237.1 ng/mL vs. 330.4 ± 162.7 ng/mL; p < 0.001), us-CRP (p = 0.001) and HOMA-IR (p < 0.001), but no difference for TIMP1 or NT-proBNP levels. In a multivariable analysis, only MMP9 was independently associated with MS.
  
  
  CONCLUSIONS
  MS patients showed differences for echocardiographic measures of diastolic function, ECM activity, us-CRP and HOMA-IR when compared to controls. However, only MMP9 was independently associated with the MS. These findings suggest that there are early effects on ECM activity, which cannot be tracked by routine echocardiographic measures of diastolic function.
authors.forename: Angela B S
authors.initials: AB
authors.lastname: Santos
authors.forename: Mauricio
authors.initials: M
authors.lastname: Junges
authors.forename: Daiane
authors.initials: D
authors.lastname: Silvello
authors.forename: Adriana
authors.initials: A
authors.lastname: Macari
authors.forename: Bruno S de
authors.initials: BS
authors.lastname: Araújo
authors.forename: Beatriz G
authors.initials: BG
authors.lastname: Seligman
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Duncan
authors.forename: Luis Eduardo P
authors.initials: LE
authors.lastname: Rohde
authors.forename: Nadine
authors.initials: N
authors.lastname: Clausell
authors.forename: Murilo
authors.initials: M
authors.lastname: Foppa
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000503:physiopathology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003971:Diastole / Q000502:physiology; D005109:Extracellular Matrix / Q000502:physiology*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood; D024821:Metabolic Syndrome / Q000503:physiopathology*; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000097:blood; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D019715:Tissue Inhibitor of Metalloproteinase-1; D002097:C-Reactive Protein; D020780:Matrix Metalloproteinase 9