Metabolic syndrome, strain, and reduced myocardial function: multi-ethnic study of atherosclerosis.
BACKGROUND
Subclinical cardiovascular disease is prevalent in patients with Metabolic Syndrome (MetSyn). Left ventricular (LV) circumferential strain (εCC) and longitudinal strain (εLL), assessed by Speckle Tracking Echocardiography (STE), are indices of systolic function: shortening is indicated by negative strain, and thus, the more negative the strain, the better the LV systolic function. They have been used to demonstrate subclinical ventricular dysfunction in several clinical disorders.


OBJECTIVE
We hypothesized that MetSyn is associated with impaired myocardial function, as assessed by STE.


METHODS
We analyzed Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent STE and were evaluated for all MetSyn components.


RESULTS
Among the 133 participants included [women: 63%; age: 65 ± 9 years (mean ± SD)], the prevalence of MetSyn was 31% (41/133). Individuals with MetSyn had lower εCC and lower εLL than those without MetSyn (-16.3% ± 3.5% vs. -18.4% ± 3.7%, p < 0.01; and -12.1% ± 2.5% vs. -13.9% ± 2.3%, p < 0.01, respectively). The LV ejection fraction (LVEF) was similar in both groups (p = 0.09). In multivariate analysis, MetSyn was associated with less circumferential myocardial shortening as indicated by less negative εCC (B = 2.1%, 95%CI:0.6 3.5, p < 0.01) even after adjusting for age, ethnicity, LV mass, and LVEF). Likewise, presence of MetSyn (B = 1.3%, 95%CI:0.3 2.2, p < 0.01) and LV mass (B = 0.02%, 95% CI: 0.01-0.03, p = 0.02) were significantly associated with less longitudinal myocardial shortening as indicated by less negative εLL after adjustment for ethnicity, LVEF, and creatinine.


CONCLUSIONS
Left ventricular εCC and εLL, markers of subclinical cardiovascular disease, are impaired in asymptomatic individuals with MetSyn and no history of myocardial infarction, heart failure, and/or LVEF < 50%.
Johns Hopkins University, Baltimore, MD, USA.
André Luiz Cerqueira de
AL
Almeida
Johns Hopkins University, Baltimore, MD, USA.
Gisela
G
Teixido-Tura
Johns Hopkins University, Baltimore, MD, USA.
Eui-Young
EY
Choi
Johns Hopkins University, Baltimore, MD, USA.
Anders
A
Opdahl
Johns Hopkins University, Baltimore, MD, USA.
Verônica R S
VR
Fernandes
National Heart, Lung and Blood Institute, Bethesda, MD, USA.
Colin O
CO
Wu
National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD, USA.
David A
DA
Bluemke
Johns Hopkins University, Baltimore, MD, USA.
João A C
JA
Lima
D000368:Aged; D015992:Body Mass Index; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D024821:Metabolic Syndrome / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000503:physiopathology; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D012016:Reference Values; D015203:Reproducibility of Results; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000503:physiopathology