title: Right ventricle free wall mechanics in metabolic syndrome without type-2 diabetes: effects of a 3-month lifestyle intervention program.
abstract: BACKGROUND
  Growing 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.
  
  
  METHODS
  Thirty-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.
  
  
  RESULTS
  Compared 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 ± 4.5 vs -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 ± 3.8 vs -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.
  
  
  CONCLUSIONS
  MetS 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.
  
  
  BACKGROUND
  American National Institutes of Health database NCT00917917.
authors.forename: Juan
authors.initials: J
authors.lastname: Serrano-Ferrer
authors.forename: Guillaume
authors.initials: G
authors.lastname: Walther
authors.forename: Edward
authors.initials: E
authors.lastname: Crendal
authors.forename: Agnès
authors.initials: A
authors.lastname: Vinet
authors.forename: Frédéric
authors.initials: F
authors.lastname: Dutheil
authors.forename: Geraldine
authors.initials: G
authors.lastname: Naughton
authors.forename: Bruno
authors.initials: B
authors.lastname: Lesourd
authors.forename: Robert
authors.initials: R
authors.lastname: Chapier
authors.forename: Daniel
authors.initials: D
authors.lastname: Courteix
authors.forename: Philippe
authors.initials: P
authors.lastname: Obert
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006352:Heart Ventricles / Q000187:drug effects / Q000503:physiopathology*; D006801:Humans; D008019:Life Style; D008297:Male; D024821:Metabolic Syndrome / Q000503:physiopathology*; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*; D016278:Ventricular Function, Right / Q000187:drug effects / Q000502:physiology*
chemical_list: D017395:Plasminogen Activator Inhibitor 1