title: Prevalence and Prognostic Impact of Metabolic Syndrome in Asymptomatic (Stage A and B Heart Failure) Patients.
abstract: BACKGROUND
  Metabolic syndrome (MS) has an increased risk of cardiovascular events. Its relationship with asymptomatic left ventricular dysfunction (LVD) and prognosis has not been completely clarified.
  
  
  OBJECTIVE
  To determine, in asymptomatic patients (Stage A, B heart failure, HF), whether MS is associated with left ventricular systolic dysfunction (LVSD) and left ventricular diastolic dysfunction and its predictive role for cardiovascular events.
  
  
  METHODS
  We included 1920 nonconsecutive patients without symptoms of HF, with at least one cardiovascular risk factor, undergoing echocardiographic evaluation as preventive screening. We subdivided the study population according to the presence (Group 1) or absence (Group 2) of MS. The primary endpoint was a composite of cardiac death, myocardial infarction, coronary artery revascularization, stroke, and acute pulmonary edema. Secondary endpoints were hospitalization for HF and HF progression.
  
  
  RESULTS
  Overall prevalence of MS was 13.4% (n = 262, Group 1). In Group 2 (n = 1658), the prevalence of LVSD was 12.2%, while the prevalence of LVSD was 21.8% in Group 1 (relative risk [RR] 2.01; 95% confidence interval 1.4-2.8; P < 0.001). Adjusting for age and gender, MS resulted an independent predictor of LVSD (P < 0.001). After a median follow-up of 22 months, Group 1 patients had a significantly higher incidence of primary events (P < 0.001), including cardiac death (P = 0.04), and secondary events (P < 0.001). Both primary and secondary endpoints were more frequent in patients with LVSD (P < 0.001). In multivariate survival analysis, MS (but not its specific components) and LVSD were independently associated both with primary and secondary events (P ≤ 0.003). Incremental chi-square analysis showed the presence of combined LVD added to MS, and age raised significantly the predictive value of the model for the primary endpoint (Incremental chi-square = 8.6).
  
  
  CONCLUSIONS
  In stage A and B HF subjects, the coexistence of MS with functional or structural cardiac abnormalities, detected by echocardiography, showed a significant incremental value in predicting clinical cardiovascular events.
authors: 1 Ospedale Villa Sofia , Palermo, Italy .
authors: Salvatore
authors: S
authors: La Carrubba
authors: 2 Ospedale di Pordenone S. Maria degli Angeli-SSD Patologia Cardiovascolare ed Aterosclerosi , Pordenone, Italy .
authors: Francesco
authors: F
authors: Antonini-Canterin
authors: 3 Dipartimento di Patologia Medica, Chirurgica, Molecolare e dell'Area Critica, Università di Pisa , Pisa, Italy .
authors: Iacopo
authors: I
authors: Fabiani
authors: 4 Azienda Ospedaliero Universitaria Policlinico-Bari U.O.C. Cardiologia Ospedaliera , Bari, Italy .
authors: Paolo
authors: P
authors: Colonna
authors: 3 Dipartimento di Patologia Medica, Chirurgica, Molecolare e dell'Area Critica, Università di Pisa , Pisa, Italy .
authors: Nicola Riccardo
authors: NR
authors: Pugliese
authors: 5 Azienda Ospedaliera Monaldi , Napoli, Italy .
authors: Pio
authors: P
authors: Caso
authors: 3 Dipartimento di Patologia Medica, Chirurgica, Molecolare e dell'Area Critica, Università di Pisa , Pisa, Italy .
authors: Lorenzo
authors: L
authors: Conte
authors: 6 UOC Cardiologia Clinica e Riabilitativa Azienda Ospedaliera "Bianchi-Melacrino-Morelli" , Reggio Calabria, Italy .
authors: Frank
authors: F
authors: Benedetto
authors: 7 Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Messina , Messina, Italy .
authors: Concetta
authors: C
authors: Zito
authors: 8 AOU "San Giovanni di Dio e Ruggi d'Aragona" , Salerno, Italy .
authors: Rodolfo
authors: R
authors: Citro
authors: 7 Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Messina , Messina, Italy .
authors: Scipione
authors: S
authors: Carerj
authors: 2 Ospedale di Pordenone S. Maria degli Angeli-SSD Patologia Cardiovascolare ed Aterosclerosi , Pordenone, Italy .
authors: Vitantonio
authors: V
authors: Di Bello
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors