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Canadian Journal of Cardiology

Effects of the Metabolic Syndrome on Right Heart Mechanics and Function

Published:December 19, 2013DOI:https://doi.org/10.1016/j.cjca.2013.12.006

      Abstract

      Background

      We sought to investigate right ventricular (RV) and right atrial (RA) deformation obtained using 3-dimensional echocardiography (3DE) and 2-dimensional (2DE) strain in subjects with the metabolic syndrome (MS).

      Methods

      This cross-sectional study included 108 untreated subjects with the MS and 75 control subjects similar according to sex and age. The MS was defined by the presence ≥ 3 American Heart Association/National Heart, Lung, and Blood Institute criteria. All the subjects underwent adequate laboratory analyses and complete 2DE and 3DE examination.

      Results

      2DE global longitudinal strain of the RV was significantly decreased in the MS group compared with the control subjects (−24 ± 5 vs −27 ± 5%; P < 0.001). Similar results were obtained for the RA longitudinal strain (40 ± 5 vs 44 ± 7%; P < 0.001). Systolic and early diastolic RV and RA strain rates were decreased, whereas late diastolic strain rates were increased among the MS participants compared with the control subjects. 3DE RV ejection fraction was significantly decreased in the MS subjects (55 ± 4 vs 58 ± 4%; P < 0.001). The multivariate analysis of MS criteria showed that systolic blood pressure, waist circumference, and fasting glucose were independently associated with RV and/or RA myocardial function and deformation.

      Conclusions

      RV mechanics and RA mechanics, assessed using 3DE and 2DE strain, were significantly deteriorated in the MS subjects. Among all MS risk factors, systolic blood pressure, abdominal circumference, and fasting glucose were the most responsible for the right heart remodelling.

      Résumé

      Introduction

      Nous avons cherché à examiner la déformation du ventricule droit (VD) et de l’oreillette droite (OD) obtenue au moyen de l’échocardiographie tridimensionnelle (échocardiographie 3D) strain et de l’échocardiographie bidimensionnelle (échocardiographie 2D) strain chez les sujets ayant un syndrome métabolique (SM).

      Méthodes

      Cette étude transversale incluait 108 sujets non traités qui souffraient d’un SM et 75 sujets témoins similaires selon le sexe et l’âge. Le SM a été défini par la présence ≥ 3 critères selon l’American Heart Association et le National Heart, Lung, and Blood Institute. Tous les sujets ont subi des analyses de laboratoire appropriées et un examen complet en échocardiographie 2D et en échocardiographie 3D.

      Résultats

      L’échocardiographie 2D strain longitudinale globale du VD a été significativement diminuée chez le groupe ayant un SM comparativement aux sujets témoins (−24 ± 5 vs −27 ± 5 %; P < 0,001). Des résultats similaires ont été obtenus par le strain longitudinal de l’OD (40 ± 5 vs 44 ± 7 %; P < 0,001). Les vitesses de déformation systolique et diastolique précoce du VD et de l’OD ont été diminuées, tandis que les vitesses de déformation diastolique tardive ont été augmentées chez les participants ayant un SM comparativement aux sujets témoins. La fraction d’éjection du VD à l’échocardiographie 3D a été significativement diminuée chez les sujets ayant un SM (55 ± 4 vs 58 ± 4 %; P < 0,001). L’analyse multivariée des critères du SM a montré que la pression artérielle systolique, le tour de taille et la glycémie à jeun étaient indépendamment associés au fonctionnement et à la déformation myocardiques du VD ou de l’OD, ou du VD et de l’OD.

      Conclusions

      Le mécanisme du VD et le mécanisme de l’OD évalués au moyen de l’échocardiographie 3D strain et l’échocardiographie 2D strain ont été significativement détériorés chez les sujets ayant un SM. Parmi tous les facteurs de risque liés au SM, la pression artérielle systolique, le tour de taille et la glycémie à jeun ont été les principaux responsables du remodelage du cœur droit.
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