Peculiarities of cardiac remodeling and myocardial dysfunction in metabolic syndrome

Introduction. In 2016, updated recommendations for echocardiographic diagnosis of diastolic dysfunction were developed. It requires a review of the degree of metabolic syndrome (MS) influence on the heart and blood vessels remodeling and the development of left ventricle (LV) diastolic dysfunction (DD).
Purpose. Assessment of the MScontribution to the heart and blood vessels remodeling, as well as to the development of LVDD with an analysis of the LV remodeling types and the degree of LVDD.
Materials and methods. The main group: 130 patients with MS (62 (47,7%) — men, 68 (52,3%) — women; average age — 59,8±9,5 years) who underwent in-patient examination and treatment in the cardiology department for arterial hypertension (AH) in 2015-2017. The control group included 36 patients with AH (18 (50%) — men, 18 (50%) — women; average age — 56,0±12,7 years) without abdominal obesity, not meeting the criteria of MS International Diabetes Federation.
Results. MS is associated with increased prevalence of adverse LV remodeling and DD. In MS group concentric LV hypertrophy was detected significantly commoner than in group without MS, in which concentric remodeling was the most frequent structural abnormality. Eccentric LV hypertrophy was diagnosed only in pts with so-called complete MS. Moreover DD was detected in all pts with complete MS. Type 2 DD was present predominantly in subgroup with complete MS, reflecting relationship between the degree of LV DD and severity of MS in AH pts.
Conclusions. Obtained results confirm adverse influence of central obesity and MS on LV myocardial structure and function.

1. Younis A., Younis A., Tzur B. et al. Metabolic syndrome is independently associated with increased 20-year mortality in patients with stable coronary artery disease // Cardiovasc. Diabetol. 2016. Vol. 15. P. 149. doi: 10.1186/s12933-016-0466-6.

2. Nikolopoulou A., Kadoglou N.P.E. obesity and metabolic syndrome as related to cardiovascular disease // Expert Rev. Cardiovasc. Ther. 2012. Vol. 10 (7). Р. 933-939. doi: 10.1586/erc.12.74.

3. Uchamprina V.A., Romancova T.i., Kalashnikova M.F. Metabolicsyndrome: агgumentspro'sandcon's. Obesity and metabolism, 2012, No. 2, рр. 17-27 (in Russ.).

4. National clinical guidelines / cd. R.G.Oganova. 4th ed. Moscow: Publishing house Silicea-Polygraph, 2011, 568 p. (in Russ.).

5. Russian statistical yearbook. Stat. sb. / Rosstat. Moscow, 2015, 795 p. (in Russ.).

6. Ryden L., Anker S.D., Berne C. et al. ESC Guidelines on diabetes, pre-dia-betes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD) // Eur. Heart J. 2013. Vol. 34 (39). P. 3035-3087. doi: 10.1093/eurheartj/eht108.

7. Catapano A.L., Graham i., De Backer G. et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias // Eur. Heart J. 2016. Vol. 37 (39). Р. 2999-3058. doi: 10.1093/eurheartj/ehw272.

8. Diagnosis and correction of lipid metabolism disorders in order to prevent and treat atherosclerosis. Russian Journal of Cardiology, 2012, No. 4s1, рр. 4-32 (in Russ.). doi: 10.15829/1560-4071-2012-4s1-4-32.

9. Tarasov A.A., Reznikova E.A., Zahar'ina o.A., Gordeeva M.A., Davydov S.i., Babaeva A.R. Vascular lesion markers in early cardiovascular disease diagnostics. Journal of Volgograd State Medical University, 2014, No. 1, рр. 135-139 (in Russ.).

10. Slepuhina E.A., Davydov S.i., Bochkareva o.i., Babaeva A.R. Evaluation of diastolic function of the left ventricle and vascular remodeling in patients with metabolic syndrome. Volgograd Journal of Medical Research, 2016, No. 4, рр. 31-34 (in Russ.).

11. Kuznetsova T., Haddad F., Knez J. et al. Cytokines profile in hypertensive patients with left ventricular remodeling and dysfunction // J. Am. Soc. Hypertens. 2015. No. 9 (12). P. 975-984. doi: 10.1016/j.jash.2015.10,003.

12. Mirhafez S.R., Pasdar A., Avan A. et al. Cytokine and growth factor profiling in patients with the metabolic syndrome // British Journal of Nutrition. 2015. No. 113 (12). P. 1911-1919. doi: 10.1017/S0007114515001038.

13. Prasad H., Ryan D.A., Celzo M.F., Stapleton D. Metabolic syndrome: definition and therapeutic implications // Postgrad Med. 2012. No. 124 (1). P. 2130. doi: 10.3810/pgm.2012.01.2514.

14. Marwick T.H., Gillebert T.C., Aurigemma G. et al. Recommendations on the use of echocardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE) // Eur. Heart J. Cardiovasc. Imaging. 2015. No. 16 (6). P. 577-605. doi: 10.1093/ehjci/jev076.

15. Adamyan K.G., Tunyan L.G., CHilingaryan A.L., Tumasyan L.R. Predictors of Heart Failure With Preserved Ejection Fraction in Patients With Metabolic Syndrome and Preclinical Diastolic Dysfunction. Kardiologiia, 2017, No. 57 (2), рр. 23-29 (In Russ.). doi: 10.18565/cardio.2017.2.23-29.

16. Sokolov A.A., Martsinkevich G.I. Heart Failure in Patients With Preserved Ejection Fraction. Pumping Heart Failure? Kardiologiia, 2018, No 58 (6), рр. 79-84 (In Russ.). doi: 10.18087/cardio.2018.6.10125.

17. Riding E. Echocardiography. Apractical guide. Moscow: Publishing house MEDpress-inform, 2016, 280 p. (In Russ.).

18. Nagueh S.F., Smiseth O.A., Appleton C.P. et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging // J. Am. Soc. Echocardiogr. 2016. Vol. 29 (4). Р. 277-314. doi: 10.1016/j.echo.2016.01.011.

19. Williams B., Mancia G., Spiering W. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension // Eur. Heart J. 2018. Vol. 39 (33). Р. 3021-3104. doi: 10.1093/eurheartj/ehy339.