Canadian Journal of Cardiology 30 (2014) 325e331
Clinical Research
Effects of the Metabolic Syndrome on Right Heart Mechanics and Function Marijana Tadic, MD, PhD,a Cesare Cuspidi, MD,b Aleksandra Sljivic, MD,a Anita Andric, MD,a Branislava Ivanovic, MD, PhD,c,d Radisav Scepanovic, MD, PhD,a,d Irena Ilic, MD,a Ljilja Jozika, RN,a Tamara Marjanovic, RN,a and Vera Celic, MD, PhDa,d a b
University Clinical Hospital Center “Dr Dragisa Misovic,” Belgrade, Serbia
University of Milan-Bicocca and Istituto Auxologico Italiano, Clinical Research Unit, Meda, Italy c
Clinical Centre of Serbia, Clinic of Cardiology, Belgrade, Serbia d
University of Belgrade, Faculty of Medicine, Belgrade, Serbia
See editorial by Fitchett and Connelly on pages 270-271 and article by Crendal et al. on pages 320-324 of this issue. ABSTRACT
RESUM E
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
à examiner la de formation du Introduction : Nous avons cherche ventricule droit (VD) et de l’oreillette droite (OD) obtenue au moyen de chocardiographie tridimensionnelle (e chocardiographie 3D) strain et l’e chocardiographie bidimensionnelle (e chocardiographie 2D) de l’e tabolique (SM). strain chez les sujets ayant un syndrome me thodes : Cette e tude transversale incluait 108 sujets non traite s qui Me moins similaires selon le sexe et souffraient d’un SM et 75 sujets te te de fini par la pre sence 3 critères selon l’American l’âge. Le SM a e Heart Association et le National Heart, Lung, and Blood Institute. Tous es et un les sujets ont subi des analyses de laboratoire approprie chocardiographie 2D et en e chocardiographie examen complet en e 3D. sultats : L’e chocardiographie 2D strain longitudinale globale du VD Re te significativement diminue e chez le groupe ayant un SM a e
The right ventricle (RV) has been considered for a long time as a ‘dispensable’ cardiac chamber that is not particularly important for overall cardiac function. Additionally, traditional 2-dimensional echocardiographic methods could not provide an accurate determination of RV structure and function because of their complex geometry.1 The MultiEthnic Study of Atherosclerosis (MESA) study, which included more than 5000 participants who were investigated using cardiac magnetic resonance (MR), brought into light the RV and its importance for cardiac mortality and the risk of
heart failure in a multiethnic population free of clinical cardiovascular disease at the baseline.2 This study also provided the evidence about the relationship between age, sex, race, and different risk factors and RV structure and function.2-4 The MESA study established the cardiac MR as the gold standard for RV imaging. However, development of new echocardiographic techniques such as 3-dimensional echocardiography (3DE) and 2-dimensional (2DE) speckle tracking imaging provided accurate information about RV morphology and deformation, comparable with cardiac MR.5,6 Our study group previously reported RV remodelling in the metabolic syndrome (MS).7,8 However, at that time we did not have any opportunity to use sophisticated echocardiography such as 3DE and 2DE strain. However, recent studies demonstrated the relationship between arterial hypertension, diabetes, and obesity with RV function and mechanics using 2DE strain.9-11 Crendal et al. demonstrated the
Received for publication November 14, 2013. Accepted December 8, 2013. Corresponding author: Dr Marijana Tadic, University Clinical Hospital Center “Dr Dragisa Misovic,” Heroja Milana Tepica 1, 11000 Belgrade, Serbia. E-mail: [email protected] See page 329 for disclosure information.
0828-282X/$ - see front matter Ó 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.cjca.2013.12.006
326
Canadian Journal of Cardiology Volume 30 2014
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.
moins (24 5 vs 27 5 %; P < comparativement aux sujets te sultats similaires ont e te obtenus par le strain longitu0,001). Des re dinal de l’OD (40 5 vs 44 7 %; P < 0,001). Les vitesses de formation systolique et diastolique pre coce du VD et de l’OD ont e te de es, tandis que les vitesses de de formation diastolique tardive diminue te augmente es chez les participants ayant un SM comparativeont e moins. La fraction d’e jection du VD à ment aux sujets te chocardiographie 3D a e te significativement diminue e chez les l’e sujets ayant un SM (55 4 vs 58 4 %; P < 0,001). L’analyse e des critères du SM a montre que la pression arte rielle multivarie mie à jeun e taient systolique, le tour de taille et la glyce pendamment associe s au fonctionnement et à la de formation inde myocardiques du VD ou de l’OD, ou du VD et de l’OD. canisme du VD et le me canisme de l’OD e value s Conclusions : Le me chocardiographie 3D strain et l’e chocardiographie 2D au moyen de l’e te significativement de te riore s chez les sujets ayant un SM. strain ont e s au SM, la pression arte rielle Parmi tous les facteurs de risque lie mie à jeun ont e te les principaux systolique, le tour de taille et la glyce responsables du remodelage du cœur droit.
relationship between the MS and its parameters with left ventricular mechanics.12 The data about the influence of various cardiovascular risk factors, including the MS, on the right atrium (RA) are very limited. We have previously shown that RA remodelling was present in the MS,8 but we did not use strain analyses. To our knowledge, there is no study that investigated RV and RA function and deformation, using 2DE strain and 3DE, in subjects with the MS. The purposes of our study were: (1) to investigate RV and RA function and mechanics in the subjects with the MS; and (2) to determine the relationship between different MS criteria and mechanical function of the right heart.
Regarding laboratory analyses, we used the levels of fasting glucose, total cholesterol, triglycerides, low- and high-density lipoprotein (HDL) cholesterol. The MS was defined according to the American Heart Association/National Heart, Lung, and Blood Institute definition,13 which has been shown to have better predictive value than other definitions.14 The American Heart Association/ National Heart, Lung, and Blood Institute criteria for the MS are: high blood pressure (130/85 mm Hg), abdominal obesity (waist circumference 102 cm in men and 88 cm in women), increased fasting triglycerides (1.7 mmol/L), decreased HDL cholesterol (
Clinical Research
Effects of the Metabolic Syndrome on Right Heart Mechanics and Function Marijana Tadic, MD, PhD,a Cesare Cuspidi, MD,b Aleksandra Sljivic, MD,a Anita Andric, MD,a Branislava Ivanovic, MD, PhD,c,d Radisav Scepanovic, MD, PhD,a,d Irena Ilic, MD,a Ljilja Jozika, RN,a Tamara Marjanovic, RN,a and Vera Celic, MD, PhDa,d a b
University Clinical Hospital Center “Dr Dragisa Misovic,” Belgrade, Serbia
University of Milan-Bicocca and Istituto Auxologico Italiano, Clinical Research Unit, Meda, Italy c
Clinical Centre of Serbia, Clinic of Cardiology, Belgrade, Serbia d
University of Belgrade, Faculty of Medicine, Belgrade, Serbia
See editorial by Fitchett and Connelly on pages 270-271 and article by Crendal et al. on pages 320-324 of this issue. ABSTRACT
RESUM E
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
à examiner la de formation du Introduction : Nous avons cherche ventricule droit (VD) et de l’oreillette droite (OD) obtenue au moyen de chocardiographie tridimensionnelle (e chocardiographie 3D) strain et l’e chocardiographie bidimensionnelle (e chocardiographie 2D) de l’e tabolique (SM). strain chez les sujets ayant un syndrome me thodes : Cette e tude transversale incluait 108 sujets non traite s qui Me moins similaires selon le sexe et souffraient d’un SM et 75 sujets te te de fini par la pre sence 3 critères selon l’American l’âge. Le SM a e Heart Association et le National Heart, Lung, and Blood Institute. Tous es et un les sujets ont subi des analyses de laboratoire approprie chocardiographie 2D et en e chocardiographie examen complet en e 3D. sultats : L’e chocardiographie 2D strain longitudinale globale du VD Re te significativement diminue e chez le groupe ayant un SM a e
The right ventricle (RV) has been considered for a long time as a ‘dispensable’ cardiac chamber that is not particularly important for overall cardiac function. Additionally, traditional 2-dimensional echocardiographic methods could not provide an accurate determination of RV structure and function because of their complex geometry.1 The MultiEthnic Study of Atherosclerosis (MESA) study, which included more than 5000 participants who were investigated using cardiac magnetic resonance (MR), brought into light the RV and its importance for cardiac mortality and the risk of
heart failure in a multiethnic population free of clinical cardiovascular disease at the baseline.2 This study also provided the evidence about the relationship between age, sex, race, and different risk factors and RV structure and function.2-4 The MESA study established the cardiac MR as the gold standard for RV imaging. However, development of new echocardiographic techniques such as 3-dimensional echocardiography (3DE) and 2-dimensional (2DE) speckle tracking imaging provided accurate information about RV morphology and deformation, comparable with cardiac MR.5,6 Our study group previously reported RV remodelling in the metabolic syndrome (MS).7,8 However, at that time we did not have any opportunity to use sophisticated echocardiography such as 3DE and 2DE strain. However, recent studies demonstrated the relationship between arterial hypertension, diabetes, and obesity with RV function and mechanics using 2DE strain.9-11 Crendal et al. demonstrated the
Received for publication November 14, 2013. Accepted December 8, 2013. Corresponding author: Dr Marijana Tadic, University Clinical Hospital Center “Dr Dragisa Misovic,” Heroja Milana Tepica 1, 11000 Belgrade, Serbia. E-mail: [email protected] See page 329 for disclosure information.
0828-282X/$ - see front matter Ó 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.cjca.2013.12.006
326
Canadian Journal of Cardiology Volume 30 2014
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.
moins (24 5 vs 27 5 %; P < comparativement aux sujets te sultats similaires ont e te obtenus par le strain longitu0,001). Des re dinal de l’OD (40 5 vs 44 7 %; P < 0,001). Les vitesses de formation systolique et diastolique pre coce du VD et de l’OD ont e te de es, tandis que les vitesses de de formation diastolique tardive diminue te augmente es chez les participants ayant un SM comparativeont e moins. La fraction d’e jection du VD à ment aux sujets te chocardiographie 3D a e te significativement diminue e chez les l’e sujets ayant un SM (55 4 vs 58 4 %; P < 0,001). L’analyse e des critères du SM a montre que la pression arte rielle multivarie mie à jeun e taient systolique, le tour de taille et la glyce pendamment associe s au fonctionnement et à la de formation inde myocardiques du VD ou de l’OD, ou du VD et de l’OD. canisme du VD et le me canisme de l’OD e value s Conclusions : Le me chocardiographie 3D strain et l’e chocardiographie 2D au moyen de l’e te significativement de te riore s chez les sujets ayant un SM. strain ont e s au SM, la pression arte rielle Parmi tous les facteurs de risque lie mie à jeun ont e te les principaux systolique, le tour de taille et la glyce responsables du remodelage du cœur droit.
relationship between the MS and its parameters with left ventricular mechanics.12 The data about the influence of various cardiovascular risk factors, including the MS, on the right atrium (RA) are very limited. We have previously shown that RA remodelling was present in the MS,8 but we did not use strain analyses. To our knowledge, there is no study that investigated RV and RA function and deformation, using 2DE strain and 3DE, in subjects with the MS. The purposes of our study were: (1) to investigate RV and RA function and mechanics in the subjects with the MS; and (2) to determine the relationship between different MS criteria and mechanical function of the right heart.
Regarding laboratory analyses, we used the levels of fasting glucose, total cholesterol, triglycerides, low- and high-density lipoprotein (HDL) cholesterol. The MS was defined according to the American Heart Association/National Heart, Lung, and Blood Institute definition,13 which has been shown to have better predictive value than other definitions.14 The American Heart Association/ National Heart, Lung, and Blood Institute criteria for the MS are: high blood pressure (130/85 mm Hg), abdominal obesity (waist circumference 102 cm in men and 88 cm in women), increased fasting triglycerides (1.7 mmol/L), decreased HDL cholesterol (
