Prevalence of Subclinical Levt Ventricular Diastolic Dysfunction in Patient with Metabolic Syndrome in West Region of the Republic of Macedonia

Abstract

Background: Metabolic Syndrome (MetS) has been associated with subclinical changes in cardiac structure and function, including left ventricular diastolic dysfunction (LVDD) and is strong risk factors for the future development of clinical heart failure, and specifically increases the risk of heart failure with preserved ejection fraction. To date, the evidence on the prevalence of subclinical LVDD in patient with MetS and relation to components of the MetS, in west region of the Republic of Macedonia are scarce. Objective: We sought to determine the prevalence of subclinical LVDD and relation to components of the MetS, in patient with MetS in our region. Methods: We conducted a multicenter observational cross-sectional study. Recruited were 550 consecutive participants,450 with MetS (mean age 50 years,49% women) and 100 controls (no risk factors for MetS; mean 51 years,57% women) , who attended outpatient visits at general cardiology Health Care Clinics in 6 town on western region Republic of Macedonia, during 1 calendar year. Pertcipans underwent echocardiography with tissue Doppler imaging. Results: Participants with MetS, have significantly increased frequency of subclical LVDD grade 1, in comparation with participants without MetS. (39, 7% vs. 6%, p=0.0005). The overall frequency of subclinical LVDD grade 1, in participants with MetS, was 39, 7%; p=0.0005). Subjects with MetS also had worse measures of diastolic function, including: higher Lev Atrial Volum index {(LAVI), (p=0.00), Lower E/A ratio (p=0.00),lower mean e’(p=0.00) and lower E/ e’ ratio(p=0.00), increased Deceleratio time {(DT),(p=0.00)} and Isovolumetric Relaxation time{(IVRT), (p=0.00). Overall, participants with subclinical LVDD, had a worse cardiovascular risk factor profile, including: higher BMI (p=0.001), higher blood pressure{(BP) (p=0.003)}, elevated Weist circumference{(WC)(p=0.001)} and dyslipidemia (p=0.000) in comparation with participants with normal diastolic function. Also, participants with subclinical LVDD,have more risk factors for MetS than participants with normal diastolic function (p=0.002). There was a significant assotiation between subclinical LVDD and: Age (OR=1.108; 95% CI 1.051 -1.168), Females (OR=3.633; 95% CI2.439-5.413), BMI (OR=7.474; 95% CI 4.881-11.443), control of BP (OR=1.763; 95% CI 1.204-2.580) and number of MetS risk factors (OR= 3.609; 95% CI 2.054-6.340). Conclusion: The prevalence of subclinical LVDD in the patients with MetS, in abscence of coronary disease and other well know heart disease, is considerablye high in western region of the Republic of Macedonia and seem to be significantly associated with age, gender, BMI, Levt Ventricular mass index (LVMI) and number of risk factors for MetS.