Relation of Epicardial Fat Thickness to Subclinical Right Ventricular Dysfunction Assessed by Strain and Strain Rate Imaging in Subjects with Metabolic Syndrome: A Two‐Dimensional Speckle Tracking Echocardiography Study

Abstract

Metabolic syndrome is associated with subclinical RV systolic and diastolic dysfunction. In subjects with MetS, increased EFT is independently related to RV systolic and diastolic dysfunction.

Subclinical systolic and diastolic dysfunctions in patients with metabolic syndrome and angiographically normal coronary arteries: An echocardiographic study

“…Ivanovic et al reported that the Tei index as an indicator of global LV function was associated with systemic hypertension, diabetes mellitus, and an increased levels of triglyceride, but not decreased levels of high‐density lipoprotein and higher weight. Gökdeniz et al found that an epicardial adipose tissue thickness was significantly higher in patients with MetS, and that it was correlated with RV myocardial dysfunction. In addition, the MetS was associated with subclinical RV diastolic and systolic dysfunction evaluated by RV free and septal walls strain and RV systolic and early diastolic strain rates.…”

Right ventricle free wall mechanics in metabolic syndrome without type-2 diabetes: effects of a 3-month lifestyle intervention program

“…Additionally, there were no differences in RV free wall mechanics indices between subgroups of MetS treated or not for hypertension. Interestingly, Gökdeniz et al [12] did not shown in MetS patients any contributing effect of coexisting hypertension to RV free wall longitudinal strain by speckle tracking imaging. In contrast, systolic blood pressure emerged as an independent contributor to the altered global RV free wall strains reported by Tadic et al [20] in non-diabetic MetS patients.…”

“…This could be due in part to the low magnitude of changes observed and a relatively small sample size, although patients acted as their own controls. Accumulation of ectopic fat to the heart is emerging as the key component of myocardial dysfunction in metabolic diseases [12],[47],[52]. Increased epicardial fat, as established in MetS [53] is a local source of pro- and anti-inflammatory cytokines whereas visceral abdominal fat is mainly responsible for the increased systemic inflammation [42],[44].…”

“…As previously noted, cardiac adiposity was not measured and whether it is involved in the RV myocardial abnormalities reported here and whether improvement in RV function after lifestyle intervention are linked to favorable impacts on myocardial steatosis and/or epicardial fat remains to be determined. Of note, Gökdeniz et al [12] recently demonstrated in MetS patients using speckle tracking imaging, that epicardial fat was independently associated with RV free wall global longitudinal strain.…”

“…Abdominal obesity, glucose intolerance and systemic inflammation biomarkers have emerged as important contributors to the depressed left ventricular longitudinal strain in MetS individuals [3],[8]. Whether right ventricular (RV) free wall mechanics are also altered in MetS remains not yet fully understood, as existing results maybe confounded by the presence of diabetes [9]-[12]. Diabetes is indeed a clinical entity, associated with altered left ventricular and RV free wall mechanics [13]-[18].…”