Key result
Left ventricle diastolic dysfunction (≥3 ASE/EACVI criteria) in patients with metabolic syndrome and obesity was associated with reduced maximal oxygen uptake (16 vs 19.6 ml/kg/min, p<0.05).
Why the study?
Left ventricle diastolic dysfunction is common in high-risk individuals and associated with reduced exercise capacity, but its prevalence using the 2016 ASE/EACVI guidelines and association with exercise capacity needed assessment in patients with overweight/obesity and metabolic syndrome.
Does the presence of left ventricle diastolic dysfunction according to 2016 ASE/EACVI guidelines associate with reduced exercise capacity in patients with metabolic syndrome and overweight/obesity?
Cross-Sectional (n=235)
Does the presence of left ventricle diastolic dysfunction according to 2016 ASE/EACVI guidelines associate with reduced exercise capacity in patients with metabolic syndrome and overweight/obesity?
Applying the 2016 ASE/EACVI guidelines identifies a small subset (3%) of overweight/obese patients with metabolic syndrome who have definitive LVDD and significantly reduced exercise capacity.
Supports 2016 ASE/EACVI criteria for identifying reduced exercise capacity in metabolic syndrome; leaves open prospective validation before changing practice.
BACKGROUND: Left ventricle diastolic dysfunction (LVDD) is a common finding in high risk individuals, its presence being associated with reduced exercise capacity (EC). We assessed the prevalence of LVDD, applying the 2016 guidelines of the American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI), in a population with overweight/obesity and metabolic syndrome and its association with EC. METHODS AND RESULTS: This was a prospective, cross-sectional study of a cohort of 235 patients (mean age of 65 ± 5 years old and 33% female) without heart disease and an ejection fraction >50% who underwent a complete echocardiographic assessment and cardiopulmonary exercise testing. Individuals meeting three or more criteria of the 2016 ASE/EACVI guidelines are considered to have LVDD, while tests are considered indeterminate in those meeting only two. Overall, 178 (76%) of our patients met one echocardiographic cutoff value for LVDD, 91 (39%) met two and 7 (3%) three or more. Patients meeting three cutoffs values showed a significant reduction in maximal oxygen uptake (16 ± 3 vs. 19.6 ± 5 ml/kg/min, p < .05), unlike those with indeterminate tests. In multiple regression analysis, meeting three cutoffs was associated with number of METS (ß = -2.2, p = .018). In exploratory analysis, using two criteria based on cutoffs different from those proposed in the guidelines, we identified groups with different EC. CONCLUSIONS: The application of 2016 ASE/EACVI guidelines limited the prevalence of LVDD to 3%. This group showed a clear reduction of the EC. New echocardiographic cutoff values proposed in this study allow us to establish subgroups with different levels of EC.
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Alonso‐Gómez et al. (2018) conducted a cross-sectional in Metabolic syndrome and overweight/obesity (n=235). Left ventricle diastolic dysfunction (≥3 criteria of 2016 ASE/EACVI guidelines) vs. Indeterminate tests or fewer criteria was evaluated on Maximal oxygen uptake (p=< .05). Left ventricle diastolic dysfunction (≥3 ASE/EACVI criteria) in patients with metabolic syndrome and obesity was associated with reduced maximal oxygen uptake (16 vs 19.6 ml/kg/min, p<0.05).
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