Chopra H K, Aggarwal K K, Krishna C K, Sambi Ravinder S, Parashar S K, Gupta Rakesh, Kasliwal R R, Mittal Sanjay, Bansal Manish, Gaur A K, Anand V, Bali A K, Langer V, Vermani A, Jagadeesh K N, Mishra Sundeep, Nanda Navin C
Department of Cardiology, Moolchand Medcity, New Delhi-110024, India.
Indian Heart J. 2009 May-Jun;61(3):231-41.
AIMS & OBJECTIVE: To evaluate the impact of the Metabolic Syndrome (MetS) on various echo variables by 3D Echocardiography.
100 patients of MetS from indoor and outdoor patient departments were subjected to Echocardiographic and Carotid Doppler evaluation. They were divided into three groups: Group A, Group B and Group C on the basis of age <40 yrs, 40-60 yrs and >60 yrs respectively. The echo variables included left ventricular myocardial performance index (LVMPI), left ventricular mass index (LVMi), left ventricular diastolic dysfunction (LVDD), systolic function (LVEF), left atrial volume index (LAVi) and composite common carotid intima media thickness (CCIMT).
The mean LVMPI was abnormal in all the groups and showed an increasing trend with prolonged LVMPI (> 0.4) in 74% of the total population. Prolonged LVMPI in Group A, Group B and Group C were 12.1%, 52.7% and 35.1% respectively. There was also a strong correlation between LVMPI & LVDD (p-value < 0.0001). Only 9% had systolic dysfunction (LVEF < 50%), but 68% of patients had abnormal diastolic function, of which 53% had grade I LVDD, 12% had grade II LVDD and 3% had grade III diastolic dysfunction. None of our patients had grade IV diastolic dysfunction. The mean LA Vi was normal in all the groups, but LAVi increased with worsening LVDD. The mean LVMi indexed to Body Surface Area (BSA) was normal in all the groups, but showed a statistically significant increasing trend from Group A to Group C (p-value < 0.05). Statistically significant higher LVMi values were observed for males as compared to females (p-value < 0.0001). On analysis of patients having left ventricular hypertrophy (LVH), 76% had concentric remodeling; only 11 % had concentric hypertrophy, but none had eccentric hypertrophy. Most of our patients in Group B & Group C had higher mean Composite CCIMT (0.73 +/- 0.33 & 0.84 +/- 0.42 respectively) which was statistically very significant (p-value < 0.001)
Metabolic Syndrome is associated with masked cardiovascular disease (CVD) as evident by 3D Echo in this series of patients. LVMPI was an early indicator and the most robust marker of early LVDD. Impaired relaxation was highly prevalent; while LAVi was less robust predictor of LVDD in this series of patients. Concentric left ventricular remodeling was the most common pattern of LVH. Most of our series of patients had increased Composite CCIMT. Thus 3D Echocardiography has great potential and is very useful for early detection and timely therapeutic interventions in patients with subclinical CVD in MetS.
目的：通过三维超声心动图评估代谢综合征（MetS）对各种超声心动图变量的影响。
对来自室内和室外科室的100例MetS患者进行超声心动图和颈动脉多普勒评估。根据年龄分别分为三组：A组年龄<40岁，B组年龄40 - 60岁，C组年龄>60岁。超声心动图变量包括左心室心肌性能指数（LVMPI）、左心室质量指数（LVMi）、左心室舒张功能障碍（LVDD）、收缩功能（LVEF）、左心房容积指数（LAVi）和颈总动脉内膜中层复合厚度（CCIMT）。
所有组的平均LVMPI均异常，在74%的总人口中，LVMPI延长（>0.4）呈上升趋势。A组、B组和C组LVMPI延长的比例分别为12.1%、52.7%和35.1%。LVMPI与LVDD之间也存在强相关性（p值<0.0001）。只有9%的患者有收缩功能障碍（LVEF<50%），但68%的患者有舒张功能异常，其中53%为I级LVDD，12%为II级LVDD，3%为III级舒张功能障碍。我们的患者均无IV级舒张功能障碍。所有组的平均LA Vi均正常，但LAVi随LVDD加重而增加。所有组以体表面积（BSA）校正的平均LVMi均正常，但从A组到C组呈统计学显著上升趋势（p值<0.05）。与女性相比，男性的LVMi值在统计学上显著更高（p值<0.0001）。在分析有左心室肥厚（LVH）的患者时，76%有向心性重塑；只有11%有向心性肥厚，但无一例有离心性肥厚。B组和C组的大多数患者平均复合CCIMT较高（分别为0.73±0.33和0.84±0.42），在统计学上非常显著（p值<0.001）
在这一系列患者中，三维超声心动图显示代谢综合征与隐匿性心血管疾病（CVD）相关。LVMPI是早期指标，也是早期LVDD最可靠的标志物。舒张功能受损非常普遍；而在这一系列患者中，LAVi对LVDD的预测性较差。向心性左心室重塑是LVH最常见的模式。我们这一系列患者中的大多数复合CCIMT增加。因此，三维超声心动图在MetS亚临床CVD患者的早期检测和及时治疗干预方面具有巨大潜力且非常有用。
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