Mancusi Costantino, Midtbø Helga, De Luca Nicola, Halland Hilde, de Simone Giovanni, Gerdts Eva
Hypertension Research Center, Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy.
Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway.
J Clin Med. 2021 Apr 8;10(8):1581. doi: 10.3390/jcm10081581.
Lower myocardial mechanic-energetic efficiency (MEEi), expressed as stroke volume/heart rate ratio (SV/HR) in mL/s/g of the left ventricular (LV) mass, is associated with the incidence of heart failure in subjects with cardiometabolic disorders. We explored the association of MEEi with LV systolic circumferential and longitudinal myocardial function in 480 subjects with increased body mass index (BMI) without known cardiovascular disease (mean age 47 ± 9 years, 61% women, 63% obese, 74% with hypertension) participating in the fat-associated cardiovascular dysfunction (FATCOR) study. Insulin resistance was assessed by the homeostasis model assessment insulin-resistance index (HOMA-IR). SV was calculated by Doppler echocardiography. The LV systolic circumferential myocardial function was evaluated by midwall fractional shortening (MFS) and longitudinal function by global longitudinal strain (GLS). Patients were grouped into MEEi quartiles. The lowest MEEi quartile (<0.41 mL/s per g) was considered low MEEi. The association of MEEi with MFS and GLS were tested in multivariable linear regression analyses. Patients with low MEEi were more frequently men, with obesity and hypertension, dyslipidemia and higher HOMA-IR index (all for trend <0.05). In multivariable analyses, lower MEEi was associated with lower LV myocardial function by MFS and GLS independent of higher LV mass and clinical variables, including older age, male sex, presence of hypertension and a higher triglycerides level (all < 0.05). In conclusion, in subjects with increased BMI without known cardiovascular disease participating in the FATCOR study, reduced MEEi was associated with lower LV myocardial function both in the circumferential and longitudinal direction, independent of cardiometabolic factors.
较低的心肌机械 - 能量效率（MEEi），以左心室（LV）质量每克的每搏量/心率比值（SV/HR，单位为mL/s/g）表示，与心脏代谢紊乱患者的心力衰竭发生率相关。我们在480名体重指数（BMI）升高但无已知心血管疾病的受试者（平均年龄47±9岁，61%为女性，63%肥胖，74%患有高血压）中探讨了MEEi与左心室收缩圆周和纵向心肌功能的关联，这些受试者参与了脂肪相关心血管功能障碍（FATCOR）研究。通过稳态模型评估胰岛素抵抗指数（HOMA - IR）评估胰岛素抵抗。通过多普勒超声心动图计算每搏量。通过室壁中层缩短分数（MFS）评估左心室收缩圆周心肌功能，通过整体纵向应变（GLS）评估纵向功能。将患者分为MEEi四分位数组。最低的MEEi四分位数（<0.41 mL/s/g）被认为是低MEEi。在多变量线性回归分析中测试了MEEi与MFS和GLS的关联。低MEEi患者男性比例更高，伴有肥胖、高血压、血脂异常和更高的HOMA - IR指数（所有趋势P<0.05）。在多变量分析中，较低的MEEi与通过MFS和GLS评估的较低左心室心肌功能相关，独立于较高的左心室质量和临床变量，包括年龄较大、男性、高血压的存在和较高的甘油三酯水平（所有P<0.05）。总之，在参与FATCOR研究的无已知心血管疾病且BMI升高的受试者中，MEEi降低与左心室心肌在圆周和纵向方向的功能降低相关，独立于心脏代谢因素。
