Chen Jiming, Wang Xing, Dong Bin, Liu Chen, Zhao Jingjing, Dong Yugang, Liang Weihao, Huang Huiling
Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
National Health Committee (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.
Front Cardiovasc Med. 2022 Aug 11;9:974802. doi: 10.3389/fcvm.2022.974802. eCollection 2022.
Metabolic syndrome is a pre-diabetes condition that is associated with increased cardiovascular morbidity and mortality. We aimed to explore how exercise capacity, cardiac structure, and function were affected in patients with metabolic syndrome.
Outpatients with echocardiography and exercise stress test combined with impedance cardiography (ETT + ICGG) results available from Nov 2018 to Oct 2020 were retrospectively enrolled. Echocardiographic, ETT + ICG profiles, and exercise performance were compared between patients with metabolic syndrome and the ones without. Sensitivity analyses were performed excluding patients without established coronary heart disease and further 1:1 paired for age and gender, respectively. Multiple linear regression was used to find out related predictors for maximal metabolic equivalents (METs).
Three hundred and twenty-third patients were included, among whom 97 were diagnosed as metabolic syndrome. Compared to patients without metabolic syndrome, echocardiography showed that patients with metabolic syndrome had a significantly lower E/A ratio ( < 0.001). Besides, they have larger left atrium, larger right ventricle, and thicker interventricular septum (all < 0.001), but similar left ventricular ejection fraction ( = 0.443). ICG showed that patients with metabolic syndrome had significantly higher stroke volume at rest and maximum ( < 0.001), higher left cardiac work index at rest and maximum ( = 0.005), higher systemic vascular resistance (SVR) at rest ( < 0.001), but similar SVI ( = 0.888). During exercise, patients with metabolic syndrome had lower maximal METs ( < 0.001), and a higher proportion suffering from ST-segment depression during exercise ( = 0.009). Sensitivity analyses yielded similar results. As for the linear regression model, 6 independent variables (systolic blood pressure, BMI, E/A ratio, the height of O wave, the peak value of LCWi, and the baseline of SVR) had statistically significant effects on the maximal METs tested in exercise ( = 0.525, = 0.246, < 0.001).
Patients with metabolic syndrome had significant structural alteration, apparent overburden of left ventricular work index, pre-and afterload, which may be the main cause of impaired exercise tolerance.
代谢综合征是一种糖尿病前期病症，与心血管疾病发病率和死亡率的增加相关。我们旨在探讨代谢综合征患者的运动能力、心脏结构和功能是如何受到影响的。
回顾性纳入2018年11月至2020年10月有超声心动图和运动负荷试验结合阻抗心动图（ETT + ICGG）结果的门诊患者。比较代谢综合征患者和非代谢综合征患者的超声心动图、ETT + ICG特征及运动表现。进行敏感性分析，排除无确诊冠心病的患者，并分别按年龄和性别进行1:1配对。采用多元线性回归来找出最大代谢当量（METs）的相关预测因素。
共纳入323例患者，其中97例被诊断为代谢综合征。与非代谢综合征患者相比，超声心动图显示代谢综合征患者的E/A比值显著更低（<0.001）。此外，他们的左心房更大、右心室更大、室间隔更厚（均<0.001），但左心室射血分数相似（=0.443）。阻抗心动图显示，代谢综合征患者静息和最大时的每搏输出量显著更高（<0.001），静息和最大时的左心作功指数更高（=0.005），静息时的全身血管阻力（SVR）更高（<0.001），但每搏量指数相似（=0.888）。运动期间，代谢综合征患者的最大METs更低（<0.001），运动期间出现ST段压低的比例更高（=0.009）。敏感性分析得出类似结果。对于线性回归模型，6个自变量（收缩压、体重指数、E/A比值、O波高度、左心作功指数峰值和SVR基线）对运动中测试的最大METs有统计学显著影响（=0.525，=0.246，<0.001）。
代谢综合征患者存在明显的结构改变，左心室作功指数、前负荷和后负荷明显过重，这可能是运动耐量受损的主要原因。
