Abstract 18238: Is the Impairment of Diastolic Function in Metabolic Syndrome Simply a Consequence of Hypertension?

Abstract

Purpose: Metabolic syndrome (MS) is associated with diastolic dysfunction (DD). However, hypertension (HTN) is a constituent of MS, which may itself be sufficient to explain this association. Hypothesis: We sought to establish the balance between HTN and visceral adipose (measured as epicardial fat volume, EFV) in DD. Methods: Pts were eligible if cardiac CT and echo were obtained within 6 months, as long as there was no history of myocardial infarction, revascularization), >2+ valvular regurgitation, valvular stenosis or systolic dysfunction. MS was defined by ≥3 of: fasting blood sugar ≥ 100 mg/dl or diagnosis of DM, body mass index >30 kg/m 2 , HTN, triglycerides ≥150 mg/dl or HDL <40 mg/dl. HTN was defined by either use of antihypertensive medication(s) and/or blood pressure ≥ 130/85 mmHg. DD was defined as per ASE guidelines. EFV was measured using previously validated CT software by 2 independent cardiologists blinded to the echo data. Results: Of 110 pts (age 55±13 years, 65% men, body mass index 28±5 kg/m²) HTN, MS and DM were present in 42%, 40% and 12%, respectively. Systolic function (LVEF=58±4%) and mean E/e’ (8±3) were generally normal, but left atrial volume index (25±9 cm³/m²) and diastolic parameters (E/A=1.2±0.5, mean e’ 10±4 cm/s) were variable. Pts were divided into 3 groups: A) MS with HTN; B) MS without HTN; C) No MS but with HTN. Markers of DD are shown in the Table 1. In a univariate analysis, there were no significant differences among the 3 groups in any of the parameters. In contrast, higher EFV was strongly correlated with presence of MS (102±7 vs 80±6 cm 3 , p=0.02) and diastolic dysfunction (107±8 vs 80±6 cm 3 , p=0.005). In a multivariate logistic regression analysis (R 2 =0.39), only age (p<0.001) and EFV (p=0.0008) were independent predictors of DD (decreased mean e'velocities) whereas MS and HTN were not (p=0.7). Conclusions: In conclusion, despite the usual association of DD with HTN, its link with MS seems to involve EFV.