Insulin resistance, the metabolic syndrome and global right and left myocardial performance index

الملخص EN

Purpose : Cardiovascular dysmetabolic syndrome (CDS), dysmetabolic syndrome, syndrome X, DROP syndrome (dyslipidemia, insulin resistance (IR), obesity, and high blood pressure) and IR syndrome are all synonymies for the syndrome characterized by four critical elements : atherogenic dyslipidemia, IR, central obesity, and high blood pressure.

The aim of the study was to describe the global right and left myocardial function, in patients with metabolic syndrome (MS), defined according to the criteria proposed by NCEP-ATP III.

Methods : A descriptive, cross-sectional, hospital based study in which, 730 patients, mean age (54 years + 6), (430 men and 300 women) who attended Suez Canal university (SCU) outpatient clinic of cardiology and diabetes were screened for CDS criteria of whom 150 were diagnosed (63 men and 87 women).

Those who met the dysmetabolic syndrome criteria were subjected to careful history taking, blood pressure measurement anthropometric measures (Height and weight, body mass index, waist circumference).

ECG and Blood samples: (Na and K, Fasting blood sugar (FBS), fasting plasma insulin (FPI) (normal values from 5-15 µlU /ml), serum creatinine (S.

Cr.), serum uric acid and Lipids were measured.

HOMA-IR was assessed according to the level of FBS and which was measured with electrochemiluminescence immunoassay method Serum intact pro-insulin was measured by using a highly specific solid phase enzyme linked immunosorbant assay based on sandwich principle.

All participants were subjected to full echocardiographic study including right and left ventriculardiastoiic and systolic function, and the combined index of myocardial performance (Tei index = IRT + ICT / ET).

Results : Most of parameters of insulin resistance (IR) were higher in females than males, fasting plasma insulin, PPBS and HOMA-IR (27 vs.

21 µIu / mL), (162 vs.

151 mg / dl), and (10 vs.

8.5) respectively, (P value < 0.05).

In addition, waist circumference and BM1 were higher in females than males, (130 vs.

127 cm) and (44 vs.

39 kg /m2) respectively, (P value < 0.05).

HDL were higher in females than males (43 vs.

39 mg/dl) respectively, with statistical significant difference (P value'< 0.05).

Total body obesity (BMI) and central obesity (waist circumference) had a statistically significant direct correlation relation with fasting plasma insulin, HOMA-IR, HDL, TG, FBS and PPBS.

Central obesity alone had a statistically significant direct correlation relation with serum uric acid.

Participants with the MS had greater left ventricular (LV) dimension, mass, and relative wall thickness, and left atrial diameter (all p < 0.01), and a higher prevalence of LV hypertrophy (p < O.001), with lower ejection fraction (p < 0.05), and mitral E /A ratio (p < 0.05) than participants who did not have the MS.

Regarding the left ventricular global function there was significant difference between the groups.

On the other hand there is no significant difference regarding right ventricular function between them.

HOMA-IR was a predictor of incident global myocardial left ventricular dysfunction.

Conclusions: The metabolic syndrome is associated with a global left rather than right ventricular dysfunction and HOMA-IR is a predictor.

There is a pressing need for a national preventive program to combat obesity, diabetes and related co morbidities by general practitioners and dialectologists