Central Obesity is the Key Component in the Association of Metabolic Syndrome With Left Ventricular Global Longitudinal Strain Impairment

Rev Esp Cardiol (Engl Ed). 2018 Jul;71(7):524-530. doi: 10.1016/j.rec.2017.10.008. Epub 2017 Nov 14.
[Article in English, Spanish]


Introduction and objectives: Subclinical systolic dysfunction is one of the proposed mechanisms for increased cardiovascular risk associated with metabolic syndrome (MS). This study investigated the association between MS and impaired left ventricular global longitudinal strain (GLS) and the role of each MS criteria in this association.

Methods: We analyzed a random sample of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) after excluding participants with prevalent heart disease.

Results: Among the 1055 participants fulfilling the inclusion criteria (53% women; 52±9 years), 444 (42%) had MS. Those with MS had worse GLS (-18.0%±2.5%) than those without (-19.0%±2.4%; P<.0001). In multiple linear regression models, MS was associated with worse GLS after adjustment for various risk factors (GLS difference=0.86%; P <.0001), even after inclusion of body mass index. Adjusted PR for impaired GLS as assessed by 3 cutoffs (1, 1.5, and 2 standard deviations) were higher among participants with than without MS: GLS -16.1% (PR, 1.76; 95%CI, 1.30-2.39); GLS -14.8% (PR, 2.35; 95%CI, 1.45-3.81); and GLS -13.5% (PR, 2.07; 95%CI, 0.97-4.41). After inclusion of body mass index in the models, these associations were attenuated, suggesting that they may, at least in part, be mediated by obesity. In quantile regression analyses, elevated waist circumference was the only MS component found to be independently associated with GLS across the whole range of values.

Conclusions: Metabolic syndrome is independently associated with impaired GLS. Among the MS criteria, central obesity best depicted the link between metabolic derangement and cardiac function.

Keywords: Contracción miocárdica; Ecocardiografía de speckle-tracking; Función del ventrículo izquierdo; Left ventricular function; Metabolic syndrome; Myocardial contraction; Speckle-tracking echocardiography; Strain imaging; Strain miocárdico; Síndrome metabólico.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Brazil
  • Echocardiography
  • Female
  • Humans
  • Male
  • Metabolic Syndrome / complications*
  • Metabolic Syndrome / physiopathology
  • Middle Aged
  • Obesity, Abdominal / complications*
  • Obesity, Abdominal / physiopathology
  • Prospective Studies
  • Risk Factors
  • Stress, Physiological / physiology
  • Stroke Volume / physiology
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / etiology*
  • Ventricular Dysfunction, Left / physiopathology
  • Waist Circumference