Are all criteria of metabolic syndrome equally harmful?

Objective: The metabolic syndrome (MS) is associated with subclinical damage of different organs.The aim of this study was to determine which risk factors of MS were independently associated with left ventricular structure and function (diastolic and global).

Methods: The study included 204 subjects with MS and 88 control subjects with no risk factors. The metabolic syndrome was defined by the presence of three or more of ATP-NCEP III criteria. All subjects underwent laboratory blood tests, and complete two-dimensional echocardiography which also included tissue Doppler. The echocardiography was used to assess left ventricular (LV) structure (LVmass/Ht2.7), systolic (LVEF, Ssepptal, Slateral) and diastolic function, by pulse-wave Doppler (E/A ratio) and tissue Doppler imaging (E/e'average), and global function (Tei index). Appropriate time intervals for the estimation of the Tei index were obtained by tissue Doppler.

Results: The LV mass index, E/e'average and Tei index were significantly higher in the MS group, whereas there was no difference in LV systolic function. Multiple regression analysis showed that LVmass/Ht2 was independently associated with systolic blood pressure (beta = 0.41, P < 0.001) and waist circumference (beta = 0.22, P = 0.016).The same analysis revealed that E/e'verage was independently associated with systolic blood pressure (3 = 0.35, P < 0.001), waist circumference (beta = 0.24,P = 0.004) and triglycerides level (3 = 0.21,P = 0.012); while theTei index was independently associated with systolic blood pressure (beta = 0.42, P < 0.001) and fasting glucose (beta = 0.31, P < 0.001).

Conclusion: MS impairs left ventricular structure and diastolic and global function. Systolic blood pressure was the only MS criterion which was, at the same time, independently associated with LVmass/Ht27, E/e'averag3, and the Tei index.