The impact of epicardial adipose tissue and right ventricular hypertrophy on diastolic and global function of right ventricle in patients with metabolic syndrome

Abstract Background Metabolic syndrome (MetS) and visceral obesity represent important cardiometabolic risk factors. Right ventricular (RV) function is affected in MetS. Epicardial adipose tissue is a metabolically active organ which might influence cardiac morphology and function, especially in patients with MetS. Epicardial fat thickness (EFT) is proposed as a new marker of visceral obesity. Purpose The objective of our study was to evaluate the role of EFT and RV hypertrophy in global (determined by Tei index) and diastolic function of RV in patients with MetS. Methods The study included 85 subjects with MetS (mean age 52±9.1 years) and 85 controls without MetS (mean age 50±8.9 years, P=0.06). MetS was defined by ≥3 criteria of International Diabetes Federation and American Heart Association/National Heart, Lung, and Blood Institute. All the subjects underwent complete 2D echocardiography with the assessment of the ratio of early and late diastolic tricuspid flow velocities (Et/At), the ratio of early diastolic tricuspid flow velocity and early diastolic tricuspid annular velocity (Et/e't), Et deceleration time (DT), RV end-diastolic free wall thickness (EDWT) and EFT. We determined Tei index of RV by pulsed and pulsed tissue Doppler. Results All the parameters of RV diastolic function, as well as Tei index, were significantly changed in MetS group: Et/At 0.85±0.39 vs. 1.17±0.43, P<0.001; Et/e't 5.1±1.3 vs. 4.5±0.8, P<0.001; DT 235±8 ms vs. 208±14 ms, P<0.001; Tei index by pulsed Doppler (0.48±0.05 vs. 0.34±0.06, P<0.001) and by pulsed tissue Doppler (0.58±0.05 vs. 0.46±0.04, P<0.001). Also, RV EDWT was significantly higher in MetS patients (6.3±0.8 mm vs. 4.6±1.2 mm, P<0.001) and positively correlated with Tei index (r=0.658, P<0.001; fig.1.A), Et/e't (r=0.269, P<0.001) and EFT (r=0.547, P<0.001). EFT was higher in MetS subjects (7.9±0.07 mm vs. 5.4±1.2 mm, P<0.001) and correlated with RV Tei index (r=0.614, P<0.001; fig.1.B), Et/e't (r=0.432, P<0.001). Multivariate regression analysis showed that systolic blood pressure, plasma glucose level, EFT and RV EDWT were independently associated with RV global and diastolic dysfunction in patients with MetS (P<0.05 for all parameters). Conclusions Our findings support that MetS is associated with diastolic and global dysfunction of RV. In subjects with MetS increased EFT and RV hypertrophy are independently associated with RV diastolic and global function. Funding Acknowledgement Type of funding source: None