The Study On Left Ventricular Function Change In Patients With Metabolic Syndrome By Real-Time Three-Dimensional Echocardiography,Strain And Strain Rate Imaging And The Relationship Between Left Ventricular Function And Adiponectin

BackgroundMany clinical studies show that cluster of risk factors that include type 2 diabetes mellitus impaired glucose tolerance, hypertension, disorder of lipid and central obesity often assembled with the same patient. In 1988, Reaven brought out the definition of Metabolic syndrome, It included the insulin resistance, lipid dysfunction, and hypertension which is also called X syndrome or insulin resistance syndrome. The prevalence of metabolic syndrome is increased in developed and developing countries as a result of improved living standard. As hypertension and obesity are major abnormalities of metabolic syndrome, and also the common reason for cardiac dysfunction. Cardiac function evaluation is an important guidance in diagnosing,therapeutic effect and prognostic assessment of cardiovascular disease.Angiocardiography and magnetic resonance imaging are used to evaluate left ventricular function broadly, but these two methods have the shortage of invasion,too expensive and being difficult for repeating exam. Compared to these two methods, echocardiograpy can estimate the movements of ventricular wall and the changes of cardiac dynamic noninvasively , precise nature and lack of ionizing radiation make it more broad applicable than other accepted techniques. Estimating cardiac-function is one of the most important contents of echocardiography. Because of noninvasive and high repeatability, echocardiography plays an important role in diagnosing disease of cardiovascular system.Metabolic syndrome comes together with decreasing of serum adiponectin. And adiponectin has multiple anti-arteriosclerosis actions. It is very important for cardiac function nonage change to make clear the relationship between metabolic syndrome and adiponectin.Objective1.To investigate LV globe and regional heart function changes , systolic synchrony in patients with MS early by strain rate imaging(SRI),strain imaging(SI) and real-time three-dimensional echocardiography(RT-3DE) simultaneously.2. To evaluate relationship among the level of serum adiponectin and cardiac function change.Methods120 patients were studied which were divided into two groups. 60 cases are diagnosed as Metabolic syndrome according to the diagnostic standard of IDF, consisting of 32 males, 28 females, 45-70 years old, with a mean age (59.1±10.5) years old; 60 cases in control without Metabolic syndrome consists of 33 males, 27 females, 47-68 years old, with a mean age (56±15.7) years old. Then we collected patients' history, had them take EKG examination and determined serum adiponectin by ELISA.Equipments and apparatus: PHILIPS IE-33 ultrasound scanner (Holland) was used to acquire 2DE, RT-3DE data, which has probe S5-1 and probe X3-1 with 2-4MHz array transducer. The data was analyzed using Qlab system .Measurement and calculate methods: Transthoracic two-dimensional, tissue Doppler and three-dimensional echocardiography examination were performed in all study objects .We use Qlab analysis software to analyze the data.Statistical analysis: All numeric data were displayed as mean±standard deviation and have been analyzed by SPSS 13.0. For all analysis, a p value of< 0.05 was considered significant.Results1 There was significant difference between two groups with metabolic syndrome and without metabolic syndrome in weight, waist, body surface area, body mass index, smoking index and alcohol consumption(p<0.05). The levels of TC, TG, LDL-C and glucose of groups with metabolic syndrome was higher than that of the groups without metabolic syndrome (p <0.05); No difference was found in the level of HDL-C and height between the two groups. SBP in patients with metabolic syndrome was higher than that of the objects without metabolic syndrome The level of adiponectin of the patients with metabolic syndrome was lower than that of the objects without metabolic syndrome (p <0.05).2 Research work proved that E/A of MV and TV was significantly decreased, while trans-mitral flow velocity to mitral annular velocity ratio (E/E')was higher in patients with metabolic syndrome than that in group without metabolic syndrome (p <0.05).3 Compare the global function results by three echo examinations: there was no significant difference among the data acquired using three echo methods (p>0.05). EDV, ESV and EF of left ventricular in group with metabolic syndrome and group without metabolic syndrome are nearly same(P>0.05); some segments function reduced obviously in group with metabolic syndrome than that in group without metabolic syndrome.4 The 17 segment volume-time curves of group with metabolic syndrome have ill-defined appearances comparing with that of group without metabolic syndrome; the end systolic time reaching minimal systolic volume is irregular; the wall motion has bad synchronism.5 Tmsv16-SD, Tmsv16-Dif, Tmsv12-SD, Tmsv12-Dif Tmsv1-4Dif, Tmsv2-5Dif and heart rate correction value Tmsv16-SD%, Tmsv16-Dif%, Tmsv12-SD%, Tmsv12-Dif%, Tmsv1-4Dif%, Tmsv2-5Dif%in group with metabolic syndrome is higher than in group without metabolic syndrome (P<0.05).6 The analysis showed that the strain rate curve and strain curve of left ventricular in group with metabolic syndrome was chaotic. S, E and A of strain rate andεof some segments were lower significantly in group with Metabolic syndrome than in group without metabolic syndrome.7 There was significant negative correlation existed between adiponectin and weight, waist, TC, TG, LDL-C , glucose and E/E'(p<0.05). There was significant excellent linear correlation existed between adiponectin and E/A of mitral annulus (p <0.05).Conclusion1. The patients with metabolic syndrome have a lower level of adiponectin than the objects without metabolic syndrome. Some segments of left ventricular displayed bad synchronism. It suggests that the lower level of protective factor in body2. Trans-mitral flow velocity to mitral annular velocity ratio (E/E') has a strong positive relationship with left ventricular filling pressure, which presents as a good indicator for evaluating left ventricular diastolic relaxation abnormality, the relaxation parameter (E/E') by TDE changed earlier than contraction indices by TDE and conventional echocardiography witch provide a new sensitive and reliable method to evaluate LV relaxation function.3 From the study, it can be shown that the children with metabolic syndrome can be early examined by strain rate imaging and three-dimensional echocardiography, which can not be found by conventional echocardiography. The SRI and RT-3DE can detect the abnormal segments movement of regional cardiac and can completely evaluate the whole and regional systolic and diastolic function of left ventricular, which makes systolic asynchrony evaluation for left ventricular more exact and more rapid.4 Adiponect is closely related with global diastolic function, regional systolic and diastolic function of left ventricular, which might lead to a bad prognosis.