Left atrial strain improves echocardiographic classification of diastolic function in patients with metabolic syndrome and overweight-obesity
Introduction
The presence of alterations in left ventricular diastolic function is well established in patients with cardiovascular risk factors who are obese and/or overweight [1,2] and in clinical practice this finding is detected using Doppler echocardiography. Current recommendations for the assessment of diastolic function by echocardiography are based on the use of different echocardiographic criteria [3], and although there is evidence that this strategy has increased specificity in the diagnosis of diastolic dysfunction (DDVI), these algorithms applied to the individual result in a high proportion of indeterminate diagnoses [4,5]. In order to improve the echocardiographic classification of LVDD, other echocardiographic parameters have been proposed, mainly those assessing left atrial function and specifically left atrial strain [6,7]. Abnormalities of diastolic function have been shown to be associated with reduced aerobic functional capacity (FAC) in people with diabetes, hypertension and obesity [5,8]. The main objective of this study is to assess whether adding the LALS criterion to the current classification can reduce the number of patients diagnosed with indeterminate LVDD.
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Patient population and design
Prospective cohort study of Predimed Plus trial participants in the Vitoria node at study entry. Predimed Plus is a multicentre, randomized, parallel-group, primary cardiovascular prevention study that compares the effect on cardiovascular morbidity and mortality of an intensive lifestyle intervention based on a low-calorie Mediterranean diet, increased physical activity and behaviour therapy (intervention group) with a non-intensive Mediterranean diet intervention without calorie restriction
Demographics and clinical characteristic of population
Of the 274 patients who met the entry criteria for the Predimed Plus study, 235 were selected who were in sinus rhythm, had an ejection fraction greater than 50%, had a complete echocardiographic study including 2DSTE of the left ventricle and a valid ergospirometry. In 229 it was possible to obtain measures of the LALS in its three components. The mean age was 65 ± 5 years and 76 (33%) were women. Table 1 shows the demographic, analytical and echocardiographic data of the group, which shows a
Discussion
The main results of this study, in which we have assessed the echocardiographic diagnosis of diastolic dysfunction in a population with metabolic syndrome and overweight/obesity, were: 1) to find a higher prevalence of diastolic dysfunction with a higher percentage of inconclusive studies than in the normal population. 2) to document the value of LALS to reduce the percentage of patients with indeterminate studies. We have used the ASE/EACVI-2016 recommendations because their accuracy has been
Conclusions
This study confirms the low prevalence of diastolic dysfunction in overweight/obese metabolic syndrome and the limitations of the recommended classification for its echocardiographic diagnosis. Adding left atrial strain criterion significantly reduces the number of indeterminate studies by reclassifying them as normal. The values obtained for maximal oxygen uptake, considered as a surrogate for diastolic dysfunction, support the usefulness of the left atrial strain as a main criterion for
Source of funding
This work has been funded: 1.- Carlos III Health Institute (Ministry of Economy, Industry and Competitiveness) through a health research fund (FIS) project coordinated by Dr. Jordi Salas-Salvadó (PI13/01056), by the CIBEROBN (Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition). 2.- The European Research Council (Advanced Research Grant 2014-2019; 340918) awarded to Dr. Miguel A. González-Martínez. 3.- Research reported in this publication was supported by the
Authors' contribution
Angel M Alonso Gómez: Has contributed substantially to the conception and design, data acquisition, or their analysis and interpretation. Has drafted the article and made a critical review of its intellectual content. Has agreed to take responsibility for all aspects of the article and has investigated and resolved any questions regarding the accuracy and truthfulness of any part of the work.
Lucas Tojal Sierra: Has contributed substantially to the conception and design, data acquisition, or
Declaration of Competing Interest
Alvaro Alonso: Reports NIH grants during the conduct of the study.
Jordi Salas-Salvadó: Declares having received grants from CIBEROBN, ISCIII, Spain, during the study; non-financial support from the Nut and Dried Fruit Foundation, personal fees from the Danone Institute Spain, grants from the Nut and Dried Fruit Foundation, personal fees from the Nut and Dried Fruit Foundation, non-financial support from Danone Institute International, others from the Patronato Español Olivarero, others from the
Acknowledgements
Jordi Salas-Salvadó, co‑lead author, gratefully acknowledges the financial support of ICREA in the framework of the ICREA Academy Programme.
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This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.