Left Ventricular Hypertrophy in Metabolic Syndrome Patients without Hypertension

Metabolic syndrome (MetS) is association of group of cardiovascular risk factors that includes insulin resistance, impaired glucose metabolism, obesity, dyslipidemia with high triglycerides and low level of high-density lipoprotein cholesterol (HDL-C), and elevated blood pressure. Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular events. Although left ventricular overload is the main factor responsible for LVH, other factors have been suggested to induce LVH in hypertensive patients like genetic, environmental, and metabolic factors. Previous studies have shown the strong association between Mets and LVH in hypertensive patients. However, the relation between LVH and MetS in the absence of hypertension has not been studied. AIM OF THE WORK was to compare between left ventricular mass in metabolic syndrome patients without hypertension and in healthy control subjects. SUBJECTS AND METHODS, - One hundred subjects (49 males and 51 females) were included in the study, among them 50 healthy control subjects (26 males and 24 females) and 50 metabolic syndrome patients without hypertension (23 males and 27 females). We excluded patients with hypertension, coronary artery disease, significant valvular or congenital heart disease, or congestive heart failure from the study. All patients were submitted to full history taking and clinical examination with measuring of weight, height, and waist circumference, complete 12-leads electrocardiography (ECG), laboratory testing with measuring of fasting serum lipids, fasting blood glucose, and hemoglobin A1c, and echocardiographic with assessment of left ventricular diastolic (LVEDD) and systolic dimensions (LVESD), fraction of shortening (FS), ejection fraction (EF), Doppler derived mitral valve flow velocity waves (E-wave, A-wave, E/A ratio), left ventricular mass and mass index. RESULTS, - Regarding clinical and laboratory data there was no significant difference between the study groups concerning age, sex, or smoking, heart rate, systolic and diastolic blood pressure. Mean weight, waist circumference, body mass index, fasting blood glucose level, hemoglobin A1c level, and triglyceride level were significantly higher while mean HDL-c leave was significantly lower in patients with MetS than in control subjects. Regarding echocardiographic data (table 3), there was no significant difference between the two groups regarding LVEDD, LVESD, FS, EF, E-wave velocity, A-wave velocity, or E/A ratio. Mean posterior wall thickness, inter-ventricular septal thickness, left ventricular mass, left ventricular mass index, and incidence of LVH were significantly higher in MetS patients. There was a significant positive correlation between LVMI and all of the following blood glucose level (r = 0.528, p less than0.00001), hemoglobin A1c (r = 0.416, p less than0.0001), and triglycerides level (r = 535, p less than0.00001). There was a significant negative correlation between LVMI and HDL-c level (r = - 0.377, p less than0.0001). CONCLUSION, - Even in the absence of hypertension, MetS patients had significantly more, LV wall thickness, more LV mass and mass index, and more incidence of LVH than control subjects.