Angel M Alonso Gómez1, Lucas Tojal Sierra2, Noris Mora Mora3, Estefanía Toledo4, Alvaro Alonso5, María Garrido Uriarte6, Carolina Sorto Sanchez7, María P Portillo8, Luis López Rodriguez9, Elena Escribano Arellano10, Helmut Schröder11, Jordi Salas-Salvadó12. 1. Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain. Electronic address: angelmaria.alonsogomez@osakidetza.eus. 2. Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain. Electronic address: lutojal@hotmail.com. 3. Balearic Islands Health Research Institute, Cardiology Department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain. Electronic address: marta.noris@ssib.es. 4. CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Navarra, Spain; Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Navarra, Spain. Electronic address: etoledo@unav.es. 5. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: alvaro.alonso@emory.edu. 6. Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain. Electronic address: mgarur@hotmail.com. 7. Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain. Electronic address: daisysorto2@yahoo.com. 8. Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain; Nutrition and Obesity Group, Dept. Pharmacy and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), Lucio Lascaray Research Centre, Vitoria, Spain. Electronic address: mariapuy.portillo@ehu.eus. 9. Balearic Islands Health Research Institute, Cardiology Department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain. Electronic address: It_lr@hotmail.com. 10. Cardiology Department, Hospital Complex of Navarra, Pamplona, Navarra, Spain. Electronic address: elesar@ono.com. 11. CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain; Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar, Barcelona, Spain; Medical Research Institute (IMIM), Barcelona, Spain. Electronic address: hschroeder@imim.es. 12. CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain; Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, Sant Joan de Reus University Hospital, IISPV, Rovira i Virgili University, c/Sant Llorenç 21, 43201 Reus, Spain. Electronic address: jordi.salas@urv.cat.
Abstract
BACKGROUND: Current recommendations for echocardiographic assessment of diastolic function (2016 guidelines of the American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) in patients with metabolic syndrome and overweight/obesity result in a significant number of patients with indeterminate diastolic dysfunction (LVDD). The aim of this article is to study whether the use of the left atrial strain criterion (LALS) reduces the number of indeterminate patients. METHODS: 229 patients were studied with a complete echocardiographic study that included left ventricular longitudinal strain (LVLS) analysis, LALS and a maximal ergospirometry test with assessment of oxygen uptake (VO2max). RESULTS: The mean age was 65 ± 5 years, 153 (67%) males, with a mean EF of 60 ± 5%. The mean LVLS was -19.4 ± 2% and the LALS Reservoir was 23.8 ± 7%. There were 140 patients who did not meet LVDD criteria and 82 who did meet the indeterminate LVDD criterion. When the left atrial volume index (LAVI) >34 ml/m2 criterion was replaced in the 2016 ASE/EACVI algorithm by LALS Reservoir ≤20%, the number of indeterminate patients was reduced from 36% to 23% (p < 0.001) at the expense of increasing normal studies (61% and 74%). Adding the LALS Reservoir criterion ≤23% in the 82 patients of the indeterminate group resulted in two groups with a different VO2max (11.6 ± 3 and 18 ± 5 ml/kg/min, p:0.081). CONCLUSIONS: This study confirms the low prevalence of diastolic dysfunction in overweight/obese patients with metabolic syndrome. Adding left atrial strain criterion to the current recommendations significantly reduces the number of indeterminate patients by reclassifying them as normal.
BACKGROUND: Current recommendations for echocardiographic assessment of diastolic function (2016 guidelines of the American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) in patients with metabolic syndrome and overweight/obesity result in a significant number of patients with indeterminate diastolic dysfunction (LVDD). The aim of this article is to study whether the use of the left atrial strain criterion (LALS) reduces the number of indeterminate patients. METHODS: 229 patients were studied with a complete echocardiographic study that included left ventricular longitudinal strain (LVLS) analysis, LALS and a maximal ergospirometry test with assessment of oxygen uptake (VO2max). RESULTS: The mean age was 65 ± 5 years, 153 (67%) males, with a mean EF of 60 ± 5%. The mean LVLS was -19.4 ± 2% and the LALS Reservoir was 23.8 ± 7%. There were 140 patients who did not meet LVDD criteria and 82 who did meet the indeterminate LVDD criterion. When the left atrial volume index (LAVI) >34 ml/m2 criterion was replaced in the 2016 ASE/EACVI algorithm by LALS Reservoir ≤20%, the number of indeterminate patients was reduced from 36% to 23% (p < 0.001) at the expense of increasing normal studies (61% and 74%). Adding the LALS Reservoir criterion ≤23% in the 82 patients of the indeterminate group resulted in two groups with a different VO2max (11.6 ± 3 and 18 ± 5 ml/kg/min, p:0.081). CONCLUSIONS: This study confirms the low prevalence of diastolic dysfunction in overweight/obese patients with metabolic syndrome. Adding left atrial strain criterion to the current recommendations significantly reduces the number of indeterminate patients by reclassifying them as normal.
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