The effect of metabolic syndrome on structural anomalies, systolic and diastolic function of left ventricle determined using echocardiography of a patient with atrial fibrillation

Introduction: Atrial fibrillation (AF) is the most common atrial arrhythmia and has a growing trend worldwide. Change in lifestyle, cessation of alcohol abuse, smoking, physical inactivity and psychological stress reduces the risk of AF occurrence in people with genetic predisposition. We insist on CV risk, primarily obesity, metabolic syndrome (or cardiometabolic), hypertension, diabetes mellitus, dyslipidemia, obstructive sleep apnea. Metabolic syndrome (MSy) is a risk factor for stroke and thromboembolism. Aim of study: To determine the frequency of MSy in patients with AF who have systolic and/or diastolic dysfunction and structural anomalies of the left ventricle in a group of observed respondents. Determine which echocardiographic parameters characterize MSy in comparison to patients with AF without metabolic syndrome (NMSy). Material and methodology: This retrospective study includes a total of 102 patients with atrial fibrillation who are being treated and are regularly being checked in Internist Clinic ‘Dr Bastac’ in Zajecar. Systolic function of left ventricle is presented with ejection fraction of left ventricle (EF) and diastolic function is presented with ratio of Doppler velocity of early diastolic filling of left ventricle-E and average velocity of tissue Doppler of mitral annulus (E prim) - ratio E/e’. Structural anomalies which were in focus are a mass of left ventricle indexed on body surface (LVMI) and diameter of left atrium (LA). Results: In the target group with AF, MSy was present with 53/102 patients (50%) and absent (NMSy) with 49/102 (48%). In the MSy subgroup, gender structure was: men 40% and women 58% and vice versa with NMSy subgroup. Average value of ejection fraction of left ventricle is almost identical in both subgroups: MSy and NMSy (55,7±13,3% versus55,2±12,1%), NS, p=0,859. With individual distribution of MSy subgroup 7/53 (13%) have lower EF (32±5,0%) relative to 4/49 (8%) with NMSy but without statistically significant difference (X²=0.601). Normal E/e’ ratio is determined in 16/53 patients in MSy subgroup or 30%, with average value of 7.3±1.0, borderline in 22 (42%) with average value of 10.8±1.5 and increased in 15 (28%) with average value of 18.5±5.2. In NMSy subgroup E/e’ has similar distribution: 25% have normal E/e’ value, 47% have borderline value and 28% have increased value (insignificant difference, p=0.800). If we observe gender stratification, 81% of women and 64% of men with MSy have pathological E/e’ ratio, but there is no statistically relevant difference (Xi²=0.505). However, women with MSy have, statistically, more severe diastolic dysfunction both in individual distribution, and in average values, respectively: 10/31(33%)vs 5/22(23%), 19.7±5.8 versus 16.3±3.2 than men (t test, p=0.04). LVMI in men with MSy was increased in 16 (73%) with Xmean=139±23g/m², and in women in 25 (80%) with Xmean=127±38g/m² but without statistically significant difference (X²=0.356). Diameter of left atrium was increased in 95% men and 97% women with MetSy but without statistical difference relative to NMSy, both with average values and individual distribution. Conclusion: Metabolic syndrome (MSy) is present in more than half of patients with atrial fibrillation (AF), and patients are mostly women. Systolic function was not significantly different in AF with MSy presence and without it (NMSy). Pathological values of E/ e’ ratio are no different in patients with atrial fibrillation than with MSy and NMSy (70 vs 75%). However, women with MSY have statistically much severe diastolic dysfunction than men (T-test, p=0.04). Hypertrophy of left ventricle in 73-80% cases and dilatation of left atrium 95-97% regularly accompany metabolic syndrome.