Right ventricular remodeling in metabolic syndrome

Abstract

Introduction: The right ventricle (RV) plays an important role in the morbidity and mortality of patients presenting with signs and symptoms of cardiopulmonary disease. However, the systematic assessment o f right heart function is not uniformly carried out. The impact of the metabolic syndrome (MS) on the RV was examined in very few studies. Considering the epidemic spreading of MS, its adverse effect on RV remodeling and the unfavorable role of RV hypertrophy on mortality, it would be very useful to find which parameters o f MS and which combinations o f parameters were independently associated with RV changes in both genders. Purpose and Objectives: Highlighting the importance of the evaluation of right ventricle function in patients with metabolic syndrome for the assessment of prognostic and possible early intervention. Material and Methods: The analysis of available literature about the methods of the assessment of right ventricle function and its particular importance in patients with metabolic syndrome. Results: For decades, the RV was considered as the “unstressed” ventricle, unnecessary for the complex cardiac function. At the beginning, authors were interested only in congenital heart diseases and pulmonary hypertension, which severely impacted the RV. However, gradually the attention of researchers focused on other pathological conditions as hypertension, diabetes and obesity or their combinations. Subjects with the MS have a significantly changed right ventricular structure and function. Women and men with MS have different predictors of RV hypertrophy and diastolic dysfunction, considering individual MS criteria or their combinations. Abdominal obesity and increased glucose level are independent predictors of RV hypertrophy and diastolic dysfunction exclusively in women with MS. In addition, among women with MS, triad of MS risk factors such as increased BP, hyperglycemia, and dyslipidemia, is an independent predictor of RV hypertrophy; whereas the other triad (increased glucose level, abdominal obesity, and dyslipidemia) is a predictor of RV diastolic dysfunction. Treatment of hypertension and diabetes not only improves the structure and function of the left ventricle as generally thought but of the RV as well. Conclusion: MS has an important role in damage of RV structure and function. Despite preserved left ventricular systolic function, both systolic and diastolic functions of the RV deteriorate in MS patients. Among MS criteria systolic blood pressure, waist circumference arid glucose level are independently associated with RV structure and function. Different parameters of MS are responsible for RV remodeling in women and men. The metabolic parameters of MS are more important for RV remodeling in women.