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Imaging techniques for the assessment of adverse cardiac remodeling in metabolic syndrome

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Abstract

Metabolic syndrome (MetS) includes different metabolic conditions (i.e. abdominal obesity, impaired glucose tolerance, hypertriglyceridemia, decreased HDL cholesterol, and/or hypertension) that concour in the development of cardiovascular disease and diabetes. MetS individuals often show adverse cardiac remodeling and myocardial dysfunction even in the absence of overt coronary artery disease or valvular affliction. Diastolic impairment and hypertrophy are hallmarks of MetS-related cardiac remodeling and represent the leading cause of heart failure with preserved ejection fraction (HFpEF). Altered cardiomyocyte function, increased neurohormonal tone, interstitial fibrosis, coronary microvascular dysfunction, and a myriad of metabolic abnormalities have all been implicated in the development and progression of adverse cardiac remodeling related to MetS. However, despite the enormous amount of literature produced on this argument, HF remains a leading cause of morbidity and mortality in such population. The early detection of initial adverse cardiac remodeling would enable the optimal implementation of effective therapies aiming at preventing the progression of the disease to the symptomatic phase. Beyond conventional imaging techniques, such as echocardiography, cardiac tomography, and magnetic resonance, novel post-processing tools and techniques provide information on the biological processes that underlie metabolic heart disease. In this review, we summarize the pathophysiology of MetS-related cardiac remodeling and illustrate the relevance of state-of-the-art multimodality cardiac imaging to identify and quantify the degree of myocardial involvement, prognosticate long-term clinical outcome, and potentially guide therapeutic strategies.

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Abbreviations

CBF :

Coronary blood flow

CFR :

Coronary flow reserve

FE :

Ejection fraction

LA :

Left atrial

LAVI :

Left atrial volume index

GLS :

Global longitudinal strain

MBF :

Microvascular blood flow

MRS :

Magnetic resonance spectroscopy

TRV :

Tricuspid regurgitation velocity

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Funding

This work has been supported by a grant from the Rete Cardiologica of the Italian Ministry of Health to FM.

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Authors and Affiliations

  1. Vita-Salute San Raffaele University, Milan, Italy

    Alberto Preda

  2. First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy

    Luca Liberale & Fabrizio Montecucco

  3. Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland

    Luca Liberale

  4. IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Genoa, Italy

    Luca Liberale & Fabrizio Montecucco

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  1. Alberto Preda
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  2. Luca Liberale
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All the authors conceived, drafted, and revised the article.

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Correspondence to Fabrizio Montecucco.

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Conflict of interest

LL is coinventor on the International Patent (WO/2020/226993) filed in April 2020 and relating to the use of antibodies which specifically bind IL-1α to reduce various sequelae of ischemia–reperfusion injury to the central nervous system. The other authors report no conflict of interest.

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Preda, A., Liberale, L. & Montecucco, F. Imaging techniques for the assessment of adverse cardiac remodeling in metabolic syndrome. Heart Fail Rev 27, 1883–1897 (2022). https://doi.org/10.1007/s10741-021-10195-6

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