The Change in Exercise Capacity, Cardiac Structure and Function in Pre-Metabolic Syndrome Adults

  • Shin, Kyung-A (Department of Laboratory Medicine Bundang Jesaeng Hospital) ;
  • Kim, Young-Joo (Department of Rehabilitation Medicine, Sanggye-Paik Hospital) ;
  • Park, Sae-Jong (Department of Sport Science, Korea Institute of Sport Science) ;
  • Oh, Jae-Keun (Department of Health and Exercise Science, Korea National Sport University)
  • Received : 2011.10.30
  • Accepted : 2011.12.31
  • Published : 2011.12.31

Abstract

This study divided a group of healthy adults aged 20 or older who had a health examination at J General Hospital in Gyeonggi Province into three groups according to the degrees of metabolic syndrome risk factors. They include the normal group (n=58), the pre-metabolic syndrome group (n=112) and the metabolic syndrome group (n=32). They were compared in exercise capacity and cardiac structure and function and impacts of exercise capacity on the cardiac diastolic function. All the groups took echocardiography to have their cardiac structures and functions examined and an exercise stress test to have their exercise capacity measured. The research findings were as follows: There were differences in exercise capacity, cardiac structure, and diastolic heart function among three groups. Between exercise capacity and diastolic heart function was found to be related. It turned out exercise capacity affected the cardiac diastolic functions. In conclusion, there were significant differences in exercise capacity between the normal group and the metabolic syndrome group and in the cardiac structure and function among the normal, metabolic syndrome, and pre-metabolic syndrome group. In addition, METs (metabolic equivalents) and heart rate recovery of exercise capacity turned out to affect cardiac diastolic functions.

Keywords

References

  1. Aijaz B, Ammar KA, Lopez-Jimenez F, Redfield MM, Jacobsen SJ, Rodeheffer RJ. Abnormal cardiac structure and function in the metabolic syndrome: a population-based study. Mayo Clin Proc. 2008. 83: 1350-1357. https://doi.org/10.4065/83.12.1350
  2. Arnlov J, Lind L, Zethelius B, Andren B, Hales CN, Vessby B, Lithell H. Several factors associated with the insulin resistance syndrome are predictors of left ventricular systolic dysfunction in a male population after 20 years of follow-up. Am Heart J. 2001. 142: 720-724. https://doi.org/10.1067/mhj.2001.116957
  3. Baldi JC, Aoina JL, Whalley GA, Carrick-Ranson G, Walsh HA, O'Shaughnessy H, Bagg W, Doughty RN. The effect of type 2 diabetes on diastolic function. Med Sci Sports Exerc. 2006. 38: 1384-1388. https://doi.org/10.1249/01.mss.0000228954.90591.95
  4. Chockalingam A, Linden MA, Dellsperger KC, Thomas TR. Correlation of normal diastolic cardiac function with $VO_2max$ in the metabolic syndrome. Prev Cardiol. 2009. 12: 163-168. https://doi.org/10.1111/j.1751-7141.2009.00027.x
  5. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med. 1999. 341: 1351-1357. https://doi.org/10.1056/NEJM199910283411804
  6. de las Fuentes L, Brown AL, Mathews SJ, Waggoner AD, Soto PF, Gropler RJ, Davila-Roman VG. Metabolic syndrome is associated with abnormal left ventricular diastolic function independent of left ventricular mass. Eur Heart J. 2007. 28: 553-559.
  7. de Simone G, Devereux RB, Roman MJ, Alderman MH, Laragh JH. Relation of obesity and gender to left ventricular hypertrophy in normotensive and hypertensive adults. Hypertension 1994. 23: 600-606. https://doi.org/10.1161/01.HYP.23.5.600
  8. de Simone G, Palmieri V, Bella JN, Celentano A, Hong Y, Oberman A, Kitzman DW, Hopkins PN, Arnett DK, Devereux RB. Association of left ventricular hypertrophy with metabolic risk factors: the HyperGEN study. J Hypertens. 2002. 20: 323-331. https://doi.org/10.1097/00004872-200202000-00024
  9. Devereux RB, Koren MJ, de Simone G, Roman MJ, Laragh JH. Left ventricular mass as a measure of preclinical hypertensive disease. Am J Hypertens. 1992. 5(6 Pt 2): 175S-181S.
  10. Expert panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001. 285: 2486-2497. https://doi.org/10.1001/jama.285.19.2486
  11. Galderisi M, Anderson KM, Wilson PW, Levy D. Echocardiographic evidence for the existence of a distinct diabetic cardiomyopathy (the Framingham Heart Study). Am J Cardiol. 1991. 68: 85-89. https://doi.org/10.1016/0002-9149(91)90716-X
  12. Gardin JM, Leifer ES, Fleg JL, Whellan D, Kokkinos P, Leblanc MH, Wolfel E, Kitzman DW. HF-ACTION Investigators. Relationship of Doppler-Echocardiographic left ventricular diastolic function to exercise performance in systolic heart failure: the HF-ACTION study. Am Heart J. 2009. 158(4 Suppl): S45-S52.
  13. Grewal J, McCully RB, Kane GC, Lam C, Pellikka PA. Left ventricular function and exercise capacity. JAMA. 2009. 301: 286-294. https://doi.org/10.1001/jama.2008.1022
  14. Kaplan NM. The deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med. 1989. 149: 1514-1520. https://doi.org/10.1001/archinte.1989.00390070054005
  15. Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med. 1991. 114: 345-352. https://doi.org/10.7326/0003-4819-114-5-345
  16. Leoncini G, Ratto E, Viazzi F, Vaccaro V, Parodi D, Parodi A, Falqui V, Tomolillo C, Deferrari G, Pontremoli R. Metabolic syndrome is associated with early signs of organ damage in nondiabetic, hypertensive patients. J Intern Med. 2005. 257: 454-460. https://doi.org/10.1111/j.1365-2796.2005.01468.x
  17. Levy D, Garrison RJ, Savage DD, Kannel WB. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990. 322: 1561-1566. https://doi.org/10.1056/NEJM199005313222203
  18. Levitt NS, Lambert EV. The foetal origins of the metabolic syndrome-a South African perspective. Cardiovasc J S Afri. 2002. 13: 179-180.
  19. Lima MM, Nunes MC, Rocha MO, Beloti FR, Alencar MC, Ribeiro AL. Left ventricular diastolic function and exercise capacity in patients with Chagas cardiomyopathy. Echocardiography 2010. 27: 519-524. https://doi.org/10.1111/j.1540-8175.2009.01081.x
  20. McNeill AM, Rosamond WD, Girman CJ, Golden SH, Schmidt MI, East HE, Ballantyne CM, Heiss G. The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. Diabetes Care 2005. 28: 385-390. https://doi.org/10.2337/diacare.28.2.385
  21. Mureddu GF, Greco R, Rosato GF, Cella A, Vaccaro O, Contaldo F, de Simone G. Relation of insulin resistance to left ventricular hypertrophy and diastolic dysfunction in obesity. Int J Obes Relat Metab Disord. 1998. 22: 363-368. https://doi.org/10.1038/sj.ijo.0800596
  22. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002. 346: 793-801. https://doi.org/10.1056/NEJMoa011858
  23. Nilsson G, Hedberg P, Jonason T, Lonnberg I, Ohrvik J. Heart rate recovery is more strongly associated with the metabolic syndrome, waist circumference, and insulin sensitivity in women than in men among the elderly in the general population. Am Heart J. 2007. 154: 460.e1-7. https://doi.org/10.1016/j.ahj.2007.06.025
  24. Poirier P, Garneau C, Bogaty P, Nadeau A, Marois L, Brochu C, Gingras C, Fortin C, Jobin J, Dumesnil JG. Impact of left ventricular diastolic dysfunction on maximal treadmill performance in normotensive subjects with well-controlled type 2 diabetes mellitus. Am J Cardiol. 2000. 85: 473-477. https://doi.org/10.1016/S0002-9149(99)00774-2
  25. Powell BD, Redfield MM, Bybee KA, Freeman WK, Rihal CS. Association of obesity with left ventricular remodeling and diastolic dysfunction in patients without coronary artery disease. Am J Cardiol. 2006. 98: 116-120. https://doi.org/10.1016/j.amjcard.2006.01.063
  26. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988. 37: 1595-1607. https://doi.org/10.2337/diabetes.37.12.1595
  27. Schiller NB, Shah PM, Crawford M, Demaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation fo Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989. 2: 358-367.
  28. Spies C, Otte C, Kanaya A, Pipkin SS, Schiller NB, Whooley MA. Association of metabolic syndrome with exercise capacity and heart rate recovery in patients with coronary heart disease in the heart and soul study. Am J Cardiol. 2005. 95: 1175-1179. https://doi.org/10.1016/j.amjcard.2005.01.045
  29. Stewart KJ, Bacher AC, Turner K, Lim JG, Hees PS, Shapiro EP, Tayback M, Ouyang P. Exercise and risk factors associated with metabolic syndrome in older adults. Am J Prev Med. 2005. 28: 9-18. https://doi.org/10.1016/j.amepre.2004.09.006
  30. Wong CY, O'Moore-Sullivan T, Fang ZY, Haluska B, Leano R, Marwick TH. Myocardial and vascular dysfunction and exercise capacity in the metabolic syndrome. Am J Cardiol. 2005. 96: 1686-1691. https://doi.org/10.1016/j.amjcard.2005.07.091
  31. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000. 894: 1-253.
  32. World Health Organization. West Pacific Region. The Asia-pacific Perspective: redefining obesity and its treatment. International Obesity Task Force. 2000. 2: 15-21.