Comparative assessment of echocardiographic aspects of cardiac remodeling in metabolic syndrome and nonmassive pulmonary embolism

Background. Currently there is no holistic view of the influence of metabolic factors and endocrine pathology on the development of thromboembolic complications, both arterial and venous, which is probably due to wide clinical variability, as well as the imperfection of diagnostic strategies. In many cases, echocardiography helps to solve the main problem and determine further therapeutic tactics. In connection with the foregoing, in patients with metabolic syndrome (MS), it is especially important to conduct echocardiography, which makes it possible to identify markers of subclinical myocardial dysfunction. The presence of MS in patients with pulmonary embolism (PE) is associated with a significantly higher recurrence rate of PE, confirming the importance of recognizing this risk factor and initiating appropriate therapy to reduce the risk of relapse.

Aim: To carry out a comparative assessment of cardiac hemodynamic parameters in MS and non-massive PE.

Material and Methods. The study included 82 patients: the first group – 52 patients with PE with a submassive or segmental lesion within 6 months before the study; the second group – 14 patients with metabolic syndrome; the third, control, group consisted of 16 patients who did not have diseases of the cardiovascular and respiratory systems.

Results. In a comparative analysis of the data of patients with MS, patients with subsegmental PE and the control group, statistically significant differences were revealed in a number of parameters: the sizes and volumes of the right heart sections were statistically significantly smaller in the MS group than in the PE group, RVSP in patients with MS was statistically significantly lower in comparison with PE, the volume of RA in systole and diastole, the transverse dimension of the right ventricle in systole and diastole was larger in the group of PE and did not differ between patients with MS and controls. Significant differences in the value of a number of TDI indicators in individual segments of the right and left areas were revealed in the group with MS: in the group with MS, the ivct of the RA, LV, and LV was statistically significantly shorter than in the other groups. Compared to the control group, the values of e′ (early diastole) according to TDI from the fibrous ring of the mitral valve (from the septal and lateral walls) were found to be lower in patients with MS and PE, and peak A (late-diastolic filling) was statistically significant lower in the MS group than in the PE group. At the tissue level, a statistically significant slowing of the synchronization time in the LV was noted in the MS, 1st degree obesity and PE groups compared to the control group. At the same time, the isovolumic contraction time of RA and LV was significantly shorter in patients with MS than in patients with PE and the control group. It is worth noting that in patients with MS, although there were changes in the right parts, the changes in the left parts of the heart reliably prevailed. Whereas in patients with subsegmental PE, the changes in the right parts of the heart were more significantly expressed.

Conclusion. A number of echocardiographic parameters have been identified to distinguish between patients with metabolic syndrome and non-massive PE. Echocardiographic indicators that allow to distinguish patients with metabolic syndrome and non-massive PE are: the time of isovolumic contraction of the left and right atria, the left ventricle according to TDI, the size and volume of the right heart, RVSP.

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