Metabolic syndrome and C reactive protein are associated with a reduced myocardial mechano-energetic efficiency

Context: Metabolic syndrome and elevated high sensitivity C-reactive protein (CRP) levels are associated with risk of cardiovascular diseases (CVD). A reduced myocardial mechano-energetic efficiency (MEE) has been found to be an independent predictor of CVD. Objective: To evaluate the association between metabolic syndrome and hsCRP levels with impaired MEE. Methods: Myocardial MEE was assessed by a validated echocardiography-derived measure in 1975 non-diabetic and prediabetic individuals subdivided into two groups according to the presence of metabolic syndrome. Results: Individuals with metabolic syndrome exhibited increased stroke work and myocardial oxygen consumption estimated by rate pressure product, and a reduced MEE per gram of LV mass (MEEi) as compared to subjects without metabolic syndrome, after adjusting for age, and sex. Myocardial MEEi progressively decreased in parallel with the increase of the number of metabolic syndrome components. In a multivariable regression analysis, both metabolic syndrome and hsCRP contributed to reduced myocardial MEEi independently of sex, total cholesterol, HDL, triglycerides, fasting and 2-h post-load glucose levels. When the study population was divided into 4 groups by the presence or absence of metabolic syndrome and by hsCRP levels above and below 3 mg/L, hsCRP levels ≥3 mg/L were associated with reduced myocardial MEEi both in subjects with metabolic syndrome and in those without the syndrome. Conclusion: Non-diabetic and prediabetic individuals with metabolic syndrome exhibit increased stroke work and myocardial oxygen consumption, and an impaired MEEi, an established predictor of adverse cardiovascular events, and elevated hsCRP levels in combination with metabolic syndrome aggravates the myocardial MEEi impairment.