The other side of the medallion in heart failure: Reverse metabolic syndrome

• Published in: Nutrition, metabolism, and cardiovascular diseases metabolism, and cardiovascular diseases, 2020-10, Vol.30 (11), p.2041-2050
• Main Authors: Ozcan Cetin, Elif H., Cetin, Mehmet S., Özbay, Mustafa B., Yaman, Nezaket M., Könte, Hasan C., Ekizler, Firdevs A., Tak, Bahar T., Kara, Meryem, Temizhan, Ahmet, Özcan, Fırat, Özeke, Özcan, Çay, Serkan, Topaloglu, Serkan, Aras, Dursun
• Format: Article
• Language: English
• Subjects: Adult; Arterial Pressure; Cardiometabolic Risk Factors; Catabolism; Female; Heart failure; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - physiopathology; Hemodynamics; Humans; Male; Metabolic syndrome; Metabolic Syndrome - diagnosis; Metabolic Syndrome - mortality; Metabolic Syndrome - physiopathology; Middle Aged; Oxygen Consumption; Prognosis; Pulmonary Artery - physiopathology; Reverse metabolic syndrome; Risk Assessment; Stroke Volume; Time Factors; Turkey; Ventricular Function, Left
• ISSN: 0939-4753; 1590-3729
• DOI: 10.1016/j.numecd.2020.06.027

Lower levels of cardiovascular risk factors are associated with an increase in mortality in H.F. To explain this paradox, the term reverse metabolic syndrome (RMetS) has recently been proposed. We suggest defining these patients with lower levels of three risk factors can be combined under the heading “RMetS.” We aimed to investigate the effect of MetS and RMetS on hemodynamic parameters and prognosis in patients with H.F. and reduced ejection fraction (HFrEF). We included 304 patients who were performed right heart catheterization and followed up for a median of 16 (0–48) months. We first grouped patients according to the presence of MetS or not, then we added the RMetS category and stratified patients into three groups as MetS, RMetS, and metabolic healthy. Compared with not MetS group, Pulmonary arterial pressures and VO2 were higher in MetS group. In the second step, LVEF, CI, VO2I, O2 delivery, and LVSWI were lowest in RMetS, pulmonary artery pressures were higher in MetS group. In multivariate Cox regression analysis, being in RMetS group was associated with 2.4 times and 1.8 times increased risk for composite end point (CEP) and all-cause mortality, respectively. In Kaplan Meier analysis, RMetS had the highest all-cause mortality and CEP. We determined that RMetS patients had the worst prognosis with unfavorable hemodynamic profile. Hence, a better understanding of the pathophysiology of RMetS may help refine the treatment targets of CV risk factors, may yield new interventions targeting catabolic syndrome. •Patients with Reverse Metabolic Syndrome had the poorest prognosis.•The prognosis of metabolic syndrome group were similiar with the metabolically-healthy group.•The patients with Reverse Metabolic Syndrome had advanced functional classes, higher BNP values.•The patients with Reverse Metabolic Syndrome had lower cardiac performance indices.