Impacts Of Metabolic Syndrome On Atrial Function And Atrial Synchronicity: A Prospective Ultrasound Study

Part One: Assessment of Intraatrial and Interatrial Synchronicity inCoronary Artery Disease with Metabolic Syndrome PatientsObjective: To investigate changes of the intraatrial and interatrialelectromechanical contraction function in coronary artery disease（CAD）patients with metabolic syndrome（MS）using pulsed wave Doppler tissueimaging (PW-TDI) and synchronous electrocardiogram (ECG). To evaluatethe impacts of metabolic syndrome on the cardiovascular disease.Methods: Totally 139 consecutive CAD patients were divided into CADwith MS (CAD-MS, n=66) and CAD without MS group (CAD-NMS, n=73)according to modified NCEP ATPⅢcriteria combined lowered centralobesity in Asians of World Health Organization and the American HeartAssociation/National Heart, Lung, and Blood Institute criteria，all patientswere treated with cardiovascular medications for at least 6 months. Allpatients were collected venous blood to assay fasting glucose, triglyceride(TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C) and apolipoprotein. Wemeasured their height, weight, waistline, hipline and blood pressure, thencalculated the body mass index (BMI) and waisttohip ratio (WHR). The sizeof atrium and ventricular, their wall thickness, valve orifice hemodynamicparameters and the other common echocardiographic parameters weremeasured by two dimension and color doppler ultrasound. we measured the left ventricular ejection fraction in apical four chamber view with Simpsonmethod, the maximal velocity of early diastole of mitral annulus(E’) onventricular septal side was measured in PW-TDI mode, and E/E’ratio wascalculated. The time intervals of electromechanical contraction between onsetof P wave and onset of A wave in atrial myocardium were measured withPW-TDI and synchronous ECG. Meanwhile, the peak A wave velocity ofatrial wall movement was compared.Results: The time interval of atrial electromechanical contractionbetween onset of P wave and onset of A wave in CAD-MS group wassignificantly longer than that in CAD-NMS group (P<0.05). The movementvelocity of left atrial anterior wall in CAD-MS group was lower than that inCAD-NMS group ([6.12±2.27]cm/s vs [7.00±2.11]cm/s, P<0.05) , and theelectromechanical contraction time interval of left atrial anterior wall inCAD-MS group was significantly delayed compared with that in CAD-NMSgroup (P<0.05). The electromechanical contraction time difference betweenleft atrial anterior wall and inferior wall atrium in CAD-MS group wasstatistically different (P<0.05).Conclusion: Intraatrial and interatrial mechanical contraction time issignificantly delayed and mechanical desynchrony exists in part of left atriumin CAD with MS patients. Objective: To investigate the atrial function and intraatrial and interatrialelectromechanical contraction function in smokers with metabolic syndrome(MS) using echocardiography and synchronous electrokardiagram (ECG). Toexplore the impacts of smoking on atrial reconstruction and atrial function inpatients with metabolic syndrome.Methods: We recruited 146 consecutive patients with prior history ofsmoking (mean age: 65±10 years, 89% male) and nonsmoking (mean age:65±10 years, 49% male) with MS patients. All patients were collected venousblood to assay fasting glucose, triglyceride (TG), total cholesterol (TC), highdensity lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol(LDL-C) and apolipoprotein. We measured their height, weight, waistline,hipline and blood pressure, then calculated the body mass index (BMI) andwaisttohip ratio (WHR). Atrial function and common echocardiographicparameters were measured by two dimension and color doppler ultrasoundand detail doppler tissue imaging (PW-TDI) was performed to assessintraatrial and interatrial electromechanical contraction function. Maximumatrial volume (AVmax), minimum atrial volume (AVmin), and the volume atonset of atrial systole (P-volume) (AVp) were corrected by body surface area(BSA). Atrial filling, active and passive emptying volumes and their emptingrate were calculated. Meanwhile, the time intervals of electromechanicalcontraction between onset of P wave and onset of A wave in atrialmyocardium were measured by PW-TDI and synchronous ECG, and the peakA wave velocity of atrial wall movement was compared.Results: After adjusting for age and sex, covariance analysis showed that smokers with MS patients had lower LVEF, E′velocity, A′velocity, AR VTI,higher E/E′, AVImax, AVImin and LAVIp, lower AVIpass%, AVIact% andatrial ejection fraction than that in nonsmokers with MS patients(all P<0.05).Moreover, the velocity of RAFW、IAS and LAAW was lower in smokers withMS patients, and the time interval of RAFW、IAS、LALW、LAIW and LAPWbetween onset of P wave and onset of A wave in smokers with MS patientswas significantly delayed compared with that in nonsmokers with MS patients(all P<0.05). There was no statistically significant difference in the timedifference of each section atrial wall.Conclusion: In smokers with MS patients, atrial reservoir functionincrease while conduit fuction and booster pump function decrease, thevelocity of part of atrial wall decline and intraatrial and interatrial mechanicalcontraction time is significantly delayed. The changes of right atrial functionis similar to left atrial function.