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Aims: The purpose of our study was to determine the effect of lifestyle intervention on left ventricular (LV) regional myocardial function in patients with metabolic syndrome (MetS) and investigate the relationships of the changes in myocardial function to changes in epicardial adipose tissue (EAT), inflammatory profile and MetS components. Methods: Eighty-seven MetS patients were enrolled in a 6 month lifestyle intervention program based on dietary management and increased physical activity, and compared with 44 aged and sex-matched healthy controls. MetS individuals were allocated to different groups randomized (computer-generated randomization) on exercise modalities (high-intensity dominant resistance or aerobic training, and moderate-intensity of both modes). EAT was measured by transthoracic echocardiography and LV longitudinal strains and strain rates were obtained using vector velocity imaging. Blood chemistry allowed assessments of adipocytokines (TNF-α: tumor necrosis factor α, PAI active: active plasminogen activator inhibitor-1 and adiponectin) and glucose tolerance markers. Results: Regardless of exercise training modalities, lifestyle intervention improved significantly LV strains and strain rates (p < 0.001) as well as metabolic and inflammatory profiles. Stepwise multiple regression analyses revealed EAT (β = 0.73, p < 0.01), log adiponectin (β = − 0.13, p < 0.05) and log TNF-α (β = 0.15, p < 0.05) as independent predictors of LV longitudinal strain (R2 = 0.74, p < 0.001) while myocardial function improvement consecutive to lifestyle intervention was explained by EAT changes only (R2 = 0.54, p < 0.001). Conclusion: The mechanisms through which regional myocardial function is impaired in MetS and improved consecutive to intervention involved EAT, possibly via paracrine effects of adipocytokines. EAT should be considered as a future therapeutic target of interest in the treatment of metabolic-related cardiac diseases.

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