DIABETES/METABOLISM RESEARCH AND REVIEWS RESEARCH ARTICLE Diabetes Metab Res Rev 2010; 26: 121–127. Published online 3 February 2010 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/dmrr.1063 The impact of metabolic syndrome on left ventricular myocardial performance Christina Voulgari 1 Ioannis Moyssakis 2 Athanasia Papazafiropoulou 1 Despoina Perrea 3 Despoina Kyriaki 1 Nicholas Katsilambros 1 Nicholas Tentolouris 1 * 1 First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece 2 Cardiology Department, Laiko General Hospital, Athens, Greece 3 Laboratory for Experimental Surgery and Surgical Research, Athens University Medical School, Athens, Greece *Correspondence to: Nicholas Tentolouris, First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, 33 Lakonias Street, 115 23 Athens, Greece. E-mail: ntentol@med.uoa.gr Received: 7 May 2009 Revised: 2 December 2009 Accepted: 3 January 2010 Abstract Background Metabolic syndrome (MetS) is common and is associated with increased cardiovascular morbidity and mortality. Recent prospective studies suggested that MetS is associated with increased risk of heart failure. In the present cross-sectional study, we examined the association between left ventricular myocardial performance with MetS. Materials and Methods A total of 550 non-diabetic subjects, 275 without MetS and 275 with MetS, matched for gender, age and body mass index and free of clinically apparent macrovascular disease were studied. MetS was diagnosed using the NCEP-ATP III criteria. Left ventricular myocardial performance was assessed using the Tei index. Results Both men and women with MetS had higher values of the Tei index, indicating worse myocardial performance, in comparison with those without MetS (p < 0.001). Participants with a cluster of more components of the MetS had higher Tei index values than those with fewer components of the MetS. In addition, among normotensive subjects, those with MetS had significantly higher Tei index values than subjects without MetS. Multivariate linear regression analysis, after adjustment for age and body mass index, demonstrated that MetS status and from the individual components of the MetS, high fasting blood glucose levels, higher blood pressure, low high density lipoprotein levels and high waist circumference were associated with worse myocardial performance. Conclusion MetS is associated with subclinical myocardial dysfunction in both men and women. Strategies to reduce the cardiovascular burden and the risk of heart failure associated with MetS should aim at prevention of the MetS and its related conditions. Copyright  2010 John Wiley & Sons, Ltd. Keywords metabolic syndrome; myocardial performance; Tei index; heart failure; low-grade inflammation; insulin resistance; microalbuminuria Introduction Metabolic syndrome (MetS) is defined as the clustering of cardiovascu- lar risk factors such as central fat distribution, increased blood pressure, serum glucose, triglycerides and low levels of high density lipoprotein cholesterol (HDL-C) [1,2]. MetS affects about 25% of the population and is associated with increased risk of cardiovascular morbidity and mortal- ity [3]. Previous data have shown that in Native Americans, a population prone to the development of obesity and diabetes, MetS was associated with left ventricular (LV) hypertrophy and myocardial dysfunction [4]. The Copyright  2010 John Wiley & Sons, Ltd.