P3533The other side of the medallion in heart failure: Reverse Metabolic Syndrome

Abstract Background As a risk factor for developing heart failure, metabolic syndrome (MetS) is associated with a reduced heart failure mortality. This paradox is also seen in most of the chronic diseases and also in the elderly population. Parameter changes representing the deteriarion of the balance in favor of catabolism including the low body mass index (BMI) and low blood pressure as well as low blood cholesterol have been associated with poor prognosis in several populations. Apart from high-density lipoprotein, which is further decreased, inverted changes in the components of MetS have been seen in heart failure population which led to the introduction of the concept of the “reverse metabolic syndrome” (RMetS). Purpose We aimed to investigate the effect of MetS and RMetS on hemodynamic parameters and long-term prognosis in patients with heart failure and reduced ejection fraction (HFrEF). Methods 400 consecutive patients who were followed with HFrEF and performed right heart catheterization were examined. 96 patients with cardiac cachexia and morbid obesity were excluded and the remaining 304 patients with BMI 18–40 kg/m2 were included. The presence of MetS is defined according to the NCEP-ATP III criteria. RMetS was accepted as having BMI <22 kg/m2 with total cholesterol level <160 mg/dL and/or systolic or diastolic blood pressures <110 mmHg and <70 mmHg respectively. Composite endpoint (CEP) was defined as either of the occurrence of all-cause mortality, assist device implantation or cardiac transplantation. Endpoints were analyzed in two step approach: first we grouped patients accoding to the presence of MetS, then we added the RMetS category and stratifed patients into three groups as metabolic syndrome, reverse metabolic syndrome and metabolic healthy Results 304 patients were followed up for a median of 16 (0–48) months. 110 patients had all-cause mortality and 148 patients had CEP. In the first step, patients with MetS (110 patients) had reduced all-cause mortality and CEP than patients without MetS (194 patients). In the second step, RMetS group had the highest all-cause mortality and CEP (chi-square: 22.187 p<0.001 and chi-square: 30.980, p<0.001, respectively) Cardiac output, cardiac index were lower and PCWP was higher in RMetS group. The endpoints were similar between MetS group and metabolically healthy patients. Conclusion Although individuals with MetS seem to have a better prognosis than patients without MetS, the latter group contains RMetS population, which had the poorest prognosis. This population may contribute to the false- assumption of the relative better findings of MetS population with regard to the non-MetS population. Further clinical studies are needed to clarify this pathologic phenomenon.