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Author Spotlight: Assessing the Cardiovascular Profile of Patients with Metabolic Syndrome
Published on: September 27, 2024
Association between Low-Grade Inflammation and Left Ventricular Diastolic Dysfunction in Patients with Metabolic
Cheng-Wei Liu1,2,3, Jui-Hung Chen1, Guo-Shiang Tseng4
1Department of Internal Medicine, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei.
Insights
Hyperuricemia (HUA) is linked to left ventricular diastolic dysfunction (LVDD) in metabolic syndrome patients, primarily due to inflammation, specifically elevated tumor necrosis factor-alpha (TNF-α), not insulin resistance.
Area of Science:
- Cardiology
- Metabolic Syndrome Research
- Inflammation Studies
Background:
- Hyperuricemia (HUA) is associated with inflammation, insulin resistance, and cardiac issues like left ventricular hypertrophy (LVH) and diastolic dysfunction (LVDD).
- Understanding the specific links between HUA, inflammation, insulin resistance, and LVDD is crucial for metabolic syndrome (MetS) patients.
Purpose of the Study:
- To investigate the associations among hyperuricemia, inflammation, and insulin resistance with left ventricular diastolic dysfunction (LVDD).
Main Methods:
- Enrolled 63 patients with metabolic syndrome (MetS).
- Assessed hyperuricemia (serum uric acid ≥ 7 mg/dl in men, ≥ 6 mg/dl in women) and LVDD via fasting blood tests and echocardiography.
- Defined MetS using Taiwanese criteria.
Main Results:
- Prevalence of HUA, LVH, and LVDD was 40%, 18%, and 10%, respectively.
- HUA group showed higher levels of inflammatory markers (interleukin-6, TNF-α) and a higher frequency of LVDD (20.0% vs. 2.6%).
- Elevated TNF-α was the most significant factor associated with LVDD in multivariate analysis (adjusted OR: 4.1).
Conclusions:
- The association between HUA and LVDD in MetS patients is partly explained by low-grade inflammation, particularly elevated TNF-α.
- Insulin resistance did not appear to be the primary driver of LVDD in this context.
Background:
Hyperuricemia (HUA) induces inflammation and insulin resistance and is reportedly associated with left ventricular hypertrophy (LVH) and possibly with left ventricular diastolic dysfunction (LVDD).
Objectives:
To investigate associations among HUA, inflammation, and insulin resistance with LVDD.
Methods:
We enrolled patients with metabolic syndrome (MetS) between August 1, 2017, and December 31, 2017. All participants underwent fasting blood tests and transthoracic echocardiography. HUA was defined as an serum uric acid level ≥ 7 mg/dl in men or ≥ 6 mg/dl in women. MetS was defined as at least three of the following Taiwanese criteria: central obesity, prehypertension, fasting glucose impairment, hypertriglyceridemia, and lower values of high-density lipoprotein cholesterol. LVDD was defined according to contemporary guidelines.
Results:
The study included 63 patients (60% male) with a mean age of 53 ± 14 years and body mass index (BMI) of 29.4 ± 4.0 kg/m2. Prevalence rates of HUA, LVH, LVDD were 40%, 18%, and 10%, respectively. Baseline characteristics were similar between the HUA and normouricemia groups, except that the HUA group had significantly higher serum high-sensitivity interleukin 6 and tumor necrosis factor-alpha (TNF-α) levels. LVDD occurred more frequently in the HUA group (20.0% vs. 2.6%, p = 0.032). HUA was associated with LVDD [crude odds ratio (OR): 9.25, 95% confidence interval (CI): 1.01-84.7, p = 0.049]. In multivariate analysis, the most relevant factor associated with LVDD was TNF-α after adjustments for age, male sex, and body mass index (adjusted OR for TNF-α: 4.1, 95% CI: 1.02-16.5, p = 0.047).
Conclusions:
The association between HUA and LVDD partially reflected a low-grade inflammation due to elevated TNF-α rather than increased insulin resistance in MetS patients.
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