Vol 24, No 4 (2017)
Original articles — Clinical cardiology
Published online: 2017-03-21

open access

Page views 1758
Article views/downloads 1328
Get Citation

Connect on Social Media

Connect on Social Media

Echocardiographic evaluation of diastolic functions in patients with polycystic ovary syndrome: A comperative study of diastolic functions in sub-phenotypes of polycystic ovary syndrome

Erkan Yildirim, Onur Karabulut, Uygar Cagdas Yuksel, Murat Celik, Baris Bugan, Yalcin Gokoglan, Mustafa Ulubay, Mutlu Gungor, Mustafa Koklu
Pubmed: 28353313
Cardiol J 2017;24(4):364-373.

Abstract

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder among reproductive-aged women. It is known to be associated with cardiovascular diseases. The aim of this study was to determine and compare the echocardiographic data of patients according to the phenotypes of PCOS.

Methods: This study included 113 patients with PCOS and 52 controls. Patients were classified into four potential PCOS phenotypes. Laboratory analyses and echocardiographic measurements were performed. Left ventricular mass was calculated by using Devereux formula and was indexed to body surface area.

Results: Phenotype-1 PCOS patients had significantly higher homeostasis model assessment — insu­lin resistance (HOMA-IR) (p = 0.023), free testosterone (p < 0.001), LDL cholesterol levels (p < 0.001) and free androgen index (p < 0.001) compared with the control group. There were significant differences between groups regarding the septal thickness, posterior wall thickness, Left ventricular ejection frac­tion, E/A ratio and left ventricular mass index (for all, p < 0.05). PCOS patients with phenotype 1 and 2 had significantly higher left ventricular mass index than the control group (p < 0.001). In univariate and multivariate analyses, PCOS phenotype, modified Ferriman-Gallwey Score and estradiol were found as variables, which independently could affect the left ventricular mass index.

Conclusions: This study showed that women in their twenties who specifically fulfilled criteria for PCOS phenotype-1 according to the Rotterdam criteria, had higher left ventricular mass index and decreased E/A ratio, which might be suggestive of early stage diastolic dysfunction. (Cariol J 2017; 24, 4: 364–373)

Article available in PDF format

View PDF Download PDF file

References

  1. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005; 352(12): 1223–1236.
  2. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004; 19(1): 41–47.
  3. Broekmans FJ, Knauff EAH, Valkenburg O, et al. PCOS according to the Rotterdam consensus criteria: Change in prevalence among WHO-II anovulation and association with metabolic factors. BJOG. 2006; 113(10): 1210–1217.
  4. Giallauria F, Orio F, Palomba S, et al. Cardiovascular risk in women with polycystic ovary syndrome. J Cardiovasc Med (Hagerstown). 2008; 9(10): 987–992.
  5. Lo JC, Feigenbaum SL, Yang J, et al. Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome. J Clin Endocrinol Metab. 2006; 91(4): 1357–1363.
  6. van Santbrink EJ, Hop WC, Fauser BC. Classification of normogonadotropic infertility: polycystic ovaries diagnosed by ultrasound versus endocrine characteristics of polycystic ovary syndrome. Fertil Steril. 1997; 67(3): 452–458.
  7. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985; 28(7): 412–419.
  8. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1): 1–39.e14.
  9. Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986; 57(6): 450–458.
  10. Lin SL, Tak T, Kawanishi DT, et al. Comparison of Doppler echocardiographic and hemodynamic indexes of left ventricular diastolic properties in coronary artery disease. Am J Cardiol. 1988; 62(13): 882–886.
  11. Apridonidze T, Essah PA, Iuorno MJ, et al. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005; 90(4): 1929–1935.
  12. Kelly CJG, Speirs A, Gould GW, et al. Altered vascular function in young women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2002; 87(2): 742–746.
  13. Legro RS, Finegood D, Dunaif A. A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 1998; 83(8): 2694–2698.
  14. Di Bello V, Santini F, Di Cori A, et al. Obesity cardiomyopathy: is it a reality? An ultrasonic tissue characterization study. J Am Soc Echocardiogr. 2006; 19(8): 1063–1071.
  15. Jialal I, Naiker P, Reddi K, et al. Evidence for insulin resistance in nonobese patients with polycystic ovarian disease. J Clin Endocrinol Metab. 1987; 64(5): 1066–1069.
  16. Wong CY, O'Moore-Sullivan T, Leano R, et al. Alterations of left ventricular myocardial characteristics associated with obesity. Circulation. 2004; 110(19): 3081–3087.
  17. Victor VM, Rocha M, Bañuls C, et al. Induction of oxidative stress and human leukocyte/endothelial cell interactions in polycystic ovary syndrome patients with insulin resistance. J Clin Endocrinol Metab. 2011; 96(10): 3115–3122.
  18. Di Bello V, Santini F, Di Cori A, et al. Relationship between preclinical abnormalities of global and regional left ventricular function and insulin resistance in severe obesity: a Color Doppler Imaging Study. Int J Obes (Lond). 2006; 30(6): 948–956.
  19. Goverde AJ, van Koert AJB, Eijkemans MJ, et al. Indicators for metabolic disturbances in anovulatory women with polycystic ovary syndrome diagnosed according to the Rotterdam consensus criteria. Hum Reprod. 2009; 24(3): 710–717.
  20. Yilmaz M, Isaoglu U, Delibas IB, et al. Anthropometric, clinical and laboratory comparison of four phenotypes of polycystic ovary syndrome based on Rotterdam criteria. J Obstet Gynaecol Res. 2011; 37(8): 1020–1026.
  21. Orio F, Palomba S, Spinelli L, et al. The cardiovascular risk of young women with polycystic ovary syndrome: an observational, analytical, prospective case-control study. J Clin Endocrinol Metab. 2004; 89(8): 3696–3701.
  22. Selcoki Y, Yilmaz OC, Carlioglu A, et al. Cardiac flow parameters with conventional and pulsed tissue Doppler echocardiography imaging in patients with polycystic ovary syndrome. Gynecol Endocrinol. 2010; 26(11): 815–818.
  23. Kosmala W, O'Moore-Sullivan TM, Plaksej R, et al. Subclinical impairment of left ventricular function in young obese women: contributions of polycystic ovary disease and insulin resistance. J Clin Endocrinol Metab. 2008; 93(10): 3748–3754.
  24. Tíras MB, Yalcìn R, Noyan V, et al. Alterations in cardiac flow parameters in patients with polycystic ovarian syndrome. Hum Reprod. 1999; 14(8): 1949–1952.
  25. Tekin A, Tekin G, Cölkesen Y, et al. Left ventricular function in patients with polycystic ovary syndrome: a Doppler echocardiographic study. Exp Clin Endocrinol Diabetes. 2009; 117(4): 165–169.
  26. Koren MJ, Devereux RB, Casale PN, et al. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med. 1991; 114(5): 345–352.
  27. Zimmermann S, Phillips RA, Dunaif A, et al. Polycystic ovary syndrome: lack of hypertension despite profound insulin resistance. J Clin Endocrinol Metab. 1992; 75(2): 508–513.
  28. Wild RA, Carmina E, Diamanti-Kandarakis E, et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab. 2010; 95(5): 2038–2049.
  29. Abhayaratna WP, Seward JB, Appleton CP, et al. Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol. 2006; 47(12): 2357–2363.
  30. Yarali H, Yildirir A, Aybar F, et al. Diastolic dysfunction and increased serum homocysteine concentrations may contribute to increased cardiovascular risk in patients with polycystic ovary syndrome. Fertil Steril. 2001; 76(3): 511–516.
  31. Taponen S, Martikainen H, Järvelin MR, et al. Northern Finland Birth Cohort 1966 Study. Hormonal profile of women with self-reported symptoms of oligomenorrhea and/or hirsutism: Northern Finland birth cohort 1966 study. J Clin Endocrinol Metab. 2003; 88(1): 141–147.