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Mirzohreh ST, Panahi P, Zafardoust H, Zavvar M, Fathi N, Dehghan M, Sarbakhsh P. The role of polycystic ovary syndrome in preclinical left ventricular diastolic dysfunction: an echocardiographic approach: a systematic review and meta-analysis. Cardiovasc Endocrinol Metab 2023; 12:e0294. [PMID: 37900050 PMCID: PMC10611352 DOI: 10.1097/xce.0000000000000294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023]
Abstract
Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of childbearing age, causing hormonal imbalances, reproductive issues, and metabolic disturbances. Women with PCOS have an increased risk of cardiovascular disease due to insulin resistance, obesity, and hyperandrogenism. Detecting impaired left ventricular (LV) function is important in managing this condition. Echocardiography, a non-invasive imaging technique, can effectively detect LV dysfunction. Aim The goal of this systematic review was to assess whether there are any variations in echocardiographic measures between women with PCOS and those without the condition in order to determine the potential impact of PCOS on LV function. Methods This review followed the PRISMA reporting guidelines. A thorough search of databases including PubMed, Scopus, Web of Science, and Cochrane was conducted. The quality of the selected studies was assessed using the Joanna Briggs Institute appraisal instruments. After applying strict eligibility criteria, data were extracted and organized in Microsoft Excel sheets. Review Manager (RevMan) software was used for the analysis. Results Analysis of 29 studies revealed significant differences in echocardiographic measures related to diastolic function between women with PCOS and healthy controls. However, there were no significant differences in measures of systolic function. Conclusion These findings indicate that PCOS may be linked to impaired LV function, thereby increasing the risk of cardiovascular disease. Further research is necessary to better understand this association and its clinical implications. Early detection and management of PCOS could potentially help prevent cardiovascular complications in affected women.
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Affiliation(s)
- Seyedeh-Tarlan Mirzohreh
- Student Research Committee, Tabriz University of Medical Sciences
- Cardiovascular Research Center, Shahid Madani Heart Center, Tabriz University of Medical Sciences
| | - Padideh Panahi
- Student Research Committee, Tabriz University of Medical Sciences
| | | | - Morteza Zavvar
- Student Research Committee, Tabriz University of Medical Sciences
| | - Nima Fathi
- Student Research Committee, Tabriz University of Medical Sciences
| | - Mahshid Dehghan
- Student Research Committee, Tabriz University of Medical Sciences
| | - Parvin Sarbakhsh
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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Saylik F, Akbulut T. The relationship between presystolic wave and subclinical left ventricular dysfunction assessed by myocardial performance ındex in patients with polycystic ovary syndrome. Echocardiography 2021; 38:1534-1542. [PMID: 34296457 DOI: 10.1111/echo.15166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/22/2021] [Accepted: 07/10/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) patients have left ventricular dysfunction (LVD) in an earlier stage. Myocardial performance index (MPI) reflects both systolic and diastolic dysfunction. A presystolic wave (PSW) detected on late diastole has been found to be associated with LVD. AIMS We sought to determine whether there is an association between PSW and subclinical LVD assessed by MPI in PCOS patients. METHODS We prospectively enrolled 106 patients diagnosed with PCOS in this study. Patients were divided into two groups based on the presence of PSW. Both groups were compared with respect to demographic, clinical, and echocardiographic properties. Univariable and multivariable regression analyses were performed to detect predictors of subclinical LVD. RESULTS The study included 58 patients with PSW-positive (54.7%, mean age: 23) and 48 patients with PSW-negative (45.3%, mean age: 25). PSW-positive patients had a higher waist-to-hip ratio, fasting insulin, and HOMA-IR compared to PSW-negative patients. Higher MPI velocities and more frequent subclinical LVD were observed in PSW-positive group than in PSW-negatives (p < 0.001, p = 0.0031, respectively). PSW velocity was significantly correlated with MPI velocity (r:.404, p = 0.0016). The presence of PSW, HOMA-IR, and waist-to-hip ratio > 85 were predictors of subclinical LVD in univariate logistic regression analysis. Only the presence of PSW was an independent predictor of subclinical LVD in multivariable logistic regression analysis (OR:3.257, p = 0.028). CONCLUSION PSW prevalence was 54.7% in PCOS patients. PSW velocity was significantly correlated with MPI velocity. The presence of PSW was independently associated with subclinical LVD in PCOS women.
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Affiliation(s)
- Faysal Saylik
- Department of Cardiology, Van Education and Research Hospital, Van, Turkey
| | - Tayyar Akbulut
- Department of Cardiology, Van Education and Research Hospital, Van, Turkey
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Ollila MME, Kaikkonen K, Järvelin MR, Huikuri HV, Tapanainen JS, Franks S, Piltonen TT, Morin-Papunen L. Self-Reported Polycystic Ovary Syndrome Is Associated With Hypertension: A Northern Finland Birth Cohort 1966 Study. J Clin Endocrinol Metab 2019; 104:1221-1231. [PMID: 30445634 PMCID: PMC7296204 DOI: 10.1210/jc.2018-00570] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 11/12/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is associated with many traditional cardiovascular disease risk factors, but it is unclear whether PCOS is an independent risk factor for hypertension. OBJECTIVE To investigate in a population-based setup whether PCOS associates with the risk of hypertension independently of body mass index (BMI) and with cardiovascular manifestations. DESIGN Cross-sectional assessments in the Northern Finland Birth Cohort 1966 at ages 31 and 46 years. SETTING General community. PARTICIPANTS Women who reported both oligo/amenorrhea and hirsutism at age 31 years and/or a diagnosis of PCOS by age 46 years [self-reported PCOS (srPCOS), n = 279] and women without PCOS symptoms or diagnosis (n = 1577). INTERVENTION None. MAIN OUTCOME MEASURES Blood pressure (BP), BMI, and cardiovascular manifestations. RESULTS Use of antihypertensive medication was significantly more common in women with srPCOS. At age 31 years, women with srPCOS had significantly higher systolic BP (SBP) and diastolic BP (DBP) than control women (SBP: normal weight: 119.9 ± 13.2 vs 116.9 ± 11.4 mm Hg, P = 0.017; overweight/obese: 126.1 ± 14.3 vs 123.0 ± 11.9 mm Hg, P = 0.031; and DBP: normal weight: 75.5 ± 10.0 vs 72.4 ± 9.6 mm Hg, P = 0.003; overweight/obese: 80.7 ± 11.8 vs 78.0 ± 10.6 mm Hg, P = 0.031). At age 46 years, srPCOS was significantly associated with hypertension (adjusted odds ratio = 1.56; 95% CI, 1.14 to 2.13) independently of BMI and with higher cardiovascular morbidity (6.8% vs 3.4%, P = 0.011). Hypertensive srPCOS displayed consistent, unfavorable changes in cardiac structure and function compared with controls. CONCLUSION Women with srPCOS displayed higher BP compared with controls already at early age and srPCOS was associated with hypertension independently of overweight/obesity. srPCOS was associated with increased cardiovascular morbidity in premenopausal women, suggesting that cardiovascular disease risk factors should be screened and efficiently managed early enough in women with PCOS.
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Affiliation(s)
- Meri-Maija E Ollila
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
- Correspondence and Reprint Requests: Meri-Maija Ollila, MD, Department of Obstetrics and Gynecology, Oulu University Hospital, PL 23 90029 OYS, Finland. E-mail:
| | - Kari Kaikkonen
- Division of Cardiology, Department of Clinical Medicine, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Marjo-Riitta Järvelin
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Unit of Primary Health Care, Oulu University Hospital, OYS, Oulu, Finland
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center, University Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
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Satler F, Vieira RDA, Firpo C, Spritzer PM. Association between left ventricular mass, androgens, adiposity and insulin resistance in girls with precocious pubarche: a case-control study. Clin Endocrinol (Oxf) 2016; 84:394-401. [PMID: 26426700 DOI: 10.1111/cen.12957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 08/21/2015] [Accepted: 09/24/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Precocious pubarche (PP) has been linked to higher prevalence of metabolic disturbances and polycystic ovary syndrome (PCOS). The aim of the study was to assess echocardiographic parameters in PP girls and to analyse their relationship with androgens and insulin resistance (IR). DESIGN Case-control study. PATIENTS Thirty-five PP girls and 35 healthy age-matched controls. MEASUREMENTS Clinical, hormonal and metabolic profiles, echocardiography, body composition and oral glucose tolerance test. RESULTS Chronological age (10·04 ± 2·6 years in PP vs 10·13 ± 2·56 years in controls, P = 0·227), and pubertal stage at the time of the study were similar between the groups. PP girls had higher free androgen index (FAI) [1·39 (0·48-3·64) vs 1·06 (0·39-1·7), P = 0·005] and QUICKI (0·58 ± 0·08 vs 0·63 ± 0·12, P = 0·021). However, HOMA-IR was not significantly different between the groups [2·79 (1·84-4·05) vs 2·15 (1·09-3·23), P = 0·085]. After adjusting for total body fat, left ventricular mass (LVM) was higher in the PP group (97·31 ± 33·37 vs 81·25 ± 19·06 g, P = 0·017) as well as A' wave (5·66 ± 1·34 vs 5·09 ± 0·98 cm/s, P = 0·025), a measurement of diastolic function. FAI and total body fat were independent predictors of higher LVM and together with HOMA-IR contributed 72% of LVM variability in the PP group. CONCLUSION In this study with PP girls, greater LVM, associated with higher androgen levels, IR and total body fat, occurred early in pubertal development.
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Affiliation(s)
- Fabíola Satler
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Raquel do Amaral Vieira
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Cora Firpo
- Institute of Cardiology, Cardiology University Foundation, Porto Alegre, Brazil
| | - Poli Mara Spritzer
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Laboratory of Molecular Endocrinology, Department of Physiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Gazi E, Gencer M, Hanci V, Temiz A, Altun B, Barutcu A, Gungor AN, Hacivelioglu S, Uysal A, Colkesen Y. Atrial conduction time, and left atrial mechanical and electromechanical functions in patients with polycystic ovary syndrome: interatrial conduction delay. Cardiovasc J Afr 2015; 26:217-21. [PMID: 26659435 PMCID: PMC4780013 DOI: 10.5830/cvja-2015-046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/12/2015] [Indexed: 02/04/2023] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders of women during the reproductive period. Cardiovascular risk factors are more frequent in patients with PCOS. We aimed to investigate the P-wave dispersion (Pd), inter- and intra-atrial conduction time and mechanical functions of the left atrium (LA) in patients with PCOS. Methods Forty-eight patients with PCOS and 38 normal healthy women were enrolled in this study. A 12-lead surface electrocardiogram was used to evaluate Pd. Left ventricular (LV) functions were measured using conventional and tissue Doppler imaging (TDI) methods. Inter- and intra-atrial conduction times were measured by TDI. LA volumes were measured echocardiographically with the biplane area–length method from the apical four-chamber view. Results Heart rate (82.02 ± 13.15 vs 74.24 ± 11.02 bpm, p = 0.014) and Pd were significantly increased in the PCOS patients [27 ± 5 vs 24 ± 6 ms, p = 0.035]. Transmitral E/A ratio was significantly lower in the PCOS patients than in the controls (1.5 ± 0.3 vs 1.7 ± 0.4 m/s, p = 0.023). Passive emptying volume (12.54 ± 4.39 vs 15.28 ± 3.85 ml/m2, p = 0.004) and passive emptying fraction [54.4 (21–69) vs 59.1% (28–74), p = 0.008] were significantly decreased in PCOS patients. Total emptying volume was significantly decreased (17.9 ± 5.49 vs 20.67 ± 4.29 ml/m2, p = 0.018) in PCOS patients. Interatrial (19 ± 7.4 vs 15 ± 6.4 ms, p = 0.035) and intra-atrial [8.5 (1–19) vs 5 ms (1–20), p = 0.026] electromechanical delays were found to be significantly higher in PCOS patients. Conclusion This study showed that patients with PCOS had increased inter- and intra-atrial conduction delays, and decreased LA passive emptying volumes and fractions.
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Affiliation(s)
- Emine Gazi
- Department of Cardiology, Canakkale Onsekiz Mart University, Canakkale, Turkey.
| | - Meryem Gencer
- Department of Obstetrics and Gynecology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Volkan Hanci
- Department of Anesthesiology and Reanimation, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ahmet Temiz
- Department of Cardiology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Burak Altun
- Department of Cardiology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ahmet Barutcu
- Department of Cardiology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ayse Nur Gungor
- Department of Obstetrics and Gynecology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Servet Hacivelioglu
- Department of Obstetrics and Gynecology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ahmet Uysal
- Department of Obstetrics and Gynecology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Yucel Colkesen
- Department of Cardiology, Canakkale Onsekiz Mart University, Canakkale, Turkey
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Office Blood Pressure, Ambulatory Blood Pressure Monitoring, and Echocardiographic Abnormalities in Women With Polycystic Ovary Syndrome. Hypertension 2014; 63:624-9. [DOI: 10.1161/hypertensionaha.113.02468] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wang ET, Ku IA, Shah SJ, Daviglus ML, Schreiner PJ, Konety SH, Williams OD, Siscovick D, Bibbins-Domingo K. Polycystic ovary syndrome is associated with higher left ventricular mass index: the CARDIA women's study. J Clin Endocrinol Metab 2012; 97:4656-62. [PMID: 23012389 PMCID: PMC3591678 DOI: 10.1210/jc.2012-1597] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 08/29/2012] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of the study was to determine whether young women with polycystic ovary syndrome (PCOS) have evidence of early structural changes in echocardiographic parameters as a measurement of cardiovascular risk. METHODS We investigated the association of PCOS and echocardiographic parameters in 984 black and white women in the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort followed prospectively for 20 yr. Women ages 34-46 (Year 16) completed questionnaires recalling symptoms of oligomenorrhea and hirsutism in their 20s and 30s. Serum androgens were obtained at Year 2. Women in their 20s and 30s were classified into four mutually exclusive groups: 1) PCOS; 2) isolated oligomenorrhea (IO); 3) isolated hyperandrogenism (IH); and 4) reference group. Outcome measures were defined as echocardiography data from Year 5. We used multivariable linear regression models to evaluate the association of PCOS and its components with left ventricular (LV) mass index, left atrial (LA) diameter, LV ejection fraction (LVEF), and mitral inflow early wave to late wave ratio. RESULTS Among 984 participants, 42 women (4.3%) were classified as PCOS, 67 (6.8%) as IO, and 178 (18.0%) as IH. In multivariable linear regression analyses, women with PCOS had a 3.14 g/m(2.7) (95% confidence interval, 0.48-5.81) higher LV mass index compared to the reference group (approximately 10% higher). PCOS women also had a 0.11 cm/m (95% confidence interval, 0.02-0.19) larger LA diameter, after adjustment for age and race. CONCLUSION PCOS, but not IO or IH, is associated with a higher LV mass index and larger LA diameter in young women, suggestive of early adverse cardiac remodeling. Additional longitudinal studies are needed to evaluate whether this difference persists over time.
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Affiliation(s)
- Erica T Wang
- Department of Obstetrics Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California 94115, USA.
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Current world literature. Curr Opin Obstet Gynecol 2011; 23:301-5. [PMID: 21734502 DOI: 10.1097/gco.0b013e3283491e27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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