Le projet RESOLVE qui a été conduit sur plusieurs années en collaboration avec l’université et l’hôpital de Clermont-Ferrand et financé par la fondation Coeur et Artères connait aujourd’hui ses premières publications.
Brièvement ce projet clinique de 150 sujets s’est intéressé à l’impact d’une prise en charge hygiéno-diététique (exercice et nutrition) sur les facteurs de risques cardiovasculaires chez des patients atteints du syndrome métabolique. Le syndrome métabolique est caractérisé par l’association de plusieurs problèmes d’origine glucidique, lipidique ou vasculaire, associés à une surcharge pondérale, et qui peuvent à terme provoquer un diabète de type 2.
La première publication publiée dans International Journal of Cardiology (IF = 7.078) est un article PRINCEPS qui décrit l’ensemble du protocole et rapporte les résultats de la prise en charge sur les facteurs du syndrome métabolique. (résumé en bas de page).
La deuxième publication (Obesity Journal, IF = 4.284) s’intéresse aux troubles de la fonction cardiaque par une analyse échocardiographique par Speckle Tracking Imaging chez ces patients atteints par le syndrome métabolique AVANT la prise en charge. D’autres analyses sont en cours de traitement.
Article Princeps :
Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome: the RESOLVE* randomized trial
Frédéric Dutheil,Gérard Lac, Bruno Lesourd, Robert Chapiera, Guillaume Walther, Agnès Vinet, Vincent Sapin, Julien Verney, Lemlih Ouchchane, Martine Duclos, Philippe Obert, Daniel Courteix.
Résumé :
Background: Opinions differ over the exercise modalities that best limit cardiovascular risk (CVR) resulting from visceral obesity in individuals with metabolic syndrome (MetS). As little is known about the combined effects of resistance and endurance training at high volumes under sound nutritional conditions, we aimed to analyze the impact of various intensities of physical activity on visceral fat and CVR in individuals with MetS.
Methods : 100 participants, aged 50–70 years, underwent a diet restriction (protein intake 1.2 g/kg/day) with a high exercise volume (15–20 h/week). They were randomized to three training groups: moderate-resistance–moderate-endurance (re), high-resistance–moderate-endurance (Re), or moderate-resistance–high-endurance (rE). A one-year at-home follow-up (M12) commenced with a three-week residential program (Day 0 to Day 21). We measured the change in visceral fat and body composition by DXA, MetS parameters, fitness, the Framingham score and carotid-intima–media-thickness.
Results : 78 participants completed the program. At D21, visceral fat loss was highest in Re (− 18%, p < .0001) and higher in rE than re (− 12% vs. − 7%, p < .0001). Similarly, from M3, visceral fat decreased more in high-intensity-groups to reach a visceral fat loss of − 21.5% (Re) and − 21.1% (rE) > − 13.0% (re) at M12 (p < .001). CVR, MetS parameters and fitness improved in all groups. Visceral fat loss correlated with changes in MetS parameters.
Conclusion : Increased intensity in high volume training is efficient in improving visceral fat loss and carotid-intima–media-thickness, and is realistic in community dwelling, moderately obese individuals. High-intensity-resistance training induced a faster visceral fat loss, and thus the potential of resistance training should not be undervalued (ClinicalTrials.gov number: NCT00917917).
Article « Coeur » :
MYOCARDIAL DEFORMATION AND TWIST MECHANICS IN ADULTS WITH METABOLIC SYNDROME: IMPACT OF CUMULATIVE METABOLIC BURDEN
Edward CRENDAL, Guillaume WALTHER, Agnes VINET, Frédéric DUTHEIL, Geraldine NAUGHTON, Bruno LESOURD, Robert CHAPIER, Thomas RUPP, Daniel COURTEIX, Philippe OBERT.
Résumé :
Objective: We aimed to characterize left ventricular (LV) myocardial mechanics in adults with metabolic syndrome (MetS), and elucidate the effects of multiple risk-factors on myocardial function using speckle tracking echocardiography (STE); a more sensitive method than conventional echocardiography for detecting subclinical myocardial dysfunction.
Design and Methods: Cross-sectional analyses of 92 adults (50-70 years) with MetS, and 50 healthy controls included conventional echocardiography, blood biochemistry, and STE-derived myocardial longitudinal, circumferential, and twist mechanics.
Results: Using conventional measures, MetS participants revealed LV hypertrophy and reduced diastolic function compared with controls, while systolic function was preserved. From STE, MetS participants showed attenuated longitudinal strain (-16.8±2.8 vs. -20.6±2.7%), and both diastolic (1.1±0.2 vs. 1.4±0.3 s.s-1) and systolic (-1.0±0.1 vs. -1.2±0.2 s.s-1) strain rate (SR). Circumferential strain, SR, and twist mechanics did not differ. Participants with the highest number of MetS factors or diabetes demonstrated the greatest reduction in longitudinal strain and SR. Abdominal obesity, TNF-α, HbA1c, and systolic dyssynchrony explained 48% of impairment in longitudinal strain.
Conclusions: Impaired longitudinal myocardial diastolic and systolic function, but preserved circumferential function and twist mechanics were found in MetS participants, indicative of altered sub-endocardial function. This dysfunction was best predicted by abdominal obesity, inflammation glucose-intolerance, and systolic dyssynchrony.