Title : Impact of metabolic syndrome on myocardial status in ICU patients

Background: Metabolic Syndrome (MetS) is a highly prevalent condition among patients with acute myocardial infarction (AMI) in the intensive care unit (ICU), yet its direct impact on inhospital outcomes remains a subject of debate. This systematic review aims to synthesize the current evidence on the prevalence of MetS in critically ill AMI patients and its association with clinical severity and in-hospital mortality.

Methods: This is a systematic observational study. Data on patients’ demographics, clinical characteristics, and clinical outcomes were systematically extracted and synthesized. The study focused on prevalence rates, patient characteristics including age, gender, body mass index, waist circumference, and comorbidities, as well as in-hospital outcomes such as mortality, heart failure, and major adverse cardiovascular events.

Results: The prevalence of MetS in patients with AMI in the ICU setting is consistently high, ranging from % to .% across different populations [ , ]. Patients with MetS are more likely to be female and present with a higher body mass index (BMI), larger waist circumference, and a greater incidence of hypertension and diabetes. While some studies report no significant increase in all-cause in-hospital mortality, others indicatea significantly higher rate of cardiovascular mortality (P = . ) and an increased risk of complications such as congestive heart failure and recurrent myocardial ischemia [ , ]. Specific components of MetS, notably hyperglycemia and a BMI ≥ kg/m², have been identified as independent predictors of major adverse cardiovascular events (MACE) [ ]. The pathophysiological mechanisms underlying these outcomes demonstrate the complex interplay between MetS components and myocardial dysfunction.

Conclusion: Metabolic Syndrome is a major health burden in critically ill patients with AMI, associated with a higher risk of specific in-hospital complications, even if its role in allcause mortality is not definitively established. The underlying pathophysiology involves a complex interplay of systemic inflammation, endothelial dysfunction, and a prothrombotic state, which collectively drive myocardial fibrosis and ventricular hypertrophy, culminating in myocardial dysfunction. These findings underscore the critical need for early identification and aggressive management of MetS and its components to improve outcomes in this high-risk population. Further large-scale prospective studies are warranted to clarify the prognostic implications of MetS in the ICU.

Keywords: Metabolic Syndrome, Myocardial Dysfunction, Critical Care, Intensive Care Unit (ICU), Acute Myocardial Infarction (AMI), In-Hospital Outcomes, Cardiovascular Mortality.

Dr. Mohamed Wasfy is an intensivist specializing in critical care medicine research. He holds MSc in both critical care medicine from Ain Shams university (Egypt) and cardiology from Menoufia university (Egypt) Epidemiology. Dr. Wasfy has worked in most of the pioneers hospitals in Egypt and American hospital Dubai as long as Fujairah hospital in UAE and has published previously a paper titled Cystatin C in coronary artery disease patients. He is currently a senior intensive care specialist in Fujairah hospital, UAE.