Myocardial lipid accumulation in patients with pressure-overloaded heart and metabolic syndrome.

We evaluated the role of sterol-regulatory element binding protein (SREBP)-1c/peroxisome proliferator activated receptor- * (PPAR * ) pathway on heart lipotoxicity in patients with metabolic syndrome (MS) and aortic stenosis (AS). Echocardiographic parameters of heart function and structural alterations of LV specimens were studied in patients with (n = 56) and without (n = 61) MS undergoing aortic valve replacement. Tissues were stained with hematoxylin-eosin (H and E) and oil red O for evidence of intramyocyte lipid accumulation. The specimens were also analyzed with PCR, Western blot, and immunohistochemical analysis for SREBP-1c and PPAR * . Ejection fraction (EF) was lower in MS compared with patients without MS ( P < 0.001); no difference was found in aortic orifi ce surface among the groups. H and E and oil red O staining of specimens from MS patients revealed several myocytes with intracellular accumulation of lipid, whereas these alterations were not detected in biopsies from patients without MS. Patients without MS have low levels and weak immunostaining of SREBP-1c and PPAR * in heart specimens. In contrast, strong immunostaining and higher levels of SREBP-1c and PPAR * were seen in biopsies from the MS patients. Moreover, we evidenced a signifi cative correlation between both SREBP-1c and PPAR * and EF and intramyocyte lipid accumulation ( P < 0.001). SREBP-1c may contribute to heart dysfunction by promoting lipid accumulation within myocytes in MS patients with AS; SREBP-1c may do it by increasing the levels of PPAR * protein.