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The prevalence of this syndrome in general population, according to some studies ranges between 30% to 50% of patients with heart failure [2, 3]. The annual mortality rate of patients presenting HF-PEF is 5-8% lower than in patients with systolic dysfunction, and it depends on the associated comorbidities [1]. Patients with heart failure (HF) frequently pesent a high number of comorbidities. In one study conducted by Senni M and Redfield MM on 216 patients with HF, fifty-nine of them had preserved systolic function and also presented valve disease, atrial fibrillation, coronary heart disease, hypertension or metabolic syndrome (MetS)[4, 5]. According to the National Cholesterol Education Program’s Adult Treatment Panel III metabolic syndrome is composed of the following 6 elements: abdominal obesity, atherogenic dyslipidaemia, elevated blood pressure, insulin resistance or impaired glucose tolerance, proinflammatory state and prothrombotic state [6].

In need for a simpler and easier definition to apply by clinicians worldwide, in 2006 the International Diabetes Federation defined metabolic syndrome as central obesity accompanied by any of the two following elements: elevated serum triglycerides (≥ 1.7 mmol/l), low HDL cholesterol (< 40 mg/dl in male,< 50 mg/dl in female), elevated blood pressure (> 130/85 mmHg), fasting hyperglycaemia (> 100 mg/dl) or diagnosed type 2 diabetes [7]. Components of the MetS such as high blood pressure, diabetes and low HDL cholesterol levels have been identified as major and independent cardiovascular risk factors [8]. The E/A ratio is efficient in assessing diastolic dysfunction (DD). The normal value is …