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This study aimed to evaluate the association of MetS with diastolic function and myocardial extracellular matrix (ECM) using cardiac MRI (CMRI) in a large community-based population. This cross-sectional analysis included 1,582 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with left ventricular ejection fraction \u226550% and no history of cardiac events. Diastolic function was assessed using tagged CMRI parameters including end-diastolic strain rate (EDSR) and strain relaxation index (SRI). ECM was evaluated using extracellular volume (ECV) quantification. Participants\u2019 mean age was 67.4 \u00b1 8.6 years, and 48.1% were males. MetS was present in 533 individuals (33.7%), and type 2 diabetes in 250 (15.8%). In the multivariable analyses, MetS (irrespective of the presence of type 2 diabetes) and higher insulin resistance were associated with impaired diastolic function (higher SRI and lower EDSR), independent of ECV. In conclusion, MetS, irrespective of the presence of type 2 diabetes, was independently associated with impaired diastole. These functional myocardial changes seem to result from intrinsic cardiomyocyte alterations, irrespective of the myocardial interstitium (including fibrosis).<\/jats:p>","DOI":"10.2337\/db17-1496","type":"journal-article","created":{"date-parts":[[2018,2,15]],"date-time":"2018-02-15T01:55:14Z","timestamp":1518659714000},"page":"1007-1012","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":30,"title":["Metabolic Syndrome Is Associated With Impaired Diastolic Function Independently of MRI-Derived Myocardial Extracellular Volume: The MESA Study"],"prefix":"10.2337","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5260-5613","authenticated-orcid":false,"given":"Ricardo","family":"Ladeiras-Lopes","sequence":"first","affiliation":[{"name":"1Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal"},{"name":"2Cardiology Department, Gaia Hospital Centre, Vila Nova de Gaia, Portugal"}]},{"given":"Henrique T.","family":"Moreira","sequence":"additional","affiliation":[{"name":"3The Johns Hopkins University, Baltimore, MD"},{"name":"4University of S\u00e3o Paulo, Ribeir\u00e3o Preto, Brazil"}]},{"given":"Nuno","family":"Bettencourt","sequence":"additional","affiliation":[{"name":"1Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal"}]},{"given":"Ricardo","family":"Fontes-Carvalho","sequence":"additional","affiliation":[{"name":"1Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal"},{"name":"2Cardiology Department, Gaia Hospital Centre, Vila Nova de Gaia, Portugal"}]},{"given":"Francisco","family":"Sampaio","sequence":"additional","affiliation":[{"name":"1Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal"},{"name":"2Cardiology Department, Gaia Hospital Centre, Vila Nova de Gaia, Portugal"}]},{"given":"Bharath","family":"Ambale-Venkatesh","sequence":"additional","affiliation":[{"name":"3The Johns Hopkins University, Baltimore, MD"}]},{"given":"Colin","family":"Wu","sequence":"additional","affiliation":[{"name":"5National Institutes of Health, Bethesda, MD"}]},{"given":"Kiang","family":"Liu","sequence":"additional","affiliation":[{"name":"6Northwestern University, Chicago, IL"}]},{"given":"Alain G.","family":"Bertoni","sequence":"additional","affiliation":[{"name":"7Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, NC"}]},{"given":"Pamela","family":"Ouyang","sequence":"additional","affiliation":[{"name":"3The Johns Hopkins University, Baltimore, MD"}]},{"given":"David A.","family":"Bluemke","sequence":"additional","affiliation":[{"name":"5National Institutes of Health, Bethesda, MD"}]},{"given":"Jo\u00e3o A.","family":"Lima","sequence":"additional","affiliation":[{"name":"3The Johns Hopkins University, Baltimore, 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