**Abstract**

Cardiomyopathy is a disease of the heart muscle, which makes the muscles harder to pump blood to the rest of the body leading to heart failure. The main types of cardiomyopathies include dilated cardiomyopathy, hypertrophic cardiomyopathy, ischemic cardiomyopathy, arrhythmogenic right ventricular dysplasia, restrictive cardiomyopathy, and Takotsubo cardiomyopathy. On the other hand, Metabolic syndrome (MetS) is the clustering of different medical conditions, which requires at least three of the five following diseases. These diseases are high blood sugar, high blood pressure, high serum triglycerides, low serum high-density lipoprotein, and central obesity. The risk of developing type 2 diabetes and cardiovascular disease associated with metabolic syndrome. In MetS, many different biomarkers are used in the early detection and risk stratification of MetS patients. It includes adiponectin, leptin, interleukin 6, tumor necrosis factor-alpha, uric acid, interleukin 10, ghrelin, adiponectin, paraoxonase, oxidized low-density lipoprotein, and plasminogen activator inhibitor-1. This chapter provides an overview and focuses on the basic role of major biomarkers of metabolic syndrome in the pathogenesis of different types of cardiomyopathies, which mainly highlights recent pathophysiological aspects in the development and progress of cardiomyopathy which is the leading cause of heart failure. In conclusion, biomarkers of metabolic syndrome play a significant role in the development and progress of cardiomyopathy which is the leading cause of heart failure.

**Keywords:** cardiomyopathy, types of cardiomyopathies, metabolic syndrome, biomarkers, heart failure

## **1. Introduction**

Metabolic syndrome (MetS) is known by other names such as dysmetabolic syndrome, syndrome X, insulin resistance syndrome, and deadly quartet. It is a fastgrowing health problem worldwide [1]. Metabolic syndrome is the clustering of different medical conditions, which requires at least three of the five following diseases. These diseases are high blood sugar, high blood pressure, high serum triglycerides, low serum high-density lipoprotein, and central obesity. The risk of developing type 2 diabetes and cardiovascular disease associated with metabolic syndrome [2].

A biomarker is a quantifiable sign of a certain biological state or condition. It is used to evaluate or measure the normal biological process, pharmacologic response, and pathogenic processes of a therapeutic intervention. In MetS, many different biomarkers are used in the early detection and risk stratification of MetS patients. It includes adiponectin, leptin, interleukin 6, tumor necrosis factor-alpha, uric acid, interleukin 10, ghrelin, adiponectin, paraoxonase, oxidized low-density lipoprotein (Ox-LDL), and plasminogen activator inhibitor-1 [3].

Cardiomyopathy is a disease of the heart muscle which makes the muscles harder to pump blood to the rest of the body leading to heart failure. The main types of cardiomyopathies include restricted cardiomyopathy, dilated cardiomyopathy, hypertrophic cardiomyopathy, ischemic cardiomyopathy, arrhythmogenic right ventricular dysplasia, and Takotsubo cardiomyopathy. The pathogenesis of dilated cardiomyopathy is complicated and includes myocardial fibrosis as well as myocyte injury induced by abnormal immune responses after viral infection are considered to be critical factors in the progress of dilated cardiomyopathy [4, 5]. Viral myocarditistriggered dilated cardiomyopathy is a common cause of heart failure and is characterized by systolic dysfunction as well as left ventricular dilation [6]. Heart failure is a complex progressive pathology in which phenotype is reflective of end-organ damage as a result of insulin/injuries such as post-partum cardiomyopathy, dyslipidemia, congenital disorders, hypertension, ischemic heart disease, and diabetes [7–10].

This chapter will give the recent development of major biomarkers of metabolic syndrome (adiponectin, leptin, uric acid, TNF-α, interleukin-6) in the development and progress of cardiomyopathy which includes the different types of cardiomyopathies such as dilated cardiomyopathy, ischemic cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, and so on, and also emphasized their contribution in the heart failure patients.
