Abstract 665: Impact of Metabolic Syndrome on LV Geometry and Function in Patients With Calcific Aortic Stenosis: A Substudy of the ASTRONOMER Trial
Background: Recent experimental studies revealed that, among animals with sustained pressure overload, those with insulin resistance induced by a high-carbohydrate/high-fat diet developed more severe LV hypertrophy and dysfunction compared to animals fed with standard diet. We hypothesized that metabolic syndrome (MetS) predisposes to the development of LV concentric hypertrophy and dysfunction in patients with calcific aortic stenosis (AS).
Method and Results: Among the 272 patients who were recruited in the ASTRONOMER study (Randomized trial to assess the effect of Rosuvastatin versus placebo on the progression of AS), none had hypercholesterolemia, diabetes, or coronary artery disease (exclusion criteria) at baseline. However, 33% had systemic hypertension (HPT) and 27% had MetS as identified by NCEP-ATPIII clinical criteria. Patients with MetS had a higher (p=0.001) prevalence of LV concentric hypertrophy (61%) compared to those without MetS (35%). After adjustment for age, gender, LDL-cholesterol, hypertension, and valvulo-arterial impedance (i.e. global LV hemodynamic load), MetS was independently associated with the presence of concentric hypertrophy (p=0.002). Moreover, the mitral annular myocardial velocities were significantly lower in patients with MetS than in those without MetS: peak early diastolic: 8.2±2.4 vs. 9.6±3.1, p=0.001 and peak systolic: 7.9±1.7 vs. 8.7±2.2, p=0.009. MetS was an independent predictor of both diastolic (p=0.01) and systolic (p=0.03) myocardial velocities after adjustment for the aforementioned factors and for the presence of LV concentric hypertrophy.
Conclusion: MetS is independently associated with more pronounced LV concentric hypertrophy and worse myocardial diastolic and systolic function in patients with AS, which may, in turn, predispose to the occurrence of adverse events in this population.