Abstract 8922: Association between Metabolic Syndrome and Concentric Left Ventricular Hypertrophy in Patients with Severe Calcific Aortic Stenosis Undergoing Aortic Valve Replacement
Background: We reported that in patients with mild to moderate aortic stenosis (AS), metabolic syndrome (MetS) is associated with more pronounced concentric LV hypertrophy. Severe LV concentric hypertrophy has been linked to reduced survival following aortic valve replacement (AVR). The aim of this study was to examine the relationship between MetS and prevalence of LV concentric hypertrophy in patients with severe AS referred to AVR.
Method and Results: 510 patients with severe AS underwent isolated AVR. Among 510 patients undergoing isolated AVR, 131 (26%) had the MetS and 109 (21%) had type 2 diabetes (T2D). Patients with T2D or MetS had larger waist circumference (T2D: 106±16; MetS: 104 ±12 vs.noMetS-noT2D: 96±13cm; p<0.0001), higher incidence of hypertension (86; 85 vs. 50%) and coronary artery disease (CAD: 22; 18 vs. 10%) compared to those with noMetS-no T2D. The severity of AS was similar in the 3 groups (Peak aortic jet velocity [Vmax]:417±81; 416 ±81 vs. 424±84mmHg; p=0.13). Patients were classified into four different LV patterns according to relative wall thickness ratio and LV mass indexed (LVMi) to a 2.7 power of height (Figure). Distribution of LV patterns was worse (p<0.0001) in T2D and MetS groups compared to noMetS-noT2D group (Figure). Diabetes and MetS were independently (p=0.02 and p=0.04) associated with higher LVMi after adjustment for age, gender, hypertension, Vmax, mitral regurgitation, CAD, history of myocardial infarction, and valvulo-arterial impedance. One year after AVR, decrease in LVMi was similar in the 3 groups (p=0.44) and thereby postoperative LVMi remained higher (p=0.003) in the T2D and MetS groups (49 ±14 and 53±12 g/m2.7) compared to noMetS-noT2D group (43±15 g/m2.7).
Conclusion: MetS and T2D are independently associated with higher prevalence of LV concentric hypertrophy in patients with severe AS and with more residual hypertrophy following AVR, which may in turn increase short- and long- term postoperative mortality.
- © 2011 by American Heart Association, Inc.