Abstract 17303: Excess Visceral Adiposity is Related to Left Ventricular Hypertrophy and Dysfunction in Patients with Aortic Stenosis - Results from the PROGRESSA Study

Abstract

BACKGROUND: We reported that metabolic syndrome (MetS) is associated with LV concentric hypertrophy and impairment of LV systolic function in patients with aortic stenosis (AS). Excessive visceral fat accumulation could be one of the key causal factors underlying this association. The aim of this study was to examine the association between total vs visceral adiposity and degree of LV hypertrophy and dysfunction in AS patients.

METHODS: 130 consecutive AS patients were recruited in the PROGRESSA study and underwent echocardiography and computed tomography (CT). Abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and total adipose tissue (TAT=VAT+SAT) areas were measured by CT. The VAT/TAT ratio was calculated as an index of the proportion of total abdominal fat located in the visceral adipose tissue compartment.

RESULTS: Body mass index (BMI) correlated strongly with VAT, SAT and TAT (r=0.71, r=0.69 and r=0.85 respectively; all p<0.0001) but weakly with VAT/TAT ratio (r=0.19; p=0.03). Patients with VAT/TAT ratio>0.42 (i.e. median value) had higher prevalence of MetS (42 vs. 24%, p=0.03), hypertension (HTN: 81 vs. 61%, p=0.02), diabetes (27 vs. 13%, p=0.04), hyperlipidemia (75 vs. 58%, p=0.04), and CAD (52 vs. 27%, p=0.006). Peak aortic jet velocity (V_peak) was similar in both groups. LV mass index was higher in patients with VAT/TAT ratio>0.42 (LVMi: 53±11 vs. 46±8 g/m^2.7, p=0.0004). In multivariate model adjusted for age, gender, HTN, MetS, CAD, AV calcification, V_peak, and valvulo-arterial impedance (Z_va), the predictors of higher LVMi were larger BMI (p<0.0001), higher creatinine level (p=0.006), and higher VAT/TAT ratio (p=0.02). VAT/TAT ratio was also associated with E/Ea ratio (r=0.17; p=0.05) and inversely associated with LVEF (r=-0.18, p=0.04). In multivariate model adjusted for age, gender, HTN, CAD, V_peak, and Z_va, higher VAT/TAT ratio was independently associated with reduced LVEF (p=0.04).

CONCLUSION: This study reports that selective deposition of lipids in the VAT compartment is associated with more pronounced LV hypertrophy and dysfunction, independently of BMI or TAT. These findings provide impetus for elaboration of interventional studies targeting excess visceral adiposity in the AS population.