Abstract 11533: Left Ventricular (LV) Geometry and Remodeling in Diabetic Patients (D) With Severe Isolated Aortic Stenosis (AS) and Preserved Left Ventricular Ejection Fraction (EF)
Objective: Diabetes is associated with faster rates of calcium deposition on the aortic valve. In AS, D have more severe left ventricular hypertrophy (LVH) and worse LV function than non-D (ND), but patterns of LV remodeling and outcomes have not been extensively evaluated. We examined LV remodeling and all-cause mortality in D with severe AS and preserved EF.
Methods: Of 439 consecutive symptomatic pts with severe isolated AS, sinus rhythm and normal EF undergoing transthoracic echocardiography (2005-2012), 100 had D and were compared with 339 ND over a mean followup of 39.3 ± 32.4 months. Clinical data were abstracted from medical records and mortality from the Social Security database. Appropriateness of LVH was determined using the de Simone equation. Statistical
Methods: Comparisons of continuous variables between the 2 groups was done using ANCOVA and Fisher’s exact test whereas survival analysis of the time to death was done using the Cox proportional hazards regression model. p-values < 0.05 were deemed statistically significant.
Results: In highly adjusted models (table, row 1, last column), D had more inappropriate LVH, similar concentric remodeling, worse LV systolic function and higher vascular loads for similar AV area. In the same models, valve replacement was highly protective in both D and ND (HR = 0.12, 95% CI, 0.04, 0.36, and HR = 0.32, 95% CI, 0.20-0.51, respectively, p< 0.0001, for both) and in only in ND, relative wall thickness was weakly associated with death ( HR = 1.02, 95% CI, 1.004,1.035, p= 0.01).
Conclusions: 1. With similar AS severity, D have greater LV mass and higher global afterload which, along with more CAD and hypertension may contribute to poorer prognosis. 2. The desirability of earlier AVR in D should be investigated.
- © 2013 by American Heart Association, Inc.