Key result
Metabolic syndrome in asymptomatic AS links to ~13% higher LV mass index and concentric hypertrophy.
Why the study?
Animal studies showed insulin resistance exacerbated LV hypertrophy and dysfunction under pressure overload, but the relationship between metabolic syndrome and LV geometry and function in asymptomatic aortic stenosis was unexamined.
Does metabolic syndrome worsen left ventricular geometry and function in patients with asymptomatic aortic stenosis?
Cross-Sectional (n=272)
Does metabolic syndrome worsen left ventricular geometry and function in patients with asymptomatic aortic stenosis?
Absolute Event Rate: 53% vs 47%
p-value: p=0.002
In patients with asymptomatic aortic stenosis, metabolic syndrome is independently associated with more pronounced LV concentric hypertrophy and worse myocardial function.
Metabolic syndrome may worsen LV remodeling in asymptomatic aortic stenosis; leaves open whether metabolic intervention alters progression.
OBJECTIVES: The aim of this study was to examine the relationship between metabolic syndrome (MetS) and left ventricular (LV) geometry and function in patients with asymptomatic aortic stenosis (AS). BACKGROUND: Recent experimental studies reveal that, among animals with sustained pressure overload, those with insulin resistance induced by a high-carbohydrate/high-fat diet have more severe LV hypertrophy and dysfunction compared to animals fed with standard diet. METHODS: Among the 272 patients who were recruited in the ASTRONOMER (Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin) study, none had hypercholesterolemia, diabetes mellitus, or coronary artery disease (exclusion criteria) at baseline. However, 33% had systemic hypertension and 27% had MetS as identified by the National Cholesterol Education Program, Adult Treatment Panel III, clinical criteria. RESULTS: Patients with MetS had higher LV mass index (53 +/- 14 g/m(2.7) vs. 47 +/- 15 g/m(2.7); p = 0.002), relative wall thickness ratio (0.47 +/- 0.09 vs. 0.42 +/- 0.09; p = 0.001), and prevalence of LV concentric hypertrophy (42% vs. 23%) and lower peak early diastolic (8.2 +/- 2.4 cm/s vs. 9.6 +/- 3.1 cm/s, p = 0.001) and peak systolic (7.9 +/- 1.7 cm/s vs. 8.7 +/- 2.2 cm/s, p = 0.009) mitral annular myocardial velocities compared to patients without MetS. After adjustment for age, sex, low-density lipoprotein cholesterol, hypertension, and valvuloarterial impedance (i.e., global LV hemodynamic load), MetS was independently associated with higher relative wall thickness ratio (p = 0.01), higher prevalence of concentric hypertrophy (p = 0.03), and reduced diastolic (p = 0.01) and systolic (p = 0.03) myocardial velocities. CONCLUSIONS: Notwithstanding AS severity and increase in hemodynamic load, MetS is independently associated with more pronounced LV concentric hypertrophy and worse myocardial function in patients with AS, which may, in turn, predispose them to the occurrence of adverse events. (Effects of Rosuvastatin on Aortic Stenosis Progression [ASTRONOMER]; NCT00800800).
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Pagé et al. (2010) conducted a cross-sectional in asymptomatic aortic stenosis (n=272). Metabolic syndrome vs. No metabolic syndrome was evaluated on Left ventricular mass index (g/m2.7) (p=0.002). Metabolic syndrome in patients with asymptomatic aortic stenosis is associated with higher LV mass index (53 vs 47 g/m2.7; p=0.002) and more pronounced LV concentric hypertrophy.
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