Metabolic syndrome is associated with more pronounced impairment of left ventricle geometry and function in patients with calcific aortic stenosis: a substudy of the ASTRONOMER (Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin)

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).