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)
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)
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DOI：
10.1016/j.jacc.2009.11.083
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发表时间：
2010-04-27
影响因子：
24
通讯作者：
Pibarot, Philippe
中科院分区：
文献类型：
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作者：
Page, Anik;Dumesnil, Jean G.;Pibarot, Philippe
目的探讨代谢综合征（MetS）与无症状性主动脉瓣狭窄（AS）患者左心室（LV）结构和功能的关系。高碳水化合物/高碳水化合物引起的胰岛素抵抗与标准饮食喂养的动物相比，高脂饮食喂养的动物具有更严重的左室肥厚和功能障碍。（主动脉瓣狭窄进展观察测量瑞舒伐他汀的作用）研究中，基线时无高胆固醇血症、糖尿病或冠状动脉疾病（排除标准）。然而，根据国家胆固醇教育计划，成人治疗组III，临床标准，33%患有全身性高血压，27%患有MetS。（53 +/- 14 g/m（2.7）vs. 47 +/- 15 g/m（2.7）; p = 0.002），相对壁厚比（0.47 +/- 0.09 vs. 0.42 +/- 0.09; p = 0.001）和LV向心性肥大的患病率（42% vs. 23%）和较低的舒张早期峰值（8.2 +/- 2.4 cm/s vs. 9.6 +/- 3.1 cm/s，p = 0.001）和收缩压峰值（7.9 +/- 1.7 cm/s vs. 8.7 +/- 2.2 cm/s，p = 0.009）二尖瓣环心肌速度与无MetS的患者相比。在调整年龄、性别、低密度脂蛋白胆固醇、高血压和瓣膜动脉阻抗（即，总体左室血流动力学负荷），MetS与较高的相对壁厚比独立相关（p = 0.01），向心性肥大的患病率较高（p = 0.03），舒张压降低（p = 0.01）和收缩压（p = 0.03）心肌运动速度。结论尽管AS严重程度和血流动力学负荷增加，MetS与AS患者更明显的左室向心性肥厚和更差的心肌功能独立相关，这反过来可能使他们更容易发生不良事件。（瑞舒伐他汀对主动脉狭窄进展的影响[ASTRONOMER]; NCT 00800800）（J Am科尔心脏病学杂志2010; 55：1867-74）（C）2010年美国心脏病学会基金会
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) (J Am Coll Cardiol 2010; 55: 1867-74) (C) 2010 by the American College of Cardiology Foundation