(P244) SEX-SPECIFIC ASSOCIATION OF ABDOMINAL OBESITY WITH LEFT VENTRICULAR STRUCTURE AND FUNCTION IN INDIVIDUALS WITH AORTIC STENOSIS, PRELIMINARY RESULTS FROM THE CCS-CARDIOMETABOLIC RESEARCH AWARD

Background: Abdominal obesity (AO) and its metabolic complications are associated with adverse myocardial remodeling in the context of aortic stenosis (AS). However, sex-specific data regarding this association are lacking, despite a differential impact of metabolic disorders on cardiovascular health being previously demonstrated in other contexts. We hypothesized that AO would be associated with worse left ventricular (LV) remodeling/function in women with AS.

METHODS AND RESULTS: From the prospective cohort study PROGRESSA (NCT01679431), which included individuals with at least mild AS not meeting criteria for aortic valve intervention, we comparted study groups according to AO (waist circumference [WC] men >102 cm; women >88 cm) and stratified by sex. Participants with previous myocardial infarction were excluded from this analysis. Using linear regression models, we evaluated the association between WC and parameters of LV structure and function measured by echocardiography per sex group, adjusted for age, valvulo-arterial impedance (Zva), hypertension and diabetes. Interaction between WC and sex was tested in a full cohort model.

Our sample included 234 individuals (30% women), among whom 79 (49%) men and 46 (73%) women had AO (participant characteristics in Table 1). Both men and women with AO+ had higher prevalence of hypertension as well as worse triglycerides, HDL-cholesterol and insulin resistance than their AO- counterparts (all p< 0.05). AS severity was comparable between AO+ and AO- (p>0.05), but Zva was higher among AO+ men than AO- men (p=0.01). After multivariable adjustment, WC was independently associated with increased height-indexed LV mass for both sexes (Figure 1). As well, among women only, increasing WC was significantly associated with worse parameters of diastolic function (mitral annular tissue Doppler e’ velocities and E/e’ ratio). Interaction was borderline significant between WC and sex regarding lateral e’ velocity (p=0.05).

Conclusion: In this cohort of individuals with AS, we found a higher prevalence of AO and an association between AO and worse diastolic function among women. Our results suggest that AO could play a contributing role in the development of diastolic dysfunction among women with AS, raising the hypothesis of an interesting potential pathway to explain the predominance of heart failure with preserved ejection fraction in women with AS. Moreover, AO and its metabolic consequences are treatable and reversible conditions and could thus represent future preventive targets in hope of improving cardiovascular prognosis in this population.