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Background: We reported that in patients with mild to moderate aortic stenosis (AS), metabolic syndrome (MetS) is associated with more pronounced concentric LV hypertrophy. Severe LV concentric hypertrophy has been linked to reduced survival following aortic valve replacement (AVR). The aim of this study was to examine the relationship between MetS and prevalence of LV concentric hypertrophy in patients with severe AS referred to AVR.Method and Results: 510 patients with severe AS underwent isolated AVR. Among these patients, 127 (25%) had the MetS and 114 (22%) had type-2 diabetes (T2D). Patients with diabetes or MetS had larger waist circumference (MetS: 106 ±16; T2D: 105±11 vs. noMetS and noT2D: 95±13cm; p<0.0001), higher incidence of coronary artery disease (CAD: 21; 18 vs. 10%) compared to those with noMetS and no T2D. The severity of AS was similar in the 3 groups (Mean gradient (MG): 45±15; 45 ±17 vs. 48±18mmHg; p=0.13). Patients were classified into four different LV patterns according to relative wall thickness ratio and LV mass indexed (LVMi) to a 2.7 power of height (Figure). Distribution of LV patterns was worse (p<0.0001) in diabetes and MetS groups compared to noMetS-noT2D group: normal pattern: 5; 4 vs.18%; concentric remodeling: 18; 25 vs.28%; concentric hypertrophy: 71; 64 vs.47%; eccentric hypertrophy: 6; 7 vs. 9% (Figure). Diabetes and MetS were independently (p=0.01 and p=0.03) associated with higher LVMi after adjustment for age, gender, hypertension, SBP, MG, mitral regurgitation, CAD, history of myocardial infarction, history of angioplasty and valvulo-arterial impedance.Conclusion: MetS is independently associated with higher prevalence of concentric hypertrophy in patients with severe AS which may in turn increase operative risk and late postoperative mortality.