Left ventricular remodeling and hypertrophy in patients with aortic stenosis: insights from cardiovascular magnetic reso
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RESEARCH
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Left ventricular remodeling and hypertrophy in patients with aortic stenosis: insights from cardiovascular magnetic resonance Marc R Dweck1,2, Sanjiv Joshi1, Timothy Murigu1, Ankur Gulati1,3, Francisco Alpendurada1, Andrew Jabbour1, Alicia Maceira1, Isabelle Roussin1, David B Northridge2, Philip J Kilner1,3, Stuart A Cook1,3, Nicholas A Boon2, John Pepper1,3, Raad H Mohiaddin1,3, David E Newby2, Dudley J Pennell1,3 and Sanjay K Prasad1,3*
Abstract Background: Cardiovascular magnetic resonance (CMR) is the gold standard non-invasive method for determining left ventricular (LV) mass and volume but has not been used previously to characterise the LV remodeling response in aortic stenosis. We sought to investigate the degree and patterns of hypertrophy in aortic stenosis using CMR. Methods: Patients with moderate or severe aortic stenosis, normal coronary arteries and no other significant valve lesions or cardiomyopathy were scanned by CMR with valve severity assessed by planimetry and velocity mapping. The extent and patterns of hypertrophy were investigated using measurements of the LV mass index, indexed LV volumes and the LV mass/volume ratio. Asymmetric forms of remodeling and hypertrophy were defined by a regional wall thickening ≥13 mm and >1.5-fold the thickness of the opposing myocardial segment. Results: Ninety-one patients (61±21 years; 57 male) with aortic stenosis (aortic valve area 0.93±0.32cm2) were recruited. The severity of aortic stenosis was unrelated to the degree (r2=0.012, P=0.43) and pattern (P=0.22) of hypertrophy. By univariate analysis, only male sex demonstrated an association with LV mass index (P=0.02). Six patterns of LV adaption were observed: normal ventricular geometry (n=11), concentric remodeling (n=11), asymmetric remodeling (n=11), concentric hypertrophy (n=34), asymmetric hypertrophy (n=14) and LV decompensation (n=10). Asymmetric patterns displayed considerable overlap in appearances (wall thickness 17 ±2mm) with hypertrophic cardiomyopathy. Conclusions: We have demonstrated that in patients with moderate and severe aortic stenosis, the pattern of LV adaption and degree of hypertrophy do not closely correlate with the severity of valve narrowing and that asymmetric patterns of wall thickening are common. Trial registration: ClinicalTrials.gov Reference Number: NCT00930735 Keywords: Aortic valve disease, MRI, Cardiac remodeling
Background Aortic stenosis is characterised by progressive narrowing of the aortic valve and can be considered the paradigm for left ventricular pressure overload. The ventricle responds to this pressure overload by triggering a hypertrophic response, leading to an increase in myocyte size, left ventricular wall thickness and mass. Initially this * Correspondence: [email protected] 1 Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom 3 Imperial College London, London, United Kingdom Full list of author information is available at the end of the article
response restores wall stress [1,2] but ultimately proves
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