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Aortic Stenosis (AS)
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Abnormal multidirectional myocardial functions in patients with AS and preserved left ventricular (LV) function
A total of 420 patients with mild, moderate, and severe AS (mean age 66.1 ± 14.5 years) had multidirectional strain and strain rate imaging by 2-dimensional (2D) speckle tracking (3) function. Patients were more likely to be older and at a worse New York Heart Association (NYHA) functional class (for both, p < 0.001) with increasing AS severity. The investigators found a progressive stepwise impairment in longitudinal, circumferential, and radial strain and strain rate with increasing severity of AS (all p < 0.001). The abnormal strain started in the subendocardium in mild AS, progressed to mid-wall with moderate AS, and to transmural dysfunction with severe AS.
Inappropriately high LV mass is associated with worse outcomes in asymptomatic patients with severe AS
Inappropriately high LV mass (LV mass exceeding 10% of expected value from height, sex, and stroke work) was present in 121 patients with asymptomatic severe AS. Their outcomes were compared to 88 patients with asymptomatic severe AS but appropriate LV mass (4). Mean age in the study was 75 ± 10 years. At the end of follow-up (22 ± 13 months), a clinical event (all-cause death, aortic valve replacement, or hospital admission for nonfatal myocardial infarction and/or heart failure) occurred in 67% of those with inappropriately high LV mass versus 30% in those with appropriate LV mass (p < 0.001). Subjects with inappropriate LV mass were older and had lower blood pressure than those with appropriate LV mass. At 1, 3, and 5 years, event-free survival was significantly higher in patients with appropriate LV mass compared to those with inappropriate LV mass (all p < 0.01). Left ventricular hypertrophy (LVH) was detected in 75% of the sample. In patients with high LV mass and LVH, the risk of adverse events was 69% versus 24% in those with LVH but normal LV mass (Figure 2).
Figure 2
Inappropriate LV Mass Is Associated With Worse Outcomes
In asymptomatic patients with severe aortic stenosis aortic valve area (0.5 ± 0.1 cm2/m2) and normal left ventricular ejection fraction (0.58 ± 0.12), those with inappropriately high LV mass (red) compared with those with appropriate LV mass (blue) have a worse event-free survival up to 5 years in all patients (A) and subgroups with LV hypertrophy (B).
Comment
In 1988, Carroll et al. (5) described the phenomenon of “excessive hypertrophy,” which also occurred more commonly in women.
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Abnormal multidirectional myocardial functions in patients with AS and preserved left ventricular (LV) function
A total of 420 patients with mild, moderate, and severe AS (mean age 66.1 ± 14.5 years) had multidirectional strain and strain rate imaging by 2-dimensional (2D) speckle tracking (3) function. Patients were more likely to be older and at a worse New York Heart Association (NYHA) functional class (for both, p < 0.001) with increasing AS severity. The investigators found a progressive stepwise impairment in longitudinal, circumferential, and radial strain and strain rate with increasing severity of AS (all p < 0.001). The abnormal strain started in the subendocardium in mild AS, progressed to mid-wall with moderate AS, and to transmural dysfunction with severe AS.
Inappropriately high LV mass is associated with worse outcomes in asymptomatic patients with severe AS
Inappropriately high LV mass (LV mass exceeding 10% of expected value from height, sex, and stroke work) was present in 121 patients with asymptomatic severe AS. Their outcomes were compared to 88 patients with asymptomatic severe AS but appropriate LV mass (4). Mean age in the study was 75 ± 10 years. At the end of follow-up (22 ± 13 months), a clinical event (all-cause death, aortic valve replacement, or hospital admission for nonfatal myocardial infarction and/or heart failure) occurred in 67% of those with inappropriately high LV mass versus 30% in those with appropriate LV mass (p < 0.001). Subjects with inappropriate LV mass were older and had lower blood pressure than those with appropriate LV mass. At 1, 3, and 5 years, event-free survival was significantly higher in patients with appropriate LV mass compared to those with inappropriate LV mass (all p < 0.01). Left ventricular hypertrophy (LVH) was detected in 75% of the sample. In patients with high LV mass and LVH, the risk of adverse events was 69% versus 24% in those with LVH but normal LV mass (Figure 2).
Figure 2
Inappropriate LV Mass Is Associated With Worse Outcomes
In asymptomatic patients with severe aortic stenosis aortic valve area (0.5 ± 0.1 cm2/m2) and normal left ventricular ejection fraction (0.58 ± 0.12), those with inappropriately high LV mass (red) compared with those with appropriate LV mass (blue) have a worse event-free survival up to 5 years in all patients (A) and subgroups with LV hypertrophy (B).
Comment
In 1988, Carroll et al. (5) described the phenomenon of “excessive hypertrophy,” which also occurred more commonly in women.
