Journal Article

Left ventricular remodeling and hypertrophy in patients with aortic stenosis: insights from cardiovascular magnetic resonance

Jabbour, Andrew, Prasad, Sanjay K, Cook, Stuart A, Alpendurada, Francisco, Kilner, Philip J, Roussin, Isabelle, Gulati, Ankur, Joshi, Sanjiv, Northridge, David B, Pepper, John, Pennell, Dudley J, Dweck, Marc R, Newby, David E, Maceira, Alicia, Mohiaddin, Raad H, Murigu, Timothy, Boon, Nicholas A

2012

Overview

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. 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. 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. 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. ClinicalTrials.gov Reference Number: NCT00930735

• Publisher: Elsevier Inc,BioMed Central,BioMed Central Ltd,Elsevier
• Subject: Aged / Angiology / Aortic valve disease / Aortic valve stenosis / Aortic Valve Stenosis - complications / Aortic Valve Stenosis - diagnosis / Aortic Valve Stenosis - physiopathology / Asymmetry / Cardiac patients / Cardiac remodeling / Cardiology / Cardiomyopathy, Hypertrophic - complications / Cardiomyopathy, Hypertrophic - diagnosis / Cardiomyopathy, Hypertrophic - physiopathology / Cardiovascular disease / Care and treatment / Case studies / Coronary vessels / Diagnosis / Diagnosis, Differential / Female / Heart attacks / Heart enlargement / Heart ventricle, Left / Heart Ventricles - pathology / Heart Ventricles - physiopathology / Humans / Hypertrophy, Left Ventricular - diagnosis / Hypertrophy, Left Ventricular - etiology / Hypertrophy, Left Ventricular - physiopathology / Imaging / Magnetic resonance / Magnetic Resonance Imaging, Cine - methods / Male / Males / Medical imaging / Medical research / Medicine / Medicine & Public Health / Middle Aged / MRI / Patients / Physiological aspects / Prognosis / Radiology / Remodeling / Risk factors / Segments / Thickening / Valves / Ventricular Function, Left / Ventricular Remodeling