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Absence of left ventricular hypertrophy in severe isolated aortic stenosis and preserved left ventricular systolic

Eddy Barasch, Jenna Kahn, Florentina Petillo

    The Journal of Heart Valve Disease
    |May 1, 2014
    PubMed

    Insights

    In severe aortic stenosis (AS), left ventricular hypertrophy (LVH) is not always present and does not worsen outcomes. Normal left ventricular geometry is linked to better survival, independent of LVH.

    Area of Science:

    • Cardiology
    • Echocardiography
    • Clinical Medicine

    Background:

    • Severe aortic stenosis (AS) traditionally assumes left ventricular hypertrophy (LVH) is necessary for preserving systolic function.
    • Recent evidence suggests this paradigm may not hold true for all patients.

    Purpose of the Study:

    • To investigate the clinical, echocardiographic, and prognostic significance of absent LVH in patients with symptomatic severe AS and preserved left ventricular ejection fraction (LVEF).
    • To determine if LVH impacts outcomes in this specific patient population.

    Main Methods:

    • Analysis of echocardiographic, clinical, and survival data from 512 patients with severe AS and preserved LVEF.
    • Classification of patients based on the presence or absence of LVH using American Society of Echocardiography criteria.
    • Follow-up for all-cause mortality and aortic valve replacement (AVR) events.

    Main Results:

    • LVH was absent in 36% of patients with severe AS and preserved LVEF.
    • Patients without LVH had distinct demographic and echocardiographic characteristics, including larger body surface area and aortic valve area index.
    • No significant association was found between left ventricular mass index (LVMi) as a continuous variable and survival.
    • A normal left ventricular geometry, not just the absence of LVH, was associated with a survival benefit.

    Conclusions:

    • Left ventricular hypertrophy is not a universal finding in severe AS with preserved LVEF and does not appear to be associated with worse outcomes.
    • Normal left ventricular geometry, rather than LVH status, is a significant predictor of lower mortality.
    • Aortic valve replacement (AVR) improves survival irrespective of LVMi, suggesting alternative mechanisms to hypertrophy can mitigate AS afterload effects.
    Abstract

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