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Impact of left ventricular remodelling patterns on outcomes in patients with aortic stenosis

Romain Capoulade1, Marie-Annick Clavel1, Florent Le Ven1

  • 1Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V-4G5.

European Heart Journal. Cardiovascular Imaging
|January 9, 2017
PubMed

Insights

Concentric hypertrophy (CH) in patients with aortic stenosis (AS) and preserved ejection fraction is linked to increased mortality risk. This association is particularly significant in women, highlighting the need for tailored risk stratification.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Clinical Outcomes

Background:

  • Aortic stenosis (AS) is a significant cause of cardiovascular morbidity and mortality.
  • Left ventricular (LV) remodelling patterns can influence prognosis in AS patients.
  • The prognostic value of different LV remodelling patterns in AS with preserved ejection fraction requires further investigation.

Purpose of the Study:

  • To investigate the association between distinct left ventricular (LV) remodelling and hypertrophy patterns and all-cause and cardiovascular mortality in patients with aortic stenosis (AS).
  • To determine if LV remodelling patterns stratify mortality risk in AS patients with preserved ejection fraction.

Main Methods:

  • Retrospective analysis of 747 consecutive AS patients with preserved LV ejection fraction.
  • Classification of patients into four LV patterns: normal, concentric remodelling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH) based on LV mass index and relative wall thickness.
  • Median follow-up of 6.4 years to assess all-cause and cardiovascular mortality.

Main Results:

  • Concentric hypertrophy (CH) was identified in 53% of patients.
  • CH was significantly associated with a higher risk of all-cause mortality compared to other LV patterns (P < 0.05).
  • After multivariable adjustment, CH remained an independent predictor of mortality (HR=1.27).
  • A significant interaction between sex and CH was observed, with CH associated with worse outcomes in women (HR=1.56) but not in men.

Conclusions:

  • Concentric hypertrophy (CH) is an independent predictor of increased mortality in aortic stenosis (AS) patients with preserved ejection fraction.
  • The adverse prognostic impact of CH is more pronounced in women than in men.
  • Integrating LV remodelling patterns into risk stratification strategies for AS patients is recommended.
Abstract

Keywords:
LV hypertrophyLV remodellingaortic stenosismortalityrisk stratification

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