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New classification of geometric ventricular patterns in severe aortic stenosis: Could it be clinically useful?
Concetta Di Nora1, Eugenio Cervesato2, Iulian Cosei3
1Cardiovascular Department, ASUITS, University of Trieste, Trieste, Italy.
Insights
A new classification for left ventricle (LV) remodeling in severe aortic stenosis may better identify symptomatic patients compared to older methods. This refined approach offers improved clinical relevance for understanding cardiac geometry in disease.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Remodeling
Background:
- Severe aortic stenosis causes left ventricle (LV) pressure overload, leading to diverse remodeling patterns with distinct clinical outcomes.
- The traditional classification of LV geometry in aortic stenosis uses relative wall thickness and LV mass index.
- A novel classification incorporating end-diastolic volume index has been proposed.
Purpose of the Study:
- To determine the prevalence of newly defined LV remodeling patterns in severe aortic stenosis.
- To assess the clinical significance of these patterns concerning patient symptoms.
Main Methods:
- Analysis of 286 consecutive patients with isolated severe aortic stenosis.
- Echocardiographic evaluation according to current guidelines.
- Symptom definition included angina, syncope, or NYHA class III-IV.
Main Results:
- The most common pattern was concentric hypertrophy (57.3%), followed by mixed (18.9%) and dilated hypertrophy (8.4%).
- Symptomatic patients exhibited a significantly higher prevalence of mixed hypertrophy (P < .05).
- The classic 4-pattern classification did not show a significant association with symptoms (P = .157).
Conclusions:
- The new classification provides a more refined description of cardiac geometric phenotypes in response to pressure overload.
- This updated classification may offer superior clinical relevance in associating LV remodeling with symptoms in severe aortic stenosis.
Background:
In severe aortic stenosis, different left ventricle (LV) remodeling patterns as a response to pressure overload have distinct hemodynamic profiles, cardiac function, and outcomes. The most common classification considers LV relative wall thickness and LV mass index to create 4 different groups. A new classification including also end-diastolic volume index has been recently proposed.
Aim:
To describe the prevalence of the newly identified remodeling patterns in patients with severe aortic stenosis and to evaluate their clinical relevance according to symptoms.
Methods:
We analyzed 286 consecutive patients with isolated severe aortic stenosis. Current guidelines were used for echocardiographic evaluation. Symptoms were defined as the presence of angina, syncope, or NYHA class III-IV.
Results:
The mean age was 75 ± 9 years, 156 patients (54%) were men, while 158 (55%) were symptomatic. According to the new classification, the most frequent remodeling pattern was concentric hypertrophy (57.3%), followed by mixed (18.9%) and dilated hypertrophy (8.4%). There were no patients with eccentric remodeling; only 4 patients had a normalLV geometry. Symptomatic patients showed significantly more mixed hypertrophy (P < .05), while the difference regarding the prevalence of the other patterns was not statistically significant. When we analyzed the distribution of the classic 4 patterns stratified by the presence of symptoms, however, we did not find a significant difference (P = .157).
Conclusions:
The new classification had refined the description of different cardiac geometric phenotypes that develop as a response to pressure overload. It might be superior to the classic 4 patterns in terms of association with symptoms.
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