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Published on: September 25, 2017
Is left ventricular hypertrophy a friend or foe of patients with aortic stenosis?
Cecilia Davies1, Katherine Zerebiec1, Agnieszka Rożanowska1
1Students' Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Insights
Left ventricular hypertrophy (LVH) is not always beneficial and can increase cardiovascular risk. Excessive LVH in aortic stenosis (AS) is linked to worse outcomes, but regression after treatment can improve function.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Cardiac Surgery
Background:
- Left ventricular hypertrophy (LVH) traditionally viewed as adaptive response to pressure overload (e.g., hypertension, aortic stenosis).
- Laplace law suggests LVH reduces wall stress, preserving systolic function.
- Emerging evidence challenges LVH as purely beneficial, linking magnitude to adverse outcomes.
Purpose of the Study:
- Review non-valvular factors influencing LV afterload and symptoms in aortic stenosis (AS).
- Examine associations between excessive LVH, LV dysfunction, and outcomes in AS.
- Evaluate prognostic significance of pre-operative LVH and its regression post-aortic valve intervention.
Main Methods:
- Literature review focusing on LVH in the context of AS.
- Analysis of studies on non-valvular afterload, LVH severity, and outcomes.
- Review of data on LVH regression and functional recovery after surgical and transcatheter aortic valve implantation (TAVI).
Main Results:
- Non-valvular factors significantly impact LV afterload and symptoms in AS patients.
- Disproportionate LVH is associated with impaired LV function and increased cardiovascular morbidity/mortality.
- LVH regression post-aortic valve replacement or TAVI correlates with improved LV function and prognosis.
Conclusions:
- LVH in AS is a complex phenomenon with significant prognostic implications.
- Excessive LVH, not solely AS severity, predicts adverse outcomes.
- LVH regression post-intervention is a key determinant of recovery and improved survival.
Abstract:
Left ventricular hypertrophy (LVH) is traditionally considered a physiological compensatory response to LV pressure overload, such as hypertension and aortic stenosis (AS), in an effort to maintain LV systolic function in the face of an increased afterload. According to the Laplace law, LV wall thickening lowers LV wall stress, which in turn would be helpful to preserve LV systolic performance. However, numerous studies have challenged the notion of LVH as a putative beneficial adaptive mechanism. In fact, the magnitude of LVH is associated with higher cardiovascular morbidity and mortality, especially when LVH is disproportionate to LV afterload. We have briefly reviewed: first, the importance of non-valvular factors, beyond AS severity, for total LV afterload and symptomatic status in AS patients; second, associations of excessive LVH with LV dysfunction and adverse outcome in AS; third, prognostic relevance of the presence or absence of pre-operative LVH in patients referred for aortic valve surgery; fourth, time course, determinants and prognostic implications of LVH regression and LV function recovery after surgical valve replacement and transcatheter aortic valve implantation (TAVI) with a focus on TAVI-specific effects; fifth, the potential of medical therapy to modulate LVH before and after surgical or interventional treatment for severe AS, a condition perceived as a relative contraindication to renin-angiotensin system blockade.
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