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Published on: October 20, 2023
Left Ventricular Mass, Myocardial Structure, and Function in Severe Aortic Stenosis: an Echocardiographic and Cardiac
Jason Craft1, Jonathan Weber2, Jane J Cao1
1DeMatteis Cardiovascular Institute; Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, New York.
Insights
In severe aortic stenosis, elevated left ventricular mass index (LVMI) did not predict worse outcomes. This study found no association between higher LVMI and increased mortality or heart failure hospitalizations.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac MRI
Background:
- Conflicting data exist on the prognostic value of left ventricular hypertrophy (LVH) in severe aortic stenosis (AS).
- Accurate prognostic stratification is crucial for managing severe AS patients.
Purpose of the Study:
- To characterize left ventricular (LV) geometry and myocardial changes in severe AS using cardiac magnetic resonance imaging (CMR) and echocardiography.
- To assess the prognostic implications of LV hypertrophy, defined by LV mass index (LVMI), in severe AS.
Main Methods:
- Prospective evaluation of 93 severe AS patients with concurrent echocardiography and CMR.
- Assessment of LVH, cardiac structure, morphology, and late gadolinium enhancement (LGE).
- Prognostic stratification using Kaplan-Meier curves and Cox proportional hazards models.
Main Results:
- 41% of patients had LVH (LVMI >2 SD above normal), and 15% had severely elevated LVMI (>4 SD).
- Patients with LVH showed higher LV volumes, increased LGE burden, and reduced LV ejection fraction.
- Impaired LV strain and atrial function were noted in patients with LVH.
- Elevated LVMI was not associated with increased all-cause mortality or heart failure hospitalization.
Conclusions:
- In severe AS, elevated LVMI is not independently associated with adverse clinical outcomes.
- Cardiac imaging findings like impaired strain and LGE in LVH warrant further investigation for prognostic significance.
Abstract:
In severe aortic stenosis (AS), there are conflicting data on the prognostic implications of left ventricular (LV) hypertrophy (LVH). We aimed to characterize the LV geometry, myocardial matrix structural changes, and prognostic stratification using cardiac magnetic resonance imaging (CMR) and echocardiography in subjects with severe AS with and without LVH. Consecutive patients who had severe isolated AS and sufficient quality echocardiography and CMR within 6 months of each other were evaluated for LVH, cardiac structure, morphology, and late gadolinium-enhancement imaging. Kaplan-Meier curves, linear models, and proportional hazards models were used for prognostic stratification. There were 93 patients enrolled (mean age 74 ± 11 years, 48% female), of whom 38 (41%) had a normal LV mass index (LVMI), 41 (44%) had LVH defined at CMR by LVMI >2 SD higher than normal, and 14 (15% of the total) with >4 SD higher than the reference LVMI (severely elevated). The Society of Thoracic Surgeons scores were similar among the LVMI groups. Compared with those with normal LVMI, patients with LVH had higher LV end-diastolic and end-systolic volumes, increased late gadolinium-enhancement burden, and lower LV ejection fraction. Most notably, CMR feature-tracking global radial strain, 2-dimensional speckle-tracking echocardiography global longitudinal strain, and left atrial reservoir function were significantly worse. On the survival analyses, LVMI was not associated with a composite of all-cause mortality and/or heart failure hospitalization. In conclusion, compared with normal LVMI, elevated LVMI was not associated with a higher risk of adverse outcomes.
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