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. 2022 Sep 10;23(10):1326-1335.
doi: 10.1093/ehjci/jeac018.

Left ventricular remodelling patterns in patients with moderate aortic stenosis

Jan Stassen  1   2 , See Hooi Ewe  3 , Kensuke Hirasawa  1 , Steele C Butcher  1   4 , Gurpreet K Singh  1 , Mohammed R Amanullah  3 , Kenny Y K Sin  3 , Zee P Ding  3 , Stephan M Pio  1 , Nicholas W S Chew  5 , Ching Hui Sia  5 , William K F Kong  5 , Kian Keong Poh  5 , David J Cohen  6   7 , Philippe Généreux  8 , Martin B Leon  9 , Nina Ajmone Marsan  1 , Victoria Delgado  1 , Jeroen J Bax  1   10
Affiliations

Left ventricular remodelling patterns in patients with moderate aortic stenosis

Jan Stassen et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Moderate aortic stenosis (AS) is associated with an increased risk of adverse events. Because outcomes in patients with AS are ultimately driven by the condition of the left ventricle (LV) and not by the valve, assessment of LV remodelling seems important for risk stratification. This study evaluated the association between different LV remodelling patterns and outcomes in patients with moderate AS.

Methods and results: Patients with moderate AS (aortic valve area 1.0-1.5 cm2) were identified and stratified into four groups according to the LV remodelling pattern: normal geometry (NG), concentric remodelling (CR), concentric hypertrophy (CH), or eccentric hypertrophy (EH). Clinical outcomes were defined as all-cause mortality and a composite endpoint of all-cause mortality and aortic valve replacement (AVR). Of 1931 patients with moderate AS (age 73 ± 10 years, 52% men), 344 (18%) had NG, 469 (24%) CR, 698 (36%) CH, and 420 (22%) EH. Patients with CH and EH showed higher 3-year mortality rates (28% and 32%, respectively) when compared with patients with NG (19%) (P < 0.001). After multivariable adjustment, CH remained independently associated with mortality (HR 1.258, 95% CI 1.016-1.558; P = 0.035), whereas both CH (HR 1.291, 95% CI 1.088-1.532; P = 0.003) and EH (HR 1.217, 95% CI 1.008-1.470; P = 0.042) were associated with the composite endpoint of death or AVR.

Conclusion: In patients with moderate AS, those who develop CH already have an increased risk of all-cause mortality. Assessment of the LV remodelling patterns may identify patients at higher risk of adverse events, warranting closer surveillance, and possibly earlier intervention.

Keywords: aortic valve replacement; left ventricular remodelling; moderate aortic stenosis; mortality.

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Conflict of interest statement

Conflict of interest: The Department of Cardiology of the Leiden University Medical Centre received unrestricted research grants from Abbott Vascular, Bayer, Biotronik, Bioventrix, Boston Scientific, Edwards Lifesciences, GE Healthcare, and Medtronic. J.J.B. received speaker fees from Abbott Vascular. N.A.M. received speaker fees from Abbott Vascular and GE Healthcare. V.D. received speaker fees from Abbott Vascular, Edwards Lifesciences, MSD, and GE Healthcare. The remaining authors have nothing to disclose.

Figures

Graphical Abstract
Graphical Abstract
Left ventricular remodeling is already frequently observed in patients with moderate aortic stenosis and is strongly associated with outcomes.
Figure 1
Figure 1
Basic patterns of left ventricular remodelling.
Figure 2
Figure 2
Kaplan–Meier curves for all-cause mortality (A) and the composite endpoint of death and AVR (B) according to different patterns of LV remodelling. AVR, aortic valve replacement; LV, left ventricular.
See this image and copyright information in PMC

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