Left ventricular remodelling patterns in patients with moderate aortic stenosis

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

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)

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.
Original languageEnglish
Pages (from-to)1326-1335
Number of pages10
JournalEuropean heart journal. Cardiovascular Imaging
Volume23
Issue number10
DOIs
Publication statusPublished - 1 Oct 2022
Externally publishedYes

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