Sage Journals: Discover world-class research

Abstract

The aim of this study was to analyze the left ventricular (LV) geometric changes occurring in chronic pressure overload due to valvular aortic stenosis (AS). Fifty-six adult patients (30 women, 26 men, mean age seventy-two ±nine years, range forty-five to eighty-five years) with isolated AS (mean valve area by Doppler=0.6 ±0.2 cm²) underwent a complete Doppler echocardiographic examination. According to the value of relative wall thickness (RWT=2 x posterior wall thickness/LV end-diastolic diameter) and LV mass index (LVMI) in normal subjects (RWT ≤ 0.44, LUMI ≤ 125 gr/m2) AS patients were subdivided into four groups: Normal: no patients; Concentric Remodeling (RWT > 0.44, LVMI ≤ 125 gr/m²): 4 patients (7%); Concentric Hypertrophy (RWT > 0.44, LVMI > 125 gr/m²): 39 patients (70%); and Eccentric Hypertrophy (RWT ≤ 0.44, LVMI > 125 gr/m²): 13 patients [23%]. Eccentric hypertrophy patients had, as compared with those with concentric hypertrophy, a larger left ventricle (61 ± 6.5 mm vs 47.6 ±6 mm, P < 0.001), a smaller mean wall thickness (11.3 ± 1.2 vs 14.7 ± 1.7 mm, P ≤ 0.001), and reduced LV fractional shortening (FS%=22.9 ±11 vs 42.6 ±8.7%, P < 0.001). Furthermore, most patients (11/13) of the former group had heart failure due to LV systolic dysfunction, while only 16 of 39 patients of the latter group had heart failure and all but 2 had normal LV systolic function.

Conclusion: In patients with aortic stenosis, different forms of LV remodeling occur in response to chronic pressure overload. According to these results (and recent experi mental data), eccentric hypertrophy likely represents a late and more severe stage of LV remodeling in aortic stenosis.

Get full access to this article

View all access options for this article.

References

Grossmann W. , Jones D. , McLaurin LP : Wall stress and pattern of hypertrophy in the human left ventricle. J Clin Invest 56:56-64, 1975.

Gunther S. , Grossmann W. : Determinants of ventricular function in pressure-overload hypertrophy in man . Circulation 59:679-688, 1979.

Grossmann W. : Cardiac hypertrophy: Useful adaptation or pathologic process? Am J Med 69:576-584, 1980.

Ganau A. , Devereux RB , Roman MJ , et al: Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 19:1550-1558, 1992.

Currie PJ , Seward JB , Reeder GS , et al: Continuous wave Doppler echocardiographic assessment of severity of calcific aortic stenosis: A simultaneous Doppler-catheter correlative study in 100 adult patients. Circulation 71:1162-1169, 1985.

Oh JK , Taliercio CP , Homes DR , et al: Prediction of severity of aortic stenosis by Doppler aortic valve area determination: Prospective Doppler-catheterization correlation in 100 patients. J Am Coll Cardiol 11:1127-1234, 1988.

Otto CM , Pearlman AS , Gardner CL , et al: Simplification of the Doppler continuity equation for calculating stenotic aortic valve area. J Am Soc Echo 1:155-157, 1988.

Faggiano P. , Ghizzoni G. , Sorgato A. , et al: Rate of progression of valvular aortic stenosis in adults. Am J Cardiol 70:229-233, 1992.

Sahn DJ , DeMaria AM , Kisslo J. : Recommendations regarding quantitation in M-mode echocardiography: Results of a survey of echocardiographic measurements. Circulation 58:1072-1078, 1978.

10.

Popp RL : M-mode echocardiographic assessment of left ventricular function. Am J Cardiol 49:1312-1318, 1982.

11.

Faggiano P. , Rusconi C. , Ghizzoni G. , et al: Clinical and echocardiographic features of severe congestive heart failure according to different pathogenetic mechanism . Appl Cardiopulm Pathophysiol 4:309-314, 1992.

12.

Devereux RB , Reichek N. : Echocardiographic determination of left ventricular mass in men. Circulation 55:613-618, 1977.

13.

Faggiano P. , Rusconi C. , Orlando G. , et al: Assessment of left ventricular filling in patients with systemic hypertension. A Doppler echocardiographic study . J Hum Hypert 3:149-156, 1989.

14.

Casale PN , Devereux RB , Milner M. : Value of echocardiographic measurement of left ventricular mass in predicting cardivascular morbid events in hypertensive men. Ann Intern Med 105:173-178, 1986.

15.

Levy D. , Garrison RJ , Savage DD , et al: Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart study. N Engl J Med 322:1561-1566, 1990.

16.

Koren MJ , Devereux RB , Casale PN , et al: Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 114:345-352, 1991.

17.

Faggiano P. , Rusconi C. , Ghizzoni G. , et al: Different pathophysiological mechanism of congestive heart failure in aortic stenosis: Echo-Doppler findings. Eur Heart J 13(Suppl):234, 1992.

18.

Cohn JN , Johnson G. : Heart failure with normal ejection fraction. The V-HeFT study. Circulation 81 (Suppl III):48-53, 1990.

19.

Randhawa AK , Singal PK : Pressure overload-induced cardiac hypertrophy with and without dilation. J Am Coll Cardiol 20:1569-1575, 1992.

20.

Faggiano P. , Rusconi C. , Ghizzoni G. : Left ventricular remodeling in valvular aortic stenosis. Echocardiographic and clinical changes in two patients during follow-up . Chest 105:1273-1275, 1994 .

Left Ventricular Remodeling and Function in Adult Aortic Stenosis

Abstract

Get full access to this article

References