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Left Ventricular Remodeling and Function in Adult Aortic Stenosis

Division of Cardiology, S. Orsola-Fatebenefratelli Hospital, Brescia, Italy

Cesare Rusconi, M.D.

Division of Cardiology, S. Orsola-Fatebenefratelli Hospital, Brescia, Italy

Giuseppe Ghizzoni, M.D.

Division of Cardiology, S. Orsola-Fatebenefratelli Hospital, Brescia, Italy

Tony Sabatini, M.D.

Division of Cardiology, S. Orsola-Fatebenefratelli Hospital, Brescia, Italy

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.

Angiology, Vol. 45, No. 12, 1033-1038 (1994)
DOI: 10.1177/000331979404501206


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