title: Left ventricular remodeling and hypertrophy in patients with aortic stenosis: insights from cardiovascular magnetic resonance.
abstract: BACKGROUND
  Cardiovascular magnetic resonance (CMR) is the gold standard non-invasive method for determining left ventricular (LV) mass and volume but has not been used previously to characterise the LV remodeling response in aortic stenosis. We sought to investigate the degree and patterns of hypertrophy in aortic stenosis using CMR.
  
  
  METHODS
  Patients with moderate or severe aortic stenosis, normal coronary arteries and no other significant valve lesions or cardiomyopathy were scanned by CMR with valve severity assessed by planimetry and velocity mapping. The extent and patterns of hypertrophy were investigated using measurements of the LV mass index, indexed LV volumes and the LV mass/volume ratio. Asymmetric forms of remodeling and hypertrophy were defined by a regional wall thickening ≥ 13 mm and >1.5-fold the thickness of the opposing myocardial segment.
  
  
  RESULTS
  Ninety-one patients (61 ± 21 years; 57 male) with aortic stenosis (aortic valve area 0.93 ± 0.32 cm2) were recruited. The severity of aortic stenosis was unrelated to the degree (r2=0.012, P=0.43) and pattern (P=0.22) of hypertrophy. By univariate analysis, only male sex demonstrated an association with LV mass index (P=0.02). Six patterns of LV adaption were observed: normal ventricular geometry (n=11), concentric remodeling (n=11), asymmetric remodeling (n=11), concentric hypertrophy (n=34), asymmetric hypertrophy (n=14) and LV decompensation (n=10). Asymmetric patterns displayed considerable overlap in appearances (wall thickness 17 ± 2mm) with hypertrophic cardiomyopathy.
  
  
  CONCLUSIONS
  We have demonstrated that in patients with moderate and severe aortic stenosis, the pattern of LV adaption and degree of hypertrophy do not closely correlate with the severity of valve narrowing and that asymmetric patterns of wall thickening are common.
authors: Royal Brompton Hospital, Sydney Street, London, SW3 6NP, United Kingdom.
authors: Marc R
authors: MR
authors: Dweck
authors: Sanjiv
authors: S
authors: Joshi
authors: Timothy
authors: T
authors: Murigu
authors: Ankur
authors: A
authors: Gulati
authors: Francisco
authors: F
authors: Alpendurada
authors: Andrew
authors: A
authors: Jabbour
authors: Alicia
authors: A
authors: Maceira
authors: Isabelle
authors: I
authors: Roussin
authors: David B
authors: DB
authors: Northridge
authors: Philip J
authors: PJ
authors: Kilner
authors: Stuart A
authors: SA
authors: Cook
authors: Nicholas A
authors: NA
authors: Boon
authors: John
authors: J
authors: Pepper
authors: Raad H
authors: RH
authors: Mohiaddin
authors: David E
authors: DE
authors: Newby
authors: Dudley J
authors: DJ
authors: Pennell
authors: Sanjay K
authors: SK
authors: Prasad
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling