title: Left ventricular remodelling in aortic stenosis.
abstract: Aortic stenosis (AS) is a progressive condition associated with high mortality if not treated. The hemodynamic effects of AS have serious implications for the left ventricle. In this review, we describe the responses of the left ventricle to AS by highlighting the process of adaptive remodelling, which begins as a beneficial compensatory mechanism but ultimately transitions to a maladaptive process with potentially irreversible consequences. We discuss the impact of left ventricular (LV) remodelling on diastolic and systolic function and on the development of symptoms. In addition, we review the adverse consequences of maladaptive LV remodelling on clinical outcomes before and after aortic valve replacement. The relative irreversibility of maladaptive remodelling and the clear relationship between its progression and clinical outcomes suggest a need to incorporate measures of LV performance beyond simply systolic function when deciding on the timing of valve replacement.
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Rassi
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: selmariah@mgh.harvard.edu.
authors.forename: Sammy
authors.initials: S
authors.lastname: Elmariah
mesh_terms: D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D020257:Ventricular Remodeling / Q000502:physiology*