title: Impact of Valvuloarterial Impedance on Concentric Remodeling in Aortic Stenosis and Its Regression after Valve Replacement.
abstract: BACKGROUND
  Left ventricle (LV) in patients with aortic stenosis (AS) faces a double hemodynamic load incorporating both valvular stenosis and reduced systemic arterial compliance (SAC). This study aimed to evaluate the impact of global LV afterload on LV hypertrophy (LVH) before and after aortic valve replacement (AVR).
  
  
  METHODS
  The study cohort included 453 patients (247 males; mean age, 64 ± 11 years) who underwent AVR. Pre- and post-AVR echocardiographic examinations were retrospectively analyzed including an index of valvuloarterial impedance (ZVA) and LV mass index/LV end-diastolic volume index (LVMI/LVEDVI) as a parameter of LVH.
  
  
  RESULTS
  Pre-AVR LVMI/LVEDVI was 2.7 ± 0.9 g/mL with an aortic valve area (AVA) of 0.6 ± 0.2 cm2. ZVAwas 5.9 ± 1.9 mm Hg/mL/m2and showed a stronger correlation (β = 0.601,p< 0.001) with pre-AVR LVMI/LVEDVI than indexed AVA (β = 0.061,p= 0.19), transvalvular peak velocity (β = 0.211,p< 0.001). During a median follow-up of 3.5 years, patients had a 18.8 ± 10.4% decrease in the LV geometry index with a decrease in SAC from 1.20 ± 0.48 to 1.00 ± 0.38 mL/m2/mm Hg (p< 0.001). Pre-AVR LV ejection fraction (r = 0.284,p< 0.001) and ZVA(r = 0.523,p< 0.001) were independent factors associated with LVH regression in 322 patients with follow-up duration >1 year after AVR.
  
  
  CONCLUSIONS
  ZVAis a major determinant of concentric remodeling in AS before AVR and LVH regression after AVR, which should be incorporated in routine evaluation of AS.
authors.affiliation: Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea.; Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Korea.
authors.forename: Jeong Yoon
authors.initials: JY
authors.lastname: Jang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicinen, Busan, Korea.
authors.forename: Jeong-Sook
authors.initials: JS
authors.lastname: Seo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Sun
authors.affiliation: Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.affiliation: Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Duk-Hyun
authors.initials: DH
authors.lastname: Kang
authors.affiliation: Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
keywords: Afterload; Aortic stenosis; Echocardiography; Left ventricular hypertrophy