title: Prognostic significance of left ventricular concentric remodelling in patients with aortic stenosis.
abstract: BACKGROUND
  Four patterns of left ventricular (LV) geometry (normal, concentric remodelling, concentric hypertrophy and eccentric hypertrophy) have been described in aortic stenosis (AS). Although LV concentric remodelling (LVCR), characterized by normal LV mass despite increased LV wall thickness, is frequently observed in AS, its prognostic implication has been not specifically studied.
  
  
  OBJECTIVE
  We aimed to assess, using echocardiography, the prognostic implication of LVCR in asymptomatic or minimally symptomatic patients with AS.
  
  
  METHODS
  Overall, 331 patients (mean age 73±13 years; 45% women) with AS (aortic valve area≤1.3cm2) and an ejection fraction >50% were enrolled. The endpoints were mortality with conservative management and mortality with conservative and/or surgical management.
  
  
  RESULTS
  Sixty-three (19%) patients died under conservative management (follow-up 29±1 months). The highest risk of mortality under conservative management compared with patients with normal LV geometry was observed for LVCR (adjusted hazard ratio [HR]: 3.53, 95% confidence interval [CI]: 1.19-10.46; P=0.023), followed by concentric LVH (adjusted HR: 2.97, 95% CI: 1.02-8.60; P=0.045). Aortic valve replacement was performed in 96 patients (29%) during the entire follow-up (37±1 months); 72 (22%) patients died. Only LVCR remained independently associated with an increased risk of mortality when surgical management during the entire follow-up was considered (adjusted HR: 2.93, 95% CI: 1.19-7.23; P=0.020).
  
  
  CONCLUSIONS
  Among the patterns of LV geometry in AS, LVCR portends the worst outcome. Patients with LVCR and AS have a considerable increased risk of mortality, regardless of clinical management.
authors.affiliation: Department of Cardiology, Lille University Hospital, F-59000 Lille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Debry
authors.affiliation: Department of Cardiology, Groupement des Hôpitaux de l'Institut Catholique de Lille, F-59160 Lille, France; Inserm U-1088, Jules-Verne University of Picardie, F-80054 Amiens, France.
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Maréchaux
authors.affiliation: Inserm U-1088, Jules-Verne University of Picardie, F-80054 Amiens, France; Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France.
authors.forename: Dan
authors.initials: D
authors.lastname: Rusinaru
authors.affiliation: Inserm U-1088, Jules-Verne University of Picardie, F-80054 Amiens, France; Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Peltier
authors.affiliation: Department of Cardiology, Bichat University Hospital, F-75018 Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
authors.affiliation: Department of Cardiology, Groupement des Hôpitaux de l'Institut Catholique de Lille, F-59160 Lille, France; Inserm U-1088, Jules-Verne University of Picardie, F-80054 Amiens, France.
authors.forename: Aymeric
authors.initials: A
authors.lastname: Menet
authors.affiliation: Inserm U-1088, Jules-Verne University of Picardie, F-80054 Amiens, France; Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France. Electronic address: tribouilloy.christophe@chu-amiens.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D058070:Asymptomatic Diseases; D016208:Databases, Factual; D015150:Echocardiography, Doppler; D005260:Female; D005602:France; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: Aortic stenosis; Chirurgie; Echocardiographie; Echocardiography; Left ventricular remodelling; Remodelage ventriculaire gauche; Rétrécissement aortique; Surgery