Prognostic implications of left ventricular asymmetry in patients with asymptomatic aortic valve stenosis.
Left ventricular (LV) regional hypertrophy in the form of LV asymmetry is a common finding in patients with aortic valve stenosis. The aim of this study was to test the hypothesis that LV asymmetry predicts future symptomatic status and indication for aortic valve replacement (AVR) in patients with asymptomatic aortic valve stenosis.



In total, 114 patients with asymptomatic aortic valve stenosis (peak velocity > 2.5 m/s assessed by echocardiographic screening and LV ejection fraction > 50%) were enrolled in the study. LV asymmetry and LV geometry was assessed by multi-detector computed tomography according to previous definitions. Follow-up was conducted using electronic health records. Event-free survival was assessed using Cox proportional hazards models. Patients were followed for a median of 2.2 years (interquartile range 1.6-3.6). Indication for AVR occurred in 46 patients (40%). Patients with LV asymmetry had more than 3 times the risk of AVR (hazard ratio: 3.16; 95% CI: 1.77-5.66; P < 0.001) compared with patients with no LV asymmetry. Multivariate Cox analysis revealed that LV asymmetry was a predictor of future need of AVR (hazard ratio: 3.10; 95% CI: 1.44-6.65; P = 0.004), independent of LV geometry, jet velocity, valvular calcification, and pro-BNP.



LV asymmetry is an independent predictor of future need for AVR in patients with asymptomatic aortic valve stenosis. It has incremental prognostic value to LV geometry and may provide a useful method of risk stratification.
Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Per Ejlstrup
PE
Sigvardsen
Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Linnea Hornbech
LH
Larsen
Department of Cardiology, Gentofte Hospital, Niels Andersens Vej 65, DK-2900 Copenhagen, Denmark.
Helle Gervig
HG
Carstensen
Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Mathias
M
Sørgaard
Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Louise
L
Hindsø
Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Christian
C
Hassager
Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Lars
L
Køber
Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Rasmus
R
Møgelvang
Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.|Department of Radiology, Rigshospitalet, Denmark.
Klaus Fuglsang
KF
Kofoed
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D058070:Asymptomatic Diseases; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D003718:Denmark; D004452:Echocardiography / Q000379:methods; D005260:Female; D006785:Hospitals, University; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D061330:Multidetector Computed Tomography / Q000379:methods; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D016019:Survival Analysis
aortic valve stenosis; cardiac computed tomography; left ventricular hypertrophy; wall thickness;  aortic valve replacement