title: Adverse prognosis associated with asymmetric myocardial thickening in aortic stenosis.
abstract: Asymmetric wall thickening has been described in patients with aortic stenosis. However, it remains poorly characterized and its prognostic implications are unclear. We hypothesized this pattern of adaptation is associated with advanced remodelling, left ventricular decompenzation, and a poor prognosis.
  
  
  
  In a prospective observational cohort study, 166 patients with aortic stenosis (age 69, 69% males, mean aortic valve area 1.0 ± 0.4 cm2) and 37 age and sex-matched healthy volunteers underwent phenotypic characterization with comprehensive clinical, imaging, and biomarker evaluation. Asymmetric wall thickening on both echocardiography and cardiovascular magnetic resonance was defined as regional wall thickening ≥ 13 mm and > 1.5-fold the thickness of the opposing myocardial segment. Although no control subject had asymmetric wall thickening, it was observed in 26% (n = 43) of patients with aortic stenosis using magnetic resonance and 17% (n = 29) using echocardiography. Despite similar demographics, co-morbidities, valve narrowing, myocardial hypertrophy, and fibrosis, patients with asymmetric wall thickening had increased cardiac troponin I and brain natriuretic peptide concentrations (both P < 0.001). Over 28 [22, 33] months of follow-up, asymmetric wall thickening was an independent predictor of aortic valve replacement (AVR) or death whether detected by magnetic resonance [hazard ratio (HR) = 2.15; 95% confidence interval (CI) 1.29-3.59; P = 0.003] or echocardiography (HR = 1.79; 95% CI 1.08-3.69; P = 0.021).
  
  
  
  Asymmetric wall thickening is common in aortic stenosis and is associated with increased myocardial injury, left ventricular decompenzation, and adverse events. Its presence may help identify patients likely to proceed quickly towards AVR.
  
  
  
  https://clinicaltrials.gov/show/NCT01755936: NCT01755936.
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.|First Department of Cardiology, Poznan University of Medical Sciences, 1/2 Dluga, 61-848 Poznan, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kwiecinski
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.|Department of Cardiovascular Science, National Heart Center Singapore.
authors.forename: Calvin W L
authors.initials: CWL
authors.lastname: Chin
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: Russell J
authors.initials: RJ
authors.lastname: Everett
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: Audrey C
authors.initials: AC
authors.lastname: White
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.|Clinical Research Imaging Centre, University of Edinburgh, UK.
authors.forename: Scott
authors.initials: S
authors.lastname: Semple
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Yeung
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: William J
authors.initials: WJ
authors.lastname: Jenkins
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: Anoop S V
authors.initials: ASV
authors.lastname: Shah
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Koo
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: Saeed
authors.initials: S
authors.lastname: Mirsadraee
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, UK.
authors.forename: Chim C
authors.initials: CC
authors.lastname: Lang
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mills
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Prasad
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: Maurits A
authors.initials: MA
authors.lastname: Jansen
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: Alan G
authors.initials: AG
authors.lastname: Japp
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: David E
authors.initials: DE
authors.lastname: Newby
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.|Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Dweck
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006332:Cardiomegaly / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D016022:Case-Control Studies; D016001:Confidence Intervals; D004452:Echocardiography / Q000379:methods; D005260:Female; D005682:Gadolinium; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome
chemical_list: D005682:Gadolinium