Adverse prognosis associated with asymmetric myocardial thickening in aortic stenosis

Figure 1. Asymmetrical wall thickening on both magnetic resonance and echocardiography. Images demonstrating asymmetric wall thickening in patients with aortic stenosis. Cardiovascular magnetic resonance short-axis cine images showing an abnormally thickened septum: in a patient with asymmetric remodelling (A) and two subjects with asymmetric hypertrophy (B) and (C). Echocardiographic parasternal long-axis images demonstrating thickening of the septum in two further patients with asymmetric remodelling (D) and (E). Echocardiographic apical 4-chamber image in a subject with asymmetric hypertrophy (F).

Figure 2. Prevalence, distribution, and resolution after aortic valve replacement of asymmetric wall thickening. (A) Seventeen segment model of the LV demonstrating the site of asymmetric wall thickening as detected by both magnetic resonance and echocardiography. Magnetic resonance was more sensitive in detecting asymmetric wall thickening (43 cases) than echocardiography (29 cases). On both modalities, asymmetric wall thickening was almost universally confined to the basal and mid-cavity segments of the septum. (B) Patient with asymmetric wall thickening at baseline, which resolved when magnetic resonance was repeated 1 year after aortic valve replacement.

Figure 3. Characteristics of patients with asymmetric vs. concentric wall thickening. Boxplots presenting: aortic valve area (A), indexed left ventricular mass (B), high sensitivity cardiac troponin I (C) and brain natriuretic peptide (D) concentrations in aortic stenosis patients with asymmetric and concentric patterns of wall thickening. Despite no difference in AVA and left ventricular mass index (P = 0.15 and P = 0.49, respectively) patients with asymmetric wall thickening had higher cardiac troponin and BNP levels than those with concentric wall thickening (P < 0.001).

Figure 4. Outcome data in aortic stenosis patients with and without asymmetric wall thickening. Kaplan–Meier event estimates by adaptation patterns for the occurrence of death and AVR in aortic stenosis patients. Asymmetric thickening was associated with worse cardiac outcomes both when detected using magnetic resonance (A) (HR = 2.15 (1.29–3.59); P = 0.003) and echocardiography (B) (HR = 1.79 (1.08–3.69); P = 0.021). Perioperative complications in aortic stenosis patients undergoing aortic valve replacement. Subjects with asymmetric wall thickening had more cardiac complications in the perioperative period than those without based upon both magnetic resonance (C) 55% vs. 13% (P = 0.004) and echocardiographic (D) 57% vs. 19% (P = 0.023) assessments.