Key result
Absence of left ventricular hypertrophy in severe aortic stenosis was associated with a non-significant trend toward higher 6-month mortality post-valve replacement (12.5% vs 7.6%, P=0.10).
Why the study?
Does the absence of left ventricular hypertrophy affect short-term ventricular adaptation and mortality after aortic valve replacement in patients with severe aortic stenosis?
Observational (n=210)
Does the absence of left ventricular hypertrophy affect short-term ventricular adaptation and mortality after aortic valve replacement in patients with severe aortic stenosis?
Absolute Event Rate: 12.5% vs 7.6%
p-value: p=0.10
A small proportion (10%) of patients with severe aortic stenosis do not develop left ventricular hypertrophy, which is associated with smaller body size and potentially less adequate ventricular adaptation after aortic valve replacement.
Absent LVH in 10% of severe AS links to small body size; leaves open differential post-AVR adaptation.
OBJECTIVES: The purpose of the present study in patients with severe aortic stenosis was to assess the prevalence of absent left ventricular hypertrophy (LVH) (determined according to mass criteria), to identify predictors of absent LVH, and to assess short-term left ventricular adaptation and prognosis after aortic valve replacement. METHODS: Left ventricular mass (LVM) was determined by echocardiography in 109 men and 101 women with severe aortic stenosis (mean pressure gradient < or = 50 mm Hg). LVH was defined as LVM > or = 109 g/m2 in women and LVM > or = 134 g/m2 in men. RESULTS: One hundred and eighty nine patients showed LVH (group 1) (90%; mean (SD) age 65 (14) years), and 21 showed no LVH (group 2) (10%, age 57 (21) years P = 0.02 for difference in age). Twelve (6%) of those without LVH had increased relative wall thickness (that is, > or = 0.45 with LV concentric remodelling) and nine (4%) showed no macroscopically detectable hypertrophic adaptation. The following variables were associated with the absence of LVH: low body surface area, low body mass index, and increased cardiac index. 76/210 patients were followed up a mean of six months after aortic valve replacement. The frequency of adequate ventricular adaptation to the decreased afterload after aortic valve replacement was higher in patients with LVH than in those without. Mortality six months after aortic valve replacement was lower, but not significantly, in patients with LVH (7.6%) than in those without LVH (12.5%, P = 0.10). CONCLUSIONS: A tenth of patients with severe aortic stenosis did not develop LVH according to mass criteria; 4% of the patients did not have any macroscopic signs of myocardial adaptation to the pressure overload despite longstanding disease. Small body size was independently associated with lack of LVH according to mass criteria. Six months after aortic valve replacement, ventricular adaptation was more often adequate in patients with LVH than in those without.
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Seiler et al. (1996) conducted an observational in Severe aortic stenosis (n=210). Absence of left ventricular hypertrophy vs. Presence of left ventricular hypertrophy was evaluated on Mortality six months after aortic valve replacement (p=0.10). Absence of left ventricular hypertrophy in severe aortic stenosis was associated with a non-significant trend toward higher 6-month mortality post-valve replacement (12.5% vs 7.6%, P=0.10).
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