Open Access Highly Accessed Research

Left ventricular remodeling and hypertrophy in patients with aortic stenosis: insights from cardiovascular magnetic resonance

Marc R Dweck12, Sanjiv Joshi1, Timothy Murigu1, Ankur Gulati13, Francisco Alpendurada1, Andrew Jabbour1, Alicia Maceira1, Isabelle Roussin1, David B Northridge2, Philip J Kilner13, Stuart A Cook13, Nicholas A Boon2, John Pepper13, Raad H Mohiaddin13, David E Newby2, Dudley J Pennell13 and Sanjay K Prasad13*

Author Affiliations

1 Royal Brompton Hospital, Sydney Street, London, SW3 6NP, United Kingdom

2 Centre for Cardiovascular Science, Edinburgh University, Edinburgh, United Kingdom

3 Imperial College London, London, United Kingdom

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Journal of Cardiovascular Magnetic Resonance 2012, 14:50  doi:10.1186/1532-429X-14-50

Published: 28 July 2012

Abstract

Background

Cardiovascular magnetic resonance (CMR) is the gold standard non-invasive method for determining left ventricular (LV) mass and volume but has not been used previously to characterise the LV remodeling response in aortic stenosis. We sought to investigate the degree and patterns of hypertrophy in aortic stenosis using CMR.

Methods

Patients with moderate or severe aortic stenosis, normal coronary arteries and no other significant valve lesions or cardiomyopathy were scanned by CMR with valve severity assessed by planimetry and velocity mapping. The extent and patterns of hypertrophy were investigated using measurements of the LV mass index, indexed LV volumes and the LV mass/volume ratio. Asymmetric forms of remodeling and hypertrophy were defined by a regional wall thickening 13 mm and >1.5-fold the thickness of the opposing myocardial segment.

Results

Ninety-one patients (61±21 years; 57 male) with aortic stenosis (aortic valve area 0.93±0.32cm2) were recruited. The severity of aortic stenosis was unrelated to the degree (r2=0.012, P=0.43) and pattern (P=0.22) of hypertrophy. By univariate analysis, only male sex demonstrated an association with LV mass index (P=0.02). Six patterns of LV adaption were observed: normal ventricular geometry (n=11), concentric remodeling (n=11), asymmetric remodeling (n=11), concentric hypertrophy (n=34), asymmetric hypertrophy (n=14) and LV decompensation (n=10). Asymmetric patterns displayed considerable overlap in appearances (wall thickness 17±2mm) with hypertrophic cardiomyopathy.

Conclusions

We have demonstrated that in patients with moderate and severe aortic stenosis, the pattern of LV adaption and degree of hypertrophy do not closely correlate with the severity of valve narrowing and that asymmetric patterns of wall thickening are common.

Trial registration

ClinicalTrials.gov Reference Number: NCT00930735

Keywords:
Aortic valve disease; MRI; Cardiac remodeling