Concetta Di Nora1, Eugenio Cervesato2, Iulian Cosei3, Andreea Ravasel3, Bogdan A Popescu3,4, Concetta Zito5, Scipione Carerj5, Francesco Antonini-Canterin6, Andreea C Popescu4,7. 1. Cardiovascular Department, ASUITS, University of Trieste, Trieste, Italy. 2. Santa Maria degli Angeli Hospital, Cardiologia, Pordenone, Italy. 3. Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania. 4. University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania. 5. Cardiology Department, University of Messina, Messina, Italy. 6. Rehabilitative Cardiology, High Speciality Rehabilitative Hospital, Motta Di Livenza, Italy. 7. Cardiology Department, Elias Emergency Hospital, Bucharest, Romania.
Abstract
BACKGROUND: In severe aortic stenosis, different left ventricle (LV) remodeling patterns as a response to pressure overload have distinct hemodynamic profiles, cardiac function, and outcomes. The most common classification considers LV relative wall thickness and LV mass index to create 4 different groups. A new classification including also end-diastolic volume index has been recently proposed. AIM: To describe the prevalence of the newly identified remodeling patterns in patients with severe aortic stenosis and to evaluate their clinical relevance according to symptoms. METHODS: We analyzed 286 consecutive patients with isolated severe aortic stenosis. Current guidelines were used for echocardiographic evaluation. Symptoms were defined as the presence of angina, syncope, or NYHA class III-IV. RESULTS: The mean age was 75 ± 9 years, 156 patients (54%) were men, while 158 (55%) were symptomatic. According to the new classification, the most frequent remodeling pattern was concentric hypertrophy (57.3%), followed by mixed (18.9%) and dilated hypertrophy (8.4%). There were no patients with eccentric remodeling; only 4 patients had a normalLV geometry. Symptomatic patients showed significantly more mixed hypertrophy (P < .05), while the difference regarding the prevalence of the other patterns was not statistically significant. When we analyzed the distribution of the classic 4 patterns stratified by the presence of symptoms, however, we did not find a significant difference (P = .157). CONCLUSIONS: The new classification had refined the description of different cardiac geometric phenotypes that develop as a response to pressure overload. It might be superior to the classic 4 patterns in terms of association with symptoms.
BACKGROUND: In severe aortic stenosis, different left ventricle (LV) remodeling patterns as a response to pressure overload have distinct hemodynamic profiles, cardiac function, and outcomes. The most common classification considers LV relative wall thickness and LV mass index to create 4 different groups. A new classification including also end-diastolic volume index has been recently proposed. AIM: To describe the prevalence of the newly identified remodeling patterns in patients with severe aortic stenosis and to evaluate their clinical relevance according to symptoms. METHODS: We analyzed 286 consecutive patients with isolated severe aortic stenosis. Current guidelines were used for echocardiographic evaluation. Symptoms were defined as the presence of angina, syncope, or NYHA class III-IV. RESULTS: The mean age was 75 ± 9 years, 156 patients (54%) were men, while 158 (55%) were symptomatic. According to the new classification, the most frequent remodeling pattern was concentric hypertrophy (57.3%), followed by mixed (18.9%) and dilated hypertrophy (8.4%). There were no patients with eccentric remodeling; only 4 patients had a normalLV geometry. Symptomatic patients showed significantly more mixed hypertrophy (P < .05), while the difference regarding the prevalence of the other patterns was not statistically significant. When we analyzed the distribution of the classic 4 patterns stratified by the presence of symptoms, however, we did not find a significant difference (P = .157). CONCLUSIONS: The new classification had refined the description of different cardiac geometric phenotypes that develop as a response to pressure overload. It might be superior to the classic 4 patterns in terms of association with symptoms.
Authors: Yu Zheng; Wei Xuan Chan; Christopher J Charles; A Mark Richards; Smita Sampath; Asad Abu Bakar Ali; Hwa Liang Leo; Choon Hwai Yap Journal: Front Physiol Date: 2022-05-31 Impact factor: 4.755
Authors: Andrea Barbieri; Alessandro Albini; Anna Maisano; Gerardo De Mitri; Giovanni Camaioni; Niccolò Bonini; Francesca Mantovani; Giuseppe Boriani Journal: Front Cardiovasc Med Date: 2021-04-27
Authors: Vladimir Shvartz; Maria Sokolskaya; Andrey Petrosyan; Artak Ispiryan; Sergey Donakanyan; Leo Bockeria; Olga Bockeria Journal: Pathophysiology Date: 2022-03-09