Abstract 2334: The Absence of Left Ventricular Hypertrophy in Patients with Severe Isolated Valvular Aortic Stenosis and Normal Left Ventricular Systolic Function; Echocardiographic, Clinical and Prognostic Characteristics
Background: Left ventricular hypertrophy (LVH) in patients (pts) with severe aortic stenosis (AS) is considered an adaptative mechanism that normalizes wall stress and is a helpful echocardiographic sign supporting the diagnosis. We observed the absence of LVH in a number of pts with severe AS and normal global and regional LV systolic function.
Aim: To determine the echocardiographic, clinical and prognostic characteristics of pts with severe AS and no LVH.
Methods: Of 202 pts (mean age, 77 ± 10 yrs, 47% females) with severe AS (mean AVA = 0.39 ± 0.1 cm2/m2, mean LVEF 64 ± 10%), normal sinus rhythm, and ≤1+ aortic or mitral regurgitation who had a transthoracic echocardiogram at St. Francis Hospital between 2002–2005, 140 had LVH and 62 did not. There were 39 pts prospectively and 163 retrospectively enrolled, mean follow-up 22 ±10 months. Echocardiographic measurements were performed on a dedicated echo workstation (Digisonics Inc.) LV mass was calculated using regression-corrected cube formula. Outcome variables were aortic valve replacement (AVR) and cardiovascular (CV) death.
Results: (table⇓): No differences in gender (x2 =1.73, p=19), AS severity, prevalence of hypertension (p=.17) or diabetes (p=.92) were found between the 2 groups. The LV mass/volume ratio, an index of concentric remodeling, was higher in both genders with absolute LVH. AVR was performed in 102 pts, and 21 pts died of CV causes before AVR.
Conclusions: 1.One third of pts with severe AS and normal regional and global LV systolic function do not have LVH. 2. This group of pts is characterized by smaller LV volumes and smaller left atrial size compared to LVH group, suggesting a lower prevalence of diastolic dysfunction. 3. The absence of LVH was not associated with either a difference in therapy or an increase in mortality. 4. The determinants of presence or absence of LVH in AS remain to be elucidated.