Letter by Covolo et al Regarding Article, “Accurate Assessment of Aortic Stenosis: A Review of Diagnostic Modalities and Hemodynamics”
To the Editor:
In their article, Saikrishnan et al1 raise some key points that merit further questioning.
Preload reserve cannot be considered an initial compensation mechanism in aortic stenosis. From physiopathological concepts, the increased pressure in aortic stenosis is faced mainly by the replication of sarcomeres in parallel, with an increase of relative wall thickness and concentric hypertrophy or remodeling, to normalize stress burden.2
In fact, the increased left ventricular pressure does not stretch the sarcomeres and thus does not allow the Frank-Starling mechanism because of the increased wall stiffness.
Only in the late stage of aortic stenosis, when hypertrophy becomes inadequate to normalize wall tension, does afterload mismatch develop, preload reserve is recruited, and the left ventricle cavity dilates.
Elisa Covolo, MD
Giuseppe Tarantini, MD, PhD
Renato Razzolini, MD
University of Padua
Department of Cardiac, Thoracic and Vascular Sciences
- © 2014 American Heart Association, Inc.
- Saikrishnan N,
- Kumar G,
- Sawaya FJ,
- Lerakis S,
- Yoganathan AP
- Katz AM