Left ventricular hypertrophy in aortic valve stenosis: preventive or promotive of systolic dysfunction and heart failure?
Abstract
AIMS: In aortic stenosis (AS), left ventricular (LV) hypertrophy is considered a compensatory response helping maintain systolic function. Recent research in experimental AS suggests, however, that LV hypertrophy is not necessary to sustain LV contractions but may in fact be maladaptive. The present work aimed to clarify the role of LV hypertrophy in AS-related heart failure (HF) in man. METHODS AND RESULTS: We studied 137 adult patients with isolated AS undergoing pre-operative echocardiography and cardiac catheterization. HF was diagnosed by the European criteria and LV hypertrophy by sex-specific limits of echocardiographic LV mass. The higher the LV mass was, the poorer was the LV ejection fraction (beta=-0.26, P< 0.001, linear regression) and the greater the likelihood of HF independent of the severity of AS (P< 0.001, logistic regression). In the subgroup of critical AS (valve area <0.4 cm(2)/m(2), n=85), patients with absent LV hypertrophy (n=19) had better preserved ejection fraction (mean+/-SE, 64+/-3 vs. 57+/-2%, P=0.045) and less HF (16 vs. 48%, P=0.025) than patients with LV hypertrophy (n=66). CONCLUSION: In isolated AS, increased LV mass predicts the presence of systolic dysfunction and HF independent of the severity of valvular obstruction. LV hypertrophy may be maladaptive rather than beneficial in AS in man.
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The LV response to chronic pressure overload from aortic stenosis is characterized by hypertrophic remodelling with myocyte hypertrophy and fibrosis, and by diastolic and systolic dysfunction.
“The LV response to chronic pressure overload from AS is characterized by hypertrophic remodelling (myocyte hypertrophy and fibrosis) and diastolic and systolic dysfunction.”
From Calcific aortic stenosis (2016) · cites this paper as [258]
The Introduction (page unavailable) describes increased LV wall thickness and mass in aortic stenosis, notes possible impairment of diastolic function, and reports an association between increased LV mass and systolic dysfunction. It does not describe fibrosis or establish that diastolic and systolic dysfunction characterize every LV response to aortic stenosis; it notes preserved systolic function in some patients with critical stenosis. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThis LV response considerably influences the morbidity and mortality of aortic stenosis.
“In many ways, this LV response considerably influences the morbidity and mortality of the disease199;257–260.”
From Calcific aortic stenosis (2016) · cites this paper as [258]
In “Predictors of HF and ejection fraction” (page unavailable), higher LV mass is independently associated with heart failure and lower ejection fraction in patients with aortic stenosis, supporting the morbidity aspect. The paper does not establish that the LV response influences mortality; its mortality discussion in “Methodological considerations” (page unavailable) does not test that relationship. The claim also states an influence more strongly than the study’s observational associations establish. (LLM, conf=0.85)
Experimental — accuracy not yet measured
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- Authors
- Kupari, M., Turto, H., & Lommi, J.
- Affiliations
- Helsinki University Hospital (FI)
- Corresponding author
- Kupari, Markku
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2005-04-28
- Volume
- 26
- Issue
- 17
- Pages
- 1790-1796
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2123889844
- Cited by
- 233
- References
- 40
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 8 · 2023: 10 · 2022: 8 · 2021: 13 · 2020: 15 · 2019: 15 · 2018: 16 · 2017: 14 · 2016: 11 · 2015: 14 · 2014: 16 · 2013: 17 · 2012: 16
- FWCI
- 5.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Foundation for Cardiovascular Research
- Helsingin ja Uudenmaan Sairaanhoitopiiri
- Sydäntutkimussäätiö
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Aortic Disease and Treatment Approaches
- Keywords
- aortic stenosis, left ventricular hypertrophy, left ventricular mass, heart failure, systolic dysfunction, ejection fraction, valvular obstruction, maladaptive hypertrophy, compensatory response
- MeSH terms
- Adaptation, Physiological, Adult, Aged, Aged, 80 and over, Aortic Valve Stenosis, Female, Cardiac Catheterization, Heart Failure, Hemodynamics, Humans, Male, Middle Aged, Postoperative Period, Stroke Volume, Ultrasonography, Hypertrophy, Left Ventricular
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