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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 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]
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“In many ways, this LV response considerably influences the morbidity and mortality of the disease199;257–260.”
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Metadata
- 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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