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Left ventricular remodelling patterns in patients with moderate aortic stenosis

Singh GK; Kong WKF; Sia CH; Delgado V; Poh KK; Hirasawa K; Stassen J; Bax JJ; Amanullah MR; Sin KYK; Pio SM; Ding ZP; Ewe SH; Marsan NA; Butcher SC; Chew NWS; Genereux P; Leon MB; Cohen DJ

Left ventricular remodelling patterns in patients with moderate aortic stenosis

Singh GK
Kong WKF
Sia CH
Delgado V
Poh KK
Hirasawa K
Stassen J
Bax JJ
Amanullah MR
Sin KYK
Pio SM
Ding ZP
Ewe SH
Marsan NA
Butcher SC
Chew NWS
Genereux P
Leon MB
Cohen DJ
Katso/Avaa
jeac018.pdf (872.5Kb)
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OXFORD UNIV PRESS
doi:10.1093/ehjci/jeac018
URI
https://doi.org/10.1093/ehjci/jeac018
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Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe2022121371292
Tiivistelmä

Aims: Moderate aortic stenosis (AS) is associated with an increased risk of adverse events. Because outcomes in patients with AS are ultimately driven by the condition of the left ventricle (LV) and not by the valve, assessment of LV remodelling seems important for risk stratification. This study evaluated the association between different LV remodelling patterns and outcomes in patients with moderate AS.

Methods and results: Patients with moderate AS (aortic valve area 1.0-1.5 cm2) were identified and stratified into four groups according to the LV remodelling pattern: normal geometry (NG), concentric remodelling (CR), concentric hypertrophy (CH), or eccentric hypertrophy (EH). Clinical outcomes were defined as all-cause mortality and a composite endpoint of all-cause mortality and aortic valve replacement (AVR). Of 1931 patients with moderate AS (age 73 ± 10 years, 52% men), 344 (18%) had NG, 469 (24%) CR, 698 (36%) CH, and 420 (22%) EH. Patients with CH and EH showed higher 3-year mortality rates (28% and 32%, respectively) when compared with patients with NG (19%) (P < 0.001). After multivariable adjustment, CH remained independently associated with mortality (HR 1.258, 95% CI 1.016-1.558; P = 0.035), whereas both CH (HR 1.291, 95% CI 1.088-1.532; P = 0.003) and EH (HR 1.217, 95% CI 1.008-1.470; P = 0.042) were associated with the composite endpoint of death or AVR.

Conclusion: In patients with moderate AS, those who develop CH already have an increased risk of all-cause mortality. Assessment of the LV remodelling patterns may identify patients at higher risk of adverse events, warranting closer surveillance, and possibly earlier intervention.

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