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Comparison of Hemodynamic Factors Predicting Prognosis in Heart Failure: A Systematic Review
Article

Better Myocardial Function in Aortic Stenosis with Low Left Ventricular Mass: A Mechanism of Protection against Heart Failure Regardless of Stenosis Severity?

1
Second Department of Cardiology, Jagiellonian University Medical College, 31-501 Cracow, Poland
2
Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 31-501 Cracow, Poland
3
Institute of Mathematics and Computer Science, The John Paul II Catholic University of Lublin, 20-708 Lublin, Poland
4
Center of Postgraduate Education for Nurses and Midwives in Rzeszów—Tarnobrzeg Branch, 39-400 Tarnobrzeg, Poland
5
Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Cracow, Poland
*
Author to whom correspondence should be addressed.
These authors contributed equally and are shared first authors.
Joint senior authors on this work.
J. Clin. Med. 2019, 8(11), 1836; https://doi.org/10.3390/jcm8111836
Received: 23 September 2019 / Revised: 20 October 2019 / Accepted: 28 October 2019 / Published: 1 November 2019
(This article belongs to the Special Issue Acute and Chronic Heart Failure)
About one-tenth to one-third of patients with severe aortic stenosis (AS) do not develop left ventricular hypertrophy (LVH). Intriguingly, the absence of LVH despite severe AS is associated with lower prevalence of heart failure (HF), which challenges the classical notion of LVH as a beneficial compensatory response. Notably, the few studies that have attempted to characterize AS subjects with inadequately low left ventricular (LV) mass relative to LV afterload (i-lowLVM) described better prognosis and enhanced LV performance in AS associated with i-lowLVM, but those reports were limited to severe AS. Our aim was to compare myocardial function between moderate and severe AS with i-lowLVM. We retrospectively analyzed in-hospital records of 225 clinically stable nondiabetic patients with isolated moderate or severe degenerative AS in sinus rhythm, free of coexistent diseases. Subjects with i-lowLVM were compared to those with appropriate or excessive LVM (a/e-LVM), defined on the basis of the ratio of a measured LVM to the LVM predicted from an individual hemodynamic load. Patients with i-lowLVM and a/e-LVM did not differ in aortic valve area, LV end-diastolic diameter (LVd, a measure of LV preload), and circumferential end-systolic LV wall stress (cESS), an estimate of LV afterload. Compared to a/e-LVM, patients with i-lowLVM had increased LV ejection fraction (EF) and especially higher LV midwall fractional shortening (a better index of LV myocardial function than EF in concentric LV geometry) (p < 0.001–0.01), in both moderate and severe AS. LVd and cESS were similar in the four subgroups of the study subjects, i.e., moderate AS with i-lowLVM, moderate AS with a/e-LVM, severe AS with i-lowLVM, and severe AS with a/e-LVM (p > 0.6). Among patients with i-lowLVM, LVM did not differ significantly between moderate and severe AS (p > 0.4), while in those with a/e-LVM, LVM was increased in severe versus moderate AS (p < 0.001). In conclusion, the association of the low-LVM phenotype with better myocardial contractility may already develop in moderate AS. Additionally, cESS appears to be a controlled variable, which is kept constant over AS progression irrespective of LVM category, but even when controlled (by increasing LVM), is not able to prevent deterioration of LV function. Whether improved myocardial performance contributes to favorable prognosis and the preventive effect against HF in AS without LVH, remains to be studied. View Full-Text
Keywords: aortic stenosis; left ventricular hypertrophy; myocardial contractility; hemodynamic load aortic stenosis; left ventricular hypertrophy; myocardial contractility; hemodynamic load
MDPI and ACS Style

Chyrchel, B.; Bolt, K.; Długosz, D.; Urbańska, A.; Nowak-Kępczyk, M.; Bałata, J.; Rożanowska, A.; Czestkowska, E.; Kruszelnicka, O.; Surdacki, A. Better Myocardial Function in Aortic Stenosis with Low Left Ventricular Mass: A Mechanism of Protection against Heart Failure Regardless of Stenosis Severity? J. Clin. Med. 2019, 8, 1836. https://doi.org/10.3390/jcm8111836

AMA Style

Chyrchel B, Bolt K, Długosz D, Urbańska A, Nowak-Kępczyk M, Bałata J, Rożanowska A, Czestkowska E, Kruszelnicka O, Surdacki A. Better Myocardial Function in Aortic Stenosis with Low Left Ventricular Mass: A Mechanism of Protection against Heart Failure Regardless of Stenosis Severity? Journal of Clinical Medicine. 2019; 8(11):1836. https://doi.org/10.3390/jcm8111836

Chicago/Turabian Style

Chyrchel, Bernadeta, Klaudiusz Bolt, Dorota Długosz, Anna Urbańska, Małgorzata Nowak-Kępczyk, Joanna Bałata, Agnieszka Rożanowska, Ewa Czestkowska, Olga Kruszelnicka, and Andrzej Surdacki. 2019. "Better Myocardial Function in Aortic Stenosis with Low Left Ventricular Mass: A Mechanism of Protection against Heart Failure Regardless of Stenosis Severity?" Journal of Clinical Medicine 8, no. 11: 1836. https://doi.org/10.3390/jcm8111836

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