Better myocardial function in aortic stenosis with low left ventricular mass : a mechanism of protection against heart failure regardless of stenosis severity?

2019
journal article
article
1
cris.lastimport.wos2024-04-09T23:17:36Z
dc.abstract.enAbout 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.pl
dc.affiliationWydział Lekarski : Instytut Kardiologiipl
dc.cm.date2020-12-02
dc.cm.id97097
dc.contributor.authorChyrchel, Bernadeta - 148302 pl
dc.contributor.authorBolt, Klaudiuszpl
dc.contributor.authorDługosz, Dorotapl
dc.contributor.authorUrbańska, Annapl
dc.contributor.authorNowak-Kępczyk, Małgorzatapl
dc.contributor.authorBałata, Joannapl
dc.contributor.authorRożanowska, Agnieszkapl
dc.contributor.authorCzestkowska, Ewapl
dc.contributor.authorKruszelnicka-Kwiatkowska, Olga - 354388 pl
dc.contributor.authorSurdacki, Andrzej - 133538 pl
dc.date.accession2019-12-16pl
dc.date.accessioned2020-12-02T10:22:44Zpl
dc.date.available2020-12-02T10:22:44Zpl
dc.date.issued2019pl
dc.date.openaccess0
dc.description.accesstimew momencie opublikowania
dc.description.number11pl
dc.description.physical1836pl
dc.description.points140pl
dc.description.versionostateczna wersja wydawcy
dc.description.volume8pl
dc.identifier.doi10.3390/jcm8111836pl
dc.identifier.eissn2077-0383pl
dc.identifier.projectROD UJ / OPpl
dc.identifier.urihttps://ruj.uj.edu.pl/xmlui/handle/item/256578
dc.identifier.weblinkhttps://www.mdpi.com/2077-0383/8/11/1836pl
dc.languageengpl
dc.language.containerengpl
dc.rightsUdzielam licencji. Uznanie autorstwa 4.0 Międzynarodowa*
dc.rights.licenceCC-BY
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/legalcode.pl*
dc.share.typeotwarte czasopismo
dc.subject.enaortic stenosispl
dc.subject.enleft ventricular hypertrophypl
dc.subject.enmyocardial contractilitypl
dc.subject.enhemodynamic loadpl
dc.subtypeArticlepl
dc.titleBetter myocardial function in aortic stenosis with low left ventricular mass : a mechanism of protection against heart failure regardless of stenosis severity?pl
dc.title.journalJournal of Clinical Medicinepl
dc.typeJournalArticlepl
dspace.entity.typePublication
cris.lastimport.wos
2024-04-09T23:17:36Z
dc.abstract.enpl
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.
dc.affiliationpl
Wydział Lekarski : Instytut Kardiologii
dc.cm.date
2020-12-02
dc.cm.id
97097
dc.contributor.authorpl
Chyrchel, Bernadeta - 148302
dc.contributor.authorpl
Bolt, Klaudiusz
dc.contributor.authorpl
Długosz, Dorota
dc.contributor.authorpl
Urbańska, Anna
dc.contributor.authorpl
Nowak-Kępczyk, Małgorzata
dc.contributor.authorpl
Bałata, Joanna
dc.contributor.authorpl
Rożanowska, Agnieszka
dc.contributor.authorpl
Czestkowska, Ewa
dc.contributor.authorpl
Kruszelnicka-Kwiatkowska, Olga - 354388
dc.contributor.authorpl
Surdacki, Andrzej - 133538
dc.date.accessionpl
2019-12-16
dc.date.accessionedpl
2020-12-02T10:22:44Z
dc.date.availablepl
2020-12-02T10:22:44Z
dc.date.issuedpl
2019
dc.date.openaccess
0
dc.description.accesstime
w momencie opublikowania
dc.description.numberpl
11
dc.description.physicalpl
1836
dc.description.pointspl
140
dc.description.version
ostateczna wersja wydawcy
dc.description.volumepl
8
dc.identifier.doipl
10.3390/jcm8111836
dc.identifier.eissnpl
2077-0383
dc.identifier.projectpl
ROD UJ / OP
dc.identifier.uri
https://ruj.uj.edu.pl/xmlui/handle/item/256578
dc.identifier.weblinkpl
https://www.mdpi.com/2077-0383/8/11/1836
dc.languagepl
eng
dc.language.containerpl
eng
dc.rights*
Udzielam licencji. Uznanie autorstwa 4.0 Międzynarodowa
dc.rights.licence
CC-BY
dc.rights.uri*
http://creativecommons.org/licenses/by/4.0/legalcode.pl
dc.share.type
otwarte czasopismo
dc.subject.enpl
aortic stenosis
dc.subject.enpl
left ventricular hypertrophy
dc.subject.enpl
myocardial contractility
dc.subject.enpl
hemodynamic load
dc.subtypepl
Article
dc.titlepl
Better myocardial function in aortic stenosis with low left ventricular mass : a mechanism of protection against heart failure regardless of stenosis severity?
dc.title.journalpl
Journal of Clinical Medicine
dc.typepl
JournalArticle
dspace.entity.type
Publication
Affiliations

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