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European Heart Journal Advance Access originally published online on April 28, 2005
European Heart Journal 2005 26(17):1790-1796; doi:10.1093/eurheartj/ehi290
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Left ventricular hypertrophy in aortic valve stenosis: preventive or promotive of systolic dysfunction and heart failure?

Markku Kupari*, Heikki Turto and Jyri Lommi

Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, 00029 Helsinki, Finland

Received 6 November 2004; revised 20 February 2005; accepted 24 March 2005; online publish-ahead-of-print 28 April 2005.

* Corresponding author. Tel: +358 9 4717 2441; fax: +358 9 4717 4574. E-mail address: markku.kupari{at}hus.fi

See page 1697 for the editorial comment on this article (doi:10.1093/eurheartj/ehi344)

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 (ß=–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 cm2/m2, 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.

Key Words: Aortic valve stenosis • Heart failure • Left ventricular hypertrophy


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