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European Heart Journal Advance Access originally published online on May 23, 2005
European Heart Journal 2005 26(17):1697-1699; doi:10.1093/eurheartj/ehi344
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Iconoclasts topple adaptive myocardial hypertrophy in aortic stenosis

Henk P.J. Buermans and Walter J. Paulus*

Laboratory of Physiology, Institute for Cardiovascular Research, VU Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands

* Corresponding author. Tel: +31 204448110; fax: +31 204448255. E-mail address: wj.paulus@vumc.nl

This editorial refers to ‘Left ventricular hypertrophy in aortic valve stenosis: preventive or promotive of systolic dysfunction and heart failure?’{dagger} by M. Kupari et al., on page 1790

The first 10% of the full text of this article appears below.

For more than 30 years, the development of concentric left ventricular (LV) hypertrophy in pressure overload was considered adaptive because the parallel deposition of new sarcomeres and the corresponding LV wall thickening succeeded in normalizing LV systolic wall stress despite the high intracavitary systolic pressure.1 In aortic stenosis, the validity of this paradigm was demonstrated by haemodynamic studies, which established an inverse relationship between LV systolic wall stress and LV ejection fraction (EF) and by clinical outcome studies, which demonstrated worse post-operative prognosis if LV performance fell below this inverse LV wall stress–LVEF relationship.2,3 This clinical paradigm of adaptive myocardial hypertrophy developing during progression of aortic stenosis clearly withstood the test of time despite the mounting epidemiological evidence of LV hypertrophy being associated with excess cardiac mortality and despite the ominous significance of LV hypertrophy in congenital aortic stenosis.

Kupari et al.4 were the first to challenge the time-honoured . . . [Full Text of this Article]

Basic inspiration

Clinical translation

Conclusions


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Related articles in EHJ:

Left ventricular hypertrophy in aortic valve stenosis: preventive or promotive of systolic dysfunction and heart failure?
Markku Kupari, Heikki Turto, and Jyri Lommi
EHJ 2005 26: 1790-1796. [Abstract] [Full Text]