Left Ventricular Mass, Myocardial Structure, and Function in Severe Aortic Stenosis: an Echocardiographic and Cardiac Magnetic Resonance Imaging Study

• Published in: The American journal of cardiology 2023-10, Vol.205, p.311-320
• Main Authors: Craft, Jason, Weber, Jonathan, Cao, Jane J., Passick, Michael, Ngai, Nora, Bond, Kristine, Khalique, Omar K., Barasch, Eddy
• Format: Article
• Language: English
• Subjects: Aorta; Aortic stenosis; cardiac MRI; Congestive heart failure; Echocardiography; Electronic health records; Gadolinium; Gender; Geometry; Heart failure; Hospitals; Hypertension; Hypertrophy; left ventricular hypertrophy; Magnetic resonance imaging; Medical prognosis; Medical records; Morbidity; Mortality; Statistical models; Structure-function relationships; Thorax; Tracking; Variables; Variance analysis; Ventricle
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2023.08.015

•Left ventricular mass assessed by cardiac magnetic resonance imaging does not predict outcomes in patients with isolated severe aortic stenosis and similar surgical mortality risk.•An elevated left ventricular mass index was associated with larger left ventricular volumes, worse left ventricular systolic function, worse left atrial function, and increased left ventricular scar mass.•Although 57% of the patients lacked left ventricular hypertrophy, their prognosis was not different from those with various severities of left ventricular hypertrophy at an average of 39 ± 38 months of follow-up.•No difference in the composite outcome of death, hospitalization for heart failure, or time to aortic valve replacement was seen between the normal and elevated left ventricular mass groups. In severe aortic stenosis (AS), there are conflicting data on the prognostic implications of left ventricular (LV) hypertrophy (LVH). We aimed to characterize the LV geometry, myocardial matrix structural changes, and prognostic stratification using cardiac magnetic resonance imaging (CMR) and echocardiography in subjects with severe AS with and without LVH. Consecutive patients who had severe isolated AS and sufficient quality echocardiography and CMR within 6 months of each other were evaluated for LVH, cardiac structure, morphology, and late gadolinium-enhancement imaging. Kaplan–Meier curves, linear models, and proportional hazards models were used for prognostic stratification. There were 93 patients enrolled (mean age 74 ± 11 years, 48% female), of whom 38 (41%) had a normal LV mass index (LVMI), 41 (44%) had LVH defined at CMR by LVMI >2 SD higher than normal, and 14 (15% of the total) with >4 SD higher than the reference LVMI (severely elevated). The Society of Thoracic Surgeons scores were similar among the LVMI groups. Compared with those with normal LVMI, patients with LVH had higher LV end-diastolic and end-systolic volumes, increased late gadolinium-enhancement burden, and lower LV ejection fraction. Most notably, CMR feature-tracking global radial strain, 2-dimensional speckle-tracking echocardiography global longitudinal strain, and left atrial reservoir function were significantly worse. On the survival analyses, LVMI was not associated with a composite of all-cause mortality and/or heart failure hospitalization. In conclusion, compared with normal LVMI, elevated LVMI was not associated with a higher risk of adverse outcomes.