Clinical and echocardiographic characteristics of severe aortic stenosis patients with inappropriate left ventricular mass

Abstract

Introduction and objectivesInappropriate left ventricular mass (iLVM) in patients with aortic stenosis (AS) was associated with unfavorable cardiovascular outcome. Our aim was to study the prevalence and characteristics of iLVM in patients with severe AS. MethodsThose patients with severe AS (valve area <1cm2) in our Echocardiography Laboratory between January 2016 and January 2018 were prospectively included. iLVM was diagnosed when the measured left ventricular mass exceeded by 28% the expected value predicted from height, sex and stroke work. Patients with significant left ventricular dysfunction (left ventricular ejection fraction <40%) were excluded. ResultsNinety patients were included (mean age 76±9 years, 55% women), 83% with iLVM. Patients with iLVM had lower indexed aortic valve area (0.39±0.08 vs 0.48±0.06cm2/m2, P<.001), time–velocity integral ratio (0.22±0.04 vs 0.27±0.04; P<.001), indexed stroke volume (39±9 vs 51±13mL/m2, P<.001), higher acceleration time (113±18 vs 88±22ms, P=.001), acceleration time/ejection time ratio (0.37±0.05 vs 0.28±0.07; P<.001) and valvuloarterial impedance (4.8±1.1 vs 4.2±1.0mmHg/mL/m2, P=.04), whilst we did not find differences in mean gradient (48±11 vs 18±12mmHg; P=.96) or peak velocity (4.4±0.5 vs 4.4±0.5m/s; P=.99). Left ventricular ejection fraction, acceleration time to ejection time ratio, indexed systolic volume and valvuloarterial impedance were the only determining variables of iLVM in multivariable analysis. ConclusionsInappropriate left ventricular mass is a frequent finding in patients with severe AS, with echocardiographic characteristics similar to paradoxical low-flow low-gradient severe AS despite normal left ventricular ejection fraction.