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20 Reappraising remodelling pattern of left ventricle in aortic stenosis: axis orientation as a unique signature of positive remodelling
  1. Kenneth Chan1,
  2. Masliza Mahmod1,
  3. Ernesto Zacur1,
  4. Marzia Rigolli1,
  5. Michelle D’Souza1,
  6. Jane Francis1,
  7. Rina Ariga1,
  8. Betty Raman1,
  9. Sairia Dass1,
  10. Theodoros Karamitsos1,
  11. Stefan Neubauer1,
  12. Saul Myerson1,
  13. Pablo Lamata2
  1. 1Oxford University
  2. 2Kings College London

Abstract

Introduction In aortic stenosis (AS), characterisation of ventricular (LV) remodelling beyond left ventricular mass measurements is lacking. We sought to study the 3-dimensional (3D) geometric LV remodelling pattern in severe AS pre- and post-surgical aortic valve replacement (AVR), and compared it with hypertensive and healthy controls.

Methods Ninety-one subjects (36 severe AS, 19 hypertension and 36 healthy controls) underwent cardiac magnetic resonance (CMR). 18 AS patients had a repeat CMR eight-month post-AVR. 3D meshes were reconstructed from the myocardial contours of the CMR cine images. Principle component analysis and linear discrimination analysis were used to derive shape coefficients.

Results AS patients had a significant shift in LV axis and apex orientation towards the septum, and more spherical LV shape which were not seen in the hypertensive and healthy control groups. As expected severe AS was associated with thicker and larger LV compared to the other two groups. Post AVR, despite significant reduction in LV thickness and sphericity, interestingly the shift in the LV axis/orientation was unchanged/irreversible (Figure 1).

Abstract 20 Figure 1

A) Comparison between average LV shape in AS (blue), AS post-AVR (green), and controls (red). B) Overlying shape between AS (orange) and control (purple) showing shift of LV axis to septum. C) Overlying shape of AS post-AVR (orange) and healthy control (purple) showing focal dilatation in the postero-septal region post AVR

Conclusion Severe AS is characterised by unique remodelling pattern which is not reversible post AVR. The novel shape metrics that comprehensively quantify the LV morphology may be a potential marker for risk stratification in the management of AS.

Conflict of Interest none

  • hypertrophy
  • aortic stenosis
  • remodelling

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