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Aortic stenosis (AS) is the most prevalent valve disease. It involves increased left ventricle (LV) postcharge leading to LV hypertrophy. The aim of the study was to assess the burden of LV hypertrophy and its different patterns among a large cohort of patients with severe AS. Methods Observational, multicentre and prospective study of consecutive cases. Patients with severe AS defined as aortic valve area (AVA) &amp;lt;1.0 cm2, and preserved LV ejection fraction (LVEF≥50%) were included. LV hypertrophy was diagnosed in case of LV indexed mass &amp;gt;95 g/m2 in females or &amp;gt;115 g/m2 in males. LV geometry was assessed by relative wall thickness ratio, considering a cut-off value of 0.42. A p value &amp;lt;0.05 was considered statistically significant. Results A total of 805 patients with severe AS were included, 49.7% (n = 400) of them females and 50.3% (n = 405) males. LV indexed mass was available in 665 subjects, most of them (74.9%, n = 498) presenting LV hypertrophy. Females showed higher prevalence of LV hypertrophy than males (82.7% vs. 60.5%; p &amp;lt; 0.01). Concentric hypertrophy was the most frequently encountered phenotype (63.9%; n = 420), being significantly more prevalent among women (74.3% vs 53.4%; p &amp;lt; 0.01). Despite that increased hypertrophy, females showed less severe AS when comparing mean transaortic gradient (39 mmHg vs 42 mmHg; p = 0.04) and indexed AVA (0.42 cm/m2 vs 0.40 cm/m2; p = 0.02). LV hypertrophy was associated with enlarged atria and higher pulmonary systolic pressure. Conclusions LV hypertrophy affects most of patients with severe AS. LV remodelling is different between gender, with women developing higher grade of hypertrophy despite lesser AS severity. LV hypertrophy is associated with poor prognosis echocardiographic signs (increased PSAP and indexed LAV). Differences related to LV mass Normal LV mass LV hypertrophy P value Indexed AVA (cm/m2) 0.42 ± 0.01 0.41 ± 0.01 0.52 Mean gradient (mmHg) 42 ± 0.7 36 ± 1.1 &amp;lt;0.01 Indexed stroke volumen (mL/m2) 41 ± 1 37 ± 1 &amp;lt;0.01 Indexed LAV (mL/m2) 46 ± 1 38 ± 1 &amp;lt;0.01 PSAP (mmHg) 30 ± 2 41 ± 1 0.01 LAV left atrial volume PSAP: pulmonary systolic arterial pressure Abstract 619 Figure. Sex related LV geometry patterns

619 Left ventricle remodelling in severe aortic stenosis: analysis of a large cohort of patients