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Recent progress has been focused on the management of severe degenerative aortic stenosis (AS), while its antecedent, moderate AS, still poses a clinical challenge due to the considerable impact of non-valvular factors on its pathophysiology and presentation [1]. Importantly, the prognosis in moderate AS is worse than commonly assumed [2]. Left ventricular (LV) hypertrophy (LVH) develops gradually in moderate AS and has traditionally been perceived as an adaptive mechanism to preserve LV systolic function. However, in hypertension [3, 4] and AS [5, 6], inappropriately high LV mass (iLVM), i.e. an excess of LV mass (eLVM) greater than 28% to 35% of the theoretical LV mass (LVM) predicted from the individual haemodynamic load in a reference population [3, 4], was associated with adverse outcome and depressed afterload-corrected LV midwall fractional shortening (mwFS). The latter is a better index of LV performance than ejection fraction (EF) that overestimates LV function in concentric LVH [7]. Although the prevalence of iLVM was increasingly high and was associated with deteriorating renal function in chronic kidney disease (CKD) and hypertension [8, 9], patients with renal disease had been excluded from key reports on determinants and prognostic value of iLVM in AS [5, 6]. Thus, our aim was to assess relations between renal function, eLVM, and mwFS in real-world patients with moderate AS.

kardiologia polska

Excessive left ventricular hypertrophy in moderate degenerative aortic stenosis: an ineffective compensatory mechanism triggered by primary myocardial dysfunction and enhanced by concomitant mild renal impairment?