Morphological and functional evaluation of the left ventricle in severe aortic stenosis with afterload mismatch: a South African single-centre, cross-sectional cardiovascular MRI-based study

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OBJECTIVES: This study aimed to investigate the relationship between left ventricular (LV) remodelling and systolic function in high-gradient severe aortic stenosis (AS) using cardiovascular magnetic resonance (CMR) imaging. Patients with low ejection fraction (left ventricular ejection fraction (LVEF) <50%) high-gradient severe AS (low ejection fraction high-gradient (LEF-HG)), that is, afterload mismatch, were compared with patients with normal ejection fraction high-gradient (NEF-HG) severe AS. The hypothesis of insufficient left ventricular hypertrophy (LVH) leading to high wall stress as the mechanism of systolic dysfunction in afterload mismatch was tested. DESIGN: This was a cross-sectional study design. SETTING: The study was performed at a single tertiary academic hospital in the Western Cape, South Africa. PARTICIPANTS: , mean gradient 53 (25) mm Hg, LVEF 64±14%). RESULTS: , p<0.0001). Elevated ESWS was associated with smaller valve areas and cavity dilation but not with LVH. CONCLUSION: The reduced LVEF in afterload mismatch was associated with high ESWS as previously suggested. However, insufficient concentric LVH was not observed in LEF-HG AS and therefore not associated with high ESWS. LV cavity dilation and smaller valve areas were instead associated with the elevated ESWS in afterload mismatch, which may represent the decompensated stage of high-gradient severe AS.

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