Compensatory or inappropriate left ventricular mass in different models of left ventricular pressure overload: comparison between patients with aortic stenosis and arterial hypertension

BACKGROUND: Aortic valve stenosis and arterial hypertension (AH) are two models of left ventricular (LV) pressure overload, which commonly induce increase in LV mass. Prevalence and predictors of excess of LV mass (inappropriate LVM) has been recently investigated in AH patients. Whether or not this phenomenon also exists in patients with aortic valve stenosis has to be defined. OBJECTIVE: To evaluate prevalence of and factors associated with inappropriate LVM as a response to overload in aortic valve stenosis compared to AH patients. DESIGN AND METHODS: One hundred patients with aortic valve stenosis (mean valve area 0.67 +/- 0.18 cm/m) were studied by Doppler echocardiography and compared to 200 patients with AH. Inappropriate LVM was diagnosed when the measured LV mass exceeded by 28% the expected value predicted from height, sex and stroke work. RESULTS: Prevalence of inappropriate LVM was similar in aortic valve stenosis (n: 24 = 24%) and AH patients (n: 55 = 27.5%). Aortic valve stenosis had greater LVM (203 +/- 57 vs. 182 +/- 53 g, P = 0.001), more concentric LV geometry, lower midwall shortening and higher left atrial systolic force than AH. In both study groups, high LV mass, concentric LV geometry and reduced systolic function emerged as independent correlates of inappropriate LV mass. CONCLUSION: Although LV and left atrial geometric adaptation in aortic valve stenosis is different from AH, reflecting a near-pure pressure overload, aortic valve stenosis patients have a prevalence of inappropriately high LVM which is similar to those with AH. Geometric and functional characteristics of inappropriate LVM do not differ in aortic valve stenosis and AH, despite the different loading conditions.