It is time to assess left ventricular segmental remodelling in aortic stenosis
Fatih Yalçın, M. Roselle Abraham, Theodore P. Abraham
Abstract
We read the article by Stassen et al.1 with great interest showing the remarkable impact of left ventricular (LV) concentric hypertrophy on mortality in moderate aortic stenosis (AS). Segmental LV remodelling analysis by real-time three-dimensional echocardiography (RT3DE) showed non-uniform morphology in patients with pressure overload. We previously developed a quantitative volume index to separate long-axis LV cavity to three equal slices as base, mid, and apex using RT3DE to visualize segmental details of LV cavity and realized that secondary LV hypertrophy to both AS and hypertension are associated with a diminished basal intracavity volume like ampulla shape two decades ago, while hypertrophic cardiomyopathy had a reduced midsegmental volume that represents the catenoid geometry.2 Predominantly developed septal base is a conjunctive point of determination in both emotion-mediated acute stress cardiomyopathy and increased afterload-mediated chronic hypertensive heart disease and called stressed heart morphology (SHM). We have recently mentioned the mechanic component of SHM in AS patients in addition to emotional and functional components of SHM.3 Regular LV remodelling distribution using third-generation microscopic ultrasonographic data in animal validation studies was different from extremely heterogenous morphology in human data.4 This observation provided us great opportunity to think some other factors which possibly have an impact on irregular morphology in humans. Then, we reported the difficulty in the determination of certain prevalence of SHM and suggested that scientists should be cautious in quantification of this morphological finding. We have recently started to focus on cognitive functions in SHM patients and our initial data have been accepted for exhibition at the ESH 2022.