Left Ventricular Septal Hypertrophy in Elderly Patients With Aortic Stenosis

Abstract

Objectives-Left ventricular (LV) septal hypertrophy in aortic stenosis raises diagnostic and therapeutic questions. However, the etiology and clinical consequences of this finding have not been well studied. The aim of this study was to perform a morphologic evaluation of the LV in aortic stenosis and to investigate the contributing factors and consequences of septal hypertrophy.Methods-Patients with moderate or severe aortic stenosis were prospectively enrolled. Patients with previous myocardial infarction, wall motion abnormalities, at least moderate valvular regurgitation, known cardiomyopathy, an LV ejection fraction of less than 50%, and age younger than 65 years were excluded.Results-Forty-one patients underwent a final analysis. Septal hypertrophy (LV septal wall thickness 15 mm) was confirmed in 21 of 41 patients. The septal hypertrophy group had higher peak aortic valve velocity, a higher diabetes mellitus rate, and a higher rate and longer duration of hypertension than those without septal hypertrophy. The peak aortic valve velocity (odds ratio, 7.1; 95% confidence interval, 1.4-37.1) and diabetes mellitus (odds ratio, 7.4; 95% confidence interval, 1.2-46.2) were the significant factors associated with septal hypertrophy by multivariate analysis. Intraventricular conduction disturbance on electrocardiography was more frequent in the septal hypertrophy group (P 5 .021).Conclusions-Left ventricular septal hypertrophy was commonly observed in elderly patients with aortic stenosis, and a higher aortic valve velocity, hypertension, and diabetes mellitus were associated factors. Intraventricular conduction disturbance occurred more often in patients with septal hypertrophy than those without, which implies the pathophysiologic consequence. Further studies are needed to determine the impact of septal hypertrophy and intraventricular conduction disturbance on the prognosis of patients after aortic valve interventions.Key Words-aortic stenosis; echocardiography (adult); electrocardiology; magnetic resonance imaging; valvular heart disease A symmetric hypertrophy, especially basal septal hypertrophy, has been identified as a variant in patients with aortic stenosis. However, the etiology and clinical consequences of this entity have not been well investigated: specifically, whether clinical factors such as hypertension, age, and the severity of aortic stenosis predispose patients to septal hypertrophy development and whether this hypertrophy has a causal effect for physiologic abnormalities. When septal thickness is excessive, differential diagnoses of hypertrophic cardiomyopathy or other infiltrative diseases need to be considered. Additionally, septal hypertrophy has an impact on clinical management that may dictate the choice of surgical procedure (traditional

Meteorin-like/Meteorin-β protects heart against cardiac dysfunction

“…This phenotype, which shows a pattern more characteristic of cardiac dysfunction than of non-asymmetrical hypertrophy, resembles that in patients with hypertrophic cardiomyopathy ( Marian and Braunwald, 2017 ; Yousefzai et al, 2017 ), one of the leading causes of sudden death among young people ( Maron and Maron, 2013 ). Although it has been shown that hypertrophic cardiomyopathy may be inherited ( Katayama et al, 2018 ), it seems unlikely that the effects observed in our global KO model are early development related, since basal signs of cardiac hypertrophy do not develop spontaneously in young Metrnβ-null mice. However, we cannot completely rule out this possibility, because Metrnβ has been reported to have effects on neuronal growth and brain development during embryogenesis ( Jørgensen et al, 2012 ).…”

Analysis of the US FDA adverse event reporting system to identify adverse cardiac events associated with hydroxychloroquine in older adults

“…We retrieved a total of 7 247 902 drug-event pairs between January cardiomyopathy. 26,27 Myocardial fibrosis is a significant risk factor for hypertrophic cardiomyopathy, and is associated with a myriad of severe adverse cardiovascular outcomes including sudden cardiac death, ventricular tachyarrhythmias, left ventricular dysfunction, and heart failure. 28…”

“…However, our novel findings include the identification of cardiac septal hypertrophy and myocardial fibrosis associated with hydroxychloroquine therapy, and these signals require further confirmation. Cardiac septal hypertrophy in older adults is associated with disturbance in intraventricular conduction and is an independent predictor of progression to atrial fibrillation in patients with hypertrophic cardiomyopathy 26,27 . Myocardial fibrosis is a significant risk factor for hypertrophic cardiomyopathy, and is associated with a myriad of severe adverse cardiovascular outcomes including sudden cardiac death, ventricular tachyarrhythmias, left ventricular dysfunction, and heart failure 28 …”

Гипертрофиялық Кардиомиопатия – Көп Қырлы Мәселенің Қазіргі Жағдайы

“…Несмотря на значимые достижения активного полувекового изучения этой загадочной патологии сердца, многочисленные современные научные исследования продолжают предпринимать попытки эволюционировать представление о ГКМП с целью определения парадигм диагностики и лечения. Подобная актуальность связана с тем, что на фоне постепенно нарастающей одышки, основным проявлением ГКМП является внезапная сердечная смерть (ВСС) [1]. Гипертрофическая кардиомиопатия, как причина ВСС у молодых людей, является наиболее часто встречающейся, а у действующих спортсменов занимает первое место среди прочих сердечно-сосудистых патологий, достигая 36% [2, 3,4].…”