Aortic Stenosis and Stressed Heart Morphology


Myocardial geometric remodeling is a response to increased stress which includes increased afterload situations during clinical conditions. In this review, we have focused on early and late geometric features in aortic stenosis, importance of recognition of these findings and consequences due to progression of valve disease. We have also pointed out the similarities in early focal and global myocardial geometric remodeling in acute and chronic conditions as hypertension and acute stress cardiomypathy which are associated with myocardial functional and geometric response to acute or chronic stress exposure and relevant increased afterload. In aortic stenosis, target organ involvement in disease progression has been evaluated and discussed in the report. In addition to quantitative evaluation of valve disease, importance of myocardial involvement and global assessment of patients with aortic stenosis also have been mentioned in the report. Finally, we have discussed the importance of global myocardial geometric changes and timing for surgery before development of heart failure in this specific group of patients.

Share and Cite:

Karatepe, C. and Yalçin, F. (2014) Aortic Stenosis and Stressed Heart Morphology. World Journal of Cardiovascular Surgery, 4, 151-157. doi: 10.4236/wjcs.2014.49022.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Nkomo, V.T., Gardin, M., Skelton, T.N., Gottdiener, J.S., Scott, C.G. and Enriquez-Sarano, M. (2006) Burden of Valvular Heart Diseases: A Population-Based Study. Lancet, 368, 1005-1011.
[2] Grossman, W., Jones, D. and McLaurin, L. (1975) Wall Stress and Patterns of Hypertrophy in the Human Left Ventricle. Journal of Clinical Investigation, 56, 56-64.
[3] Saito, T., Muro, T., Takeda, H., et al. (2012) Prognostic Value of Aortic Valve Area Index in Asymptomatic Patients with Severe Aortic Stenosis. American Journal of Cardiology, 110, 93-97.
[4] Dweck, M.R., Boon, N.A. and Newby, D.E. (2012) Calcific Aortic Stenosis: A Disease of the Valve and the Myocardium. Journal of the American College of Cardiology, 60, 1854-1863.
[5] Cioffi, G., Faggiano, P., Vizzardi, E., et al. (2011) Prognostic Effect of Inappropriately High Left Ventricular Mass in Asymptomatic Severe Aortic Stenosis. Heart, 97, 301-307.
[6] Carabello, B.A. (1995) The Relationship of Left Ventricular Geometry and Hypertrophy to Left Ventricular Function in Valvular Heart Disease. The Journal of Heart Valve Disease, 4, S132-S138.
[7] Garcia, M.J., Thomas, J.D. and Klein, A.L. (1998) New Doppler Echocardiographic Applications for the Study of Diastolic Function. Journal of the American College of Cardiology, 32, 865-875.
[8] Yalcin, F., Kaftan, A., Muderrisoglu, H., Korkmaz, M.E., Flachskampf, F., Garcia, M.J. and Thomas, J.D. (2002) Is Doppler Tissue Velocity during Early Left Ventricular Filling Preload Independent? Heart, 87, 336-339.
[9] Takeda, S., Rimington, H., Smeeton, N. and Chambers, J. (2001) Long Axis Excursion in Aortic Stenosis. Heart, 86, 52-56.
[10] Levy, D., Garrison, R.J., Savage, D.D., Kannel, W.B. and Castelli, W.P. (1990) Prognostic Implications of Echocardiographically Determined Left Ventricular Mass in the Framingham Heart Study. New England Journal of Medicine, 322, 1561-1566.
[11] Iung, B., Baron, G., Butchart, E.G., Delahaye, F., Gohlke-Barwolf, C., Levang, O.W., Tornos, P., Vanoverschelde, J.L., Vermeer, F., Boersma, E., Ravaud, P. and Vahanian, A. (2003) A Prospective Survey of Patients with Valvular Heart Disease in Europe: The Euro Heart Survey on Valvular Heart Disease. European Heart Journal, 24, 1231-1243.
[12] STS National Database (2000) STS U.S. Cardiac Surgery Database: 1997 Aortic Valve Replacement Patients: Preoperative Risk Variables. Society of Thoracic Surgeons, Chicago.
[13] Bridgewater, B., Keogh, B., Kinsman, R. and Walton, P. (2008) The Society for Cardiothoracic Surgery in Great Britain & Ireland, 6th National Adult Cardiac Surgical Database Report. Demonstrating Quality, Dendrite Clinical Systems Ltd, Henley-on-Thames, UK.
[14] Kvidal, P., Bergstrom, R., Horte, L.G. and Stahle, E. (2000) Observed and Relative Survival after Aortic Valve Replacement. Journal of the American College of Cardiology, 35, 747-756.
[15] Brown, M.L., Pellikka, P.A., Schaff, H.V., Scott, C.G., Mullany, C.J., Sundt, T.M., Dearani, J.A., Daly, R.C. and Orszulak, T.A. (2008) The Benefits of Early Valve Replacement in Asymptomatic Patients with Severe Stenosis. The Journal of Thoracic and Cardiovascular Surgery, 135, 308-315.
[16] Leon, M.B., Smith, C.R., Mack, M., Miller, D.C., Moses, J.W., Svensson, L.G., Tuzcu, E.M., Webb, J.G., Fontana, G.P., Makkar, R.R., Brown, D.L., Block, P.C., Guyton, R.A., Pichard, A.D., Bavaria, J.E., Herrmann, H.C., Douglas, P.S., Petersen, J.L., Akin, J.J., Anderson, W.N., Wang, D., Pocock, S. and Partner Trial Investigators (2010) Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. New England Journal of Medicine, 363, 1597-1607.
[17] Gurvitch, R., Wood, D.A., Tay, E.L., Leipsic, J., Ye, J., Lichtenstein, S.V., Thompson, C.R., Carere, R.G., Wijesinghe, N., Nietlispach, F., Boone, R.H., Lauck, S., Cheung, A. and Webb, J.G. (2010) Transcatheter Aorticvalve Implantation: Durability of Clinical and Hemodynamic Outcomes beyond 3 Years in a Large Patient Cohort. Circulation, 122, 1319-1327.
[18] Kalavrouziotis, D., Li, D., Buth, K.J. and Légaré, J.F. (2009) The European System for Cardiac Operative Risk Evaluation (EuroSCORE) Is Not Appropriate for Withholding Surgery in High-Risk Patients with Aortic Stenosis: A Retrospective Cohort Study. Journal of Cardiothoracic Surgery, 4, 32.
[19] Vinereanu, D., Florescu, N., Sculthorpe, N., Tweddel, A.C., Stephens, M.R. and Fraser, A.G. (2001) Differentiation between Pathologic and Physiologic Left Ventricular Hypertrophy by Tissue Doppler Assessment of Long-Axis Function in Patients with Hypertrophic Cardiomyopathy or Systemic Hypertension and in Athletes. American Journal of Cardiology, 88, 53-58.
[20] Spirito, P., Bellone, P., Harris, K.M., Bernabo, P., Bruzzi, P. and Maron, B.J. (2000) Magnitude of Left Ventricular Hypertrophy and Risk of Sudden Death in Hypertrophic Cardiomyopathy. New England Journal of Medicine, 342, 1778-1785.
[21] Schillaci, G., Verdecchia, P., Porcellati, C., Cuccurullo, O., Cosco, C. and Perticone, F. (2000) Continuous Relation between Left Ventricular Mass and Cardiovascular Risk in Essential Hypertension. Hypertension, 35, 580-586.
[22] Yalcin, F., Shiota, T., Odabashian, J., Agler, D., Greenberg, N.L., Garcia, M.J., Lever, H.M. and Thomas, J.D. (2000) Comparison by Real-Time Three-Dimensional Echocardiography of Left Ventricular Geometry in Hypertrophic Cardiomyopathy versus Secondary Left Ventricular Hypertrophy. American Journal of Cardiology, 85, 1035-1038.
[23] Yalcin, F., Muderrisoglu, H., Korkmaz, M.E., Ozin, B., Baltali, M. and Yigit, F. (2004) The Effect of Dobutamine Stress on Left Ventricular Outflow Tract Gradients in Hypertensive Patients with Basal Septal Hypertrophy. Angiology, 55, 295-301.
[24] Yalcin, F., Kucukler, N., Haq, N. and Abraham, T.P. (2011) Evaluation of Regional Myocardial Dynamics in Left Ventricular Hypertrophy Secondary to Essential Hypertension. Journal of the American College of Cardiology, 57, E2000.
[25] Kucukler, N., Yalcin, F., Abraham, T.P. and Garcia, M.J. (2011) Stress Induced Hypertensive Response: Should It Be Evaluated More Carefully? Cardiovascular Ultrasound, 9, 22.
[26] Yalcin, F., Yigit, F., Erol, T., Baltali, M., Korkmaz, M.E. and Müderrisoglu, H. (2006) Effect of Dobutamine Stress on Basal Septal Tissue Dynamics in Hypertensive Patients with Basal Septal Hypertrophy. Journal of Human Hypertension, 20, 628-630.
[27] Yalcin, F., Yalcin, H. and Abraham, T. (2010) Stress-Induced Regional Features of Left Ventricle Is Related to Pathogenesis of Clinical Conditions with both Acute and Chronic Stress. International Journal of Cardiology, 145, 367-368.
[28] Sharkey, S.W., Lesser, J.R., Zenovich, A.G., Maron, M.S., Lindberg, J., Longe, T.F. and Maron, B.J. (2005) Acute and Reversible Cardiomyopathy Provoked by Stress in Women from the United States. Circulation, 111, 472-479.
[29] Yalcin, F. and Müderrisoglu, H. (2009) Tako-Tsubo Cardiomyopathy May Be Associated with Cardiac Geometric Features as Observed in Hypetensive Heart Disease. International Journal of Cardiology, 135, 251-252.
[30] Holmgren, S., Abrahamsson, T. and Almgren, O. (1985) Adrenergic Innervation of Coronary Arteries and Ventricular Myocardium in the Pig: Fluorescence Microscopic Appearance in the Normal State and after Ischemia. Basic Research in Cardiology, 80, 18-26.
[31] Kawano, H., Okada, R. and Yano, K. (2003) Histological Study on the Distribution of Autonomic Nerves in the Human Heart. Heart and Vessels, 18, 32-39.
[32] Schlaich, M.P., Kaye, D.M., Lambert, E., Sommerville, M., Socratous, F. and Esler, M.D. (2003) Relation between Cardiac Sympathetic Activity and Hypertensive Left Ventricular Hypertrophy. Circulation, 108, 560-565.
[33] Yalcin, F., Shiota, M., Greenberg, N., Thomas, J.D. and Shiota, T. (2008) Real Time Three-Dimensional Echocardiography Evaluation of Mitral Annular Characteristics in Patients with Myocardial Hypertrophy. Echocardiography, 25, 424-428.
[34] Núnez, J., Zamorano, J.L., Pérez De Isla, L., Palomegue, C., Almería, C., Rodrigo, J.L., Corteza, J., Banchs, J. and Macaya, C. (2004) Differences in Regional Systolic and Diastolic Function by Doppler Tissue Imaging in Patients with Hypertrophic Cardiomyopathy and Hypertrophy Caused by Hypertension. Journal of the American Society of Echocardiography, 17, 717-722.
[35] Kato, T., Niizuma, S., Inuzuka, Y., Kawashima, T., Okuda, J., Tamaki, Y., et al. (2010) Analysis of Metabolic Remodeling in Compensated Left Ventricular Hypertrophy and Heart Failure. Circulation: Heart Failure, 3, 420-430.
[36] Vieira, M.L., Silva Filho, R.M., Brito Filho, F.S., Leal, S.B., Lira Filho, E.B., Fischer, C.H., de Souza, J.A. and Perin, M.A. (2003) Selective Contrast Echocardiography in Percutaneous Transluminal Septal Myocardial Ablation in an Elderly Patient with Left Ventricular Concentric Hypertrophy. Echocardiography, 20, 563-566.
[37] Azzarelli, S., Galassi, A.R., Amico, F., Giacoppo, M., Argentino, V. and Fiscella, A. (2007) Intraventricular Obstruction in a Patient with Tako-Tsubo Cardiomyopathy. International Journal of Cardiology, 121, e22-e24.
[38] Laskey, W.K. and Kussmaul, W.G. (2001) Subvalvular Gradients in Patients with Valvular Aortic Stenosis: Prevalence, Magnitude, and Physiological Importance. Circulation, 104, 1019-1022.
[39] Dweck, M.R., Joshi, S., Murigu, T., Alpendurada, F., Jabbour, A., Melina, G., Banya, W., Gulati, A., Roussin, I., Raza, S., et al. (2011) Midwall Fibrosis Is an Independent Predictor of Mortality in Patients with Aortic Stenosis. Journal of the American College of Cardiology, 58, 1271-1279.
[40] Lund, O., Flo, C., Jensen, F.T., Emmertsen, K., Nielsen, T.T., Rasmussen, B.S., Hansen, O.K., Pilegaard, H.K. and Kristensen, L.H. (1997) Left Ventricular Systolic and Diastolic Function in Aortic Stenosis. Prognostic Value after Valve Replacement and Underlying Mechanisms. European Heart Journal, 18, 1977-1987.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.