Myocardial adaptation after surgical therapy differs for aortic valve stenosis and hypertrophic obstructive cardiomyopathy

Rahana Y. Parbhudayal, Ahmet Güçlü, Alwin Zweerink, P. Stefan Biesbroek, Pierre Croisille, Patrick Clarysse, Michelle Michels, Wim Stooker, Alexander B. A. Vonk, Peter M. van der Ven, Albert C. van Rossum, Jolanda van der Velden, Robin Nijveldt

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Surgical therapies in aortic valve stenosis (AVS) and hypertrophic obstructive cardiomyopathy (HOCM) aim to relief intraventricular pressure overload and improve clinical outcome. It is currently unknown to what extent myocardial adaptation concurs with restoration of intraventricular pressures, and whether this is similar in both patient groups. The aim of this study was to investigate changes in myocardial adaptation after surgical therapies for AVS and HOCM. Ten AVS and ten HOCM patients were enrolled and underwent cardiac magnetic resonance cine imaging and myocardial tagging prior to, and 4 months after aortic valve replacement (AVR) and septal myectomy, respectively. Global left ventricular (LV) analyses were derived from cine images. Circumferential strain was assessed from myocardial tagging images at the septal and lateral wall of the mid ventricle. Pressure gradients significantly decreased in both AVS and HOCM after surgery (p < 0.01), with a concomitant decrease in left atrial volume (p < 0.05) suggesting lower diastolic filling pressures. Also, LV volumes, mass and septal wall thickness decreased in both, but to a larger extent in AVS than in HOCM patients. AVR improved wall thickening (p < 0.05) and did not change systolic strain rate. Myectomy did not affect wall thickening and reduced septal systolic strain rate (p = 0.03). Both AVR and myectomy induced positive structural remodeling in line with a reduction of pressure overload. A concomitant recovery in systolic function however was found in AVR only. The systolic functional deterioration in HOCM patients seems to be inherent to myectomy and the ongoing and irreversible disease.

Original languageEnglish
Pages (from-to)1089-1100
Number of pages12
JournalInternational Journal of Cardiovascular Imaging
Issue number6
Publication statusPublished - 1 Jun 2019


  • Aortic valve stenosis
  • Cardiac remodeling
  • Hypertrophic obstructive cardiomyopathy
  • Magnetic resonance imaging

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