Rofo 2012; 184 - KMY03
DOI: 10.1055/s-0031-1300871

Assessment of increased left ventricular wall stress with the volume-based wall stress index – prediction of left ventricular hypertrophy and late gadolinium enhancement in dilative heart failure

P Alter 1, H Rupp 1, JH Figiel 2, MB Rominger 2, B Maisch 1
  • 1Philipps-Universität Marburg, Innere Medizin – Kardiologie, Marburg
  • 2Philipps-Universität, Radiologie, Marburg

Introduction:

Increased left ventricular (LV) wall stress is an unfavourable prognostic determinant in dilative cardiomyopathy. Besides LV hypertrophy, occurrence of late gadolinium enhancement (LGE) as assessed by cardiac magnetic resonance (CMR) imaging was associated with an adverse outcome. We hypothesized, therefore, that increased LV wall stress is involved in the development of LV hypertrophy and is associated with LGE.

Methods:

LV mass, LV enddiastolic (LVEDV) and endsystolic volume (LVESV) was determined by CMR. Presence or absence of LGE was assessed in 300 patients. Based on a thick-walled sphere model, we introduced a myocardial and cavity volume-based wall stress index. In another group of 71 patients, the development of LV mass was assessed during follow-up.

Results:

LV enddiastolic and endsystolic wall stress, LV volumes and mass (P4 kPa developed greater LV hypertrophy during follow-up (P4

Conclusions:

Use of the volume-based wall stress index allows to calculate LV wall stress based on CMR measurements of LV volume and mass. As shown, increased LV wall stress leads to LV hypertrophy. It is a novel finding that increased wall stress is associated with the occurrence of LGE in dilative cardiomyopathy. Since both features are linked with worse outcome, it can be inferred that increased LV wall stress is the underlying unfavourable determinant and other parameters are surrogate markers only. Increased LV wall stress leads to a vicious circle of heart failure progression with on-going dilatation and can account for the increased risk of sudden cardiac death involving wall stress-sensitive cation channels. Since we have already established the measurement of wall stress in heart failure as diagnostic routine procedure, the volume-based wall stress index could be used whenever invasive pressure data are not available.