ArticleBMJ open2026
Morphological and functional evaluation of the left ventricle in severe aortic stenosis with afterload mismatch: a South African single-centre, cross-sectional cardiovascular MRI-based study.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThis study aimed to investigate the relationship between left ventricular (LV) remodelling and systolic function in high-gradient severe aortic stenosis (AS) using cardiovascular magnetic resonance (CMR) imaging. Patients with low ejection fraction (left ventricular ejection fraction (LVEF) <50%) high-gradient severe AS (low ejection fraction high-gradient (LEF-HG)), that is, afterload mismatch, were compared with patients with normal ejection fraction high-gradient (NEF-HG) severe AS. The hypothesis of insufficient left ventricular hypertrophy (LVH) leading to high wall stress as the mechanism of systolic dysfunction in afterload mismatch was tested.
designThis was a cross-sectional study design.
settingThe study was performed at a single tertiary academic hospital in the Western Cape, South Africa.
participantsA total of 48 participants with high-gradient (mean gradient ≥40 mm Hg) severe AS (aortic valve area (AVA) <1.0 cm
resultsEnd-systolic wall stress (ESWS) was higher in the LEF-HG group (265.3±83.5 vs 122.8±54.7×10
conclusionThe reduced LVEF in afterload mismatch was associated with high ESWS as previously suggested. However, insufficient concentric LVH was not observed in LEF-HG AS and therefore not associated with high ESWS. LV cavity dilation and smaller valve areas were instead associated with the elevated ESWS in afterload mismatch, which may represent the decompensated stage of high-gradient severe AS.
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