Editorial Iconoclasts topple adaptive myocardial hypertrophy in aortic stenosis

This editorial refers to ‘Left ventricular hypertrophy in aortic valve stenosis: preventive or promotive of systolic dysfunction and heart failure?’ † by M. Kupari et al., on page 1790 For more than 30 years, the development of concentric left ventricular (LV) hypertrophy in pressure overload was con-sidered adaptive because the parallel deposition of new sar-comeres and the corresponding LV wall thickening succeeded in normalizing LV systolic wall stress despite the high intracavitary systolic pressure.1 In aortic stenosis, the validity of this paradigm was demonstrated by haemo-dynamic studies, which established an inverse relationship between LV systolic wall stress and LV ejection fraction (EF) and by clinical outcome studies, which demonstrated worse post-operative prognosis if LV performance fel