In a patient with severe aortic stenosis, which haemodynamic findings during cardiac catheterisation best characterise the compensated phase of concentric left ventricular hypertrophy?

• A Elevated LV systolic pressure with a peak gradient across the aortic valve, normal or mildly reduced EF, elevated LV end-diastolic pressure from reduced compliance, and normal stroke volume maintained by increased wall thickness (normalised wall stress by Laplace's law) ✓
• B Dilated LV with reduced EF, low systolic pressure gradient across the valve, and elevated pulmonary capillary wedge pressure indicating decompensation
• C Normal LV systolic pressure, elevated diastolic pressure, and a large regurgitant volume indicating that the obstruction creates backflow across the stenotic valve
• D Reduced LV wall thickness due to pressure-induced apoptosis, with compensatory tachycardia maintaining cardiac output

Explanation

In compensated aortic stenosis, the LV hypertrophies concentrically (increased wall thickness, normal chamber diameter) to normalise systolic wall stress per Laplace's law (stress = Pressure × radius / 2 × wall thickness). Catheterisation shows: high LV systolic pressure, large systolic pressure gradient across the stenotic valve, near-normal EF (systolic function maintained), but elevated LVEDP due to reduced diastolic compliance of the thick wall. Stroke volume is maintained. Decompensation occurs when hypertrophy can no longer normalise stress: the chamber dilates, EF falls, and the pattern of option B emerges. Regurgitation and wall thinning are not features of aortic stenosis.

Reference: Guyton & Hall, Textbook of Medical Physiology, 14th ed.

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