Load independent impairment of reverse remodeling after valve replacement in hypertensive aortic stenosis patients |
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Authors: | Cristina Gavina,Inê s Falcã o-Pires,Joã o Rodrigues,Benjamim Marinho,Nadia Gonç alves,Ricardo Lopes,Má rio Jorge Amorim,Jorge Almeida,Paulo Pinho,Alexandra Gonç alves,Francisco Rocha-Gonç alves,Adelino Leite-Moreira |
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Affiliation: | 1. Department of Medicine, Faculty of Medicine, University of Porto, Portugal;2. Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal;3. Cardiology, Centro Hospitalar São João, Porto, Portugal;4. Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal |
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Abstract: | BackgroundWe evaluated the impact of hypertension on the left ventricular mass regression in aortic stenosis after aortic valve replacement.MethodsWe prospectively studied 135 patients with severe aortic stenosis at baseline and 1 year after surgery. In 32 patients we analyzed myocardial gene expression of collagen types I and III, connective tissue growth factor, transforming growth factor-β1, metalloproteinase-2 and its tissue inhibitor and compared its levels vs controls.ResultsSeventy-six patients (56.3%) had a history of hypertension. Hypertensive patients were older, had higher Euroscore-II and NYHA class, with no differences in stenosis severity. At 1 year follow-up there was a median decrease of mass index of 14.2% (P25–75: − 4.3%–30.4%; p < 0.001). Mass regression was significantly higher in patients without hypertension, with a median decrease of 25.9% (P25–75: 12.0%–38.7%) vs 5.4% (P25–75: − 12.5%–20.1%; p = 0.001), despite similar increase in effective orifice area and no differences in valvuloarterial impedance. After 1 year, higher baseline left ventricular mass index (p = 0.005) and the absence of hypertension (p = 0.002) or diabetes (p = 0.041) were the only independent predictors of mass regression higher than the median. Comparing with controls, aortic stenosis patients had an increased expression of collagen types I and III, but only hypertensive patients had higher relative expression of collagen type I vs III. In hypertensive patients TIMP2 expression was up-regulated and correlated with higher baseline left ventricular mass index (r = 0.61; p = 0.020).ConclusionsIn aortic stenosis, hypertension impairs mass regression one year after valve replacement, independently of total afterload. Differences in the expression of extracellular matrix remodeling genes might contribute to this finding. |
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Keywords: | Aortic stenosis Hypertension Aortic valve replacement Left ventricular mass Reverse remodeling Extracellular matrix |
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