Load independent impairment of reverse remodeling after valve replacement in hypertensive aortic stenosis patients

• Type: Article in International Scientific Journal
• Date: 2014

Authors

Gavina C (Author) FMUP; Falcao Pires, I (Author) FMUP; Rodrigues, J (Author) Other; Marinho, B (Author) Other; Goncalves, N (Author) FMUP; Lopes, R (Author) Other; Amorim MJ (Author) FMUP; Almeida, J (Author) Other; Pinho, P (Author) Other; Alexandra Goncalves (Author) FMUP; Rocha Goncalves, F (Author) Other; Leite-Moreira AF (Author) FMUP

Journal

Title: International Journal of Cardiology

Vol. 170

Pages: 324-330

ISSN: 0167-5273

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 11 Citations

Scopus - 11 Citations

Other information

Authenticus ID: P-008-K7J

DOI: 10.1016/j.ijcard.2013.11.006

Abstract (EN): Background: We evaluated the impact of hypertension on the left ventricular mass regression in aortic stenosis after aortic valve replacement. Methods: We prospectively studied 135 patients with severe aortic stenosis at baseline and 1 year after surgery. In 32 patients weanalyzedmyocardial gene expression of collagen types I and III, connective tissue growth factor, transforming growth factor-beta 1, metalloproteinase-2 and its tissue inhibitor and compared its levels vs controls. Results: Seventy-six patients (56.3%) had a history of hypertension. Hypertensive patientswere 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 b 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 ventricularmass index (r = 0.61; p = 0.020). Conclusions: In aortic stenosis, hypertension impairs mass regression one year after valve replacement, independently of total afterload. Differences in the expression of extracellular matrix remodeling genesmight contribute to this finding.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 7