Abstract 8745: Systemic Hypertension Plays an Additional Role in the Development of Left Ventricular Dysfunction in Patients With Asymptomatic Aortic Stenosis
Background: Systemic hypertension commonly coexists with degenerative aortic stenosis (AS). Its role in the development of left ventricular hypertrophy (LVH) in patients with AS is well accepted. However, the impact of systemic hypertension on left ventricular systolic and diastolic function in patients with asymptomatic AS has not been fully elucidated.To clarify this question, we performed the present study to assess left ventricular systolic and diastolic function in normotensive and hypertensive patients with asymptomatic AS.
Methods: This prospective study included a total of 219 consecutive patients with asymptomatic AS (108 males). Their mean age was 65.7±8.2 years, and the age range was 42∼81 years. According to history of hypertension, patients were divided into the normotensive (n=93) and hypertensive (n=126) groups. Severity of AS and left ventricular structure were assessed by conventional echocardiography. Tissue Doppler and Speckle tracking were performed to evaluate left ventricular systolic and diastolic function.
Results: There were no significant differences between the normotensive and hypertensive groups with respect to gender, heart rate, the presence of concomitant coronary artery disease or diabetes, left ventricular ejection fraction and severity of AS. However, compared to the normotensive group, patients in the hypertensive group were older (68.0±8.1 vs. 62.5±7.3, p<0.001) with higher body mass index (27.4±4.3 vs. 25.0±4.2, p<0.001).Furthermore, higher E/Ea ratio (12.3±1.8vs. 10.0±2.3, p<0.001), lower average longitudinal strain (−16.6±2.0 vs. −17.6±1.7%, p<0.001) and higher left ventricular mass index (165.6±34.3 vs. 148.2±37.6, p<0.001) were present in the hypertensive group. Stepwise multivariate regression analysis revealed that LVMI and history of hypertension were independent predictors of the E/Ea ratio and peak systolic longitudinal strain.
Conclusions: Systemic hypertension commonly coexists with asymptomatic AS in the elderly. It significantly impacts on the development of LVH, and further contributes to the development of left ventricular diastolic dysfunction and subclinical systolic dysfunction (impaired longitudinal myocardial contraction).
- © 2010 by American Heart Association, Inc.