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Gavina C, Falcão-Pires I, Rodrigues J, Marinho B, Gonçalves N, Lopes R, Amorim MJ, Almeida J, Pinho P, Gonçalves A, Rocha-Gonçalves F, Leite-Moreira A. Load independent impairment of reverse remodeling after valve replacement in hypertensive aortic stenosis patients. Int J Cardiol 2013; 170:324-30. [PMID: 24268509 DOI: 10.1016/j.ijcard.2013.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 08/16/2013] [Accepted: 11/02/2013] [Indexed: 11/26/2022]
Abstract
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 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. RESULTS Seventy-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). 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 genes might contribute to this finding.
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Affiliation(s)
- Cristina Gavina
- Department of Medicine, Faculty of Medicine, University of Porto, Portugal.
| | - Inês Falcão-Pires
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal
| | | | - Benjamim Marinho
- Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | - Nadia Gonçalves
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal
| | - Ricardo Lopes
- Cardiology, Centro Hospitalar São João, Porto, Portugal
| | - Mário Jorge Amorim
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal; Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | - Jorge Almeida
- Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | - Paulo Pinho
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal; Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | | | | | - Adelino Leite-Moreira
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal; Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
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