Aortic Stenosis, Aortic Regurgitation and Arterial Hypertension

Katsi, Vasiliki; Georgiopoulos, G; Oikonomou, D; Aggeli, Constadina; Grassos, Charalampos; Papadopoulos, Dimitris P.; Thomopoulos, Costas; Marketou, Maria; Dimitriadis, Kyriakos; Toutouzas, Kostas; Nihoyannopoulos, Petros; Tsioufis, Costas; Tousoulis, Dimitrios

doi:10.2174/1570161116666180101165306

Cited by 17 publications

(32 citation statements)

References 98 publications

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“…Perhaps common molecular mechanisms that are important for LV remodeling in AS and HT could provide an answer about this intriguing relationship. Growth‐stimulating signals such as angiotensin I and catecholamines produced in the hypertrophic LV and outside LV in AS and even more in HT might induce RV remodeling and functional deterioration in AS . The hemodynamic change is common for AS and HT—significant increase in afterload and well‐known activation of the renin‐angiotensin‐aldosterone system could also have an important role in further deterioration of RV function in AS patients.…”

Section: Discussionmentioning

confidence: 99%

“…Epidemiological studies demonstrated significant prevalence of arterial hypertension (HT) in AS patients, which reaches almost 80% in the older population . The impact of HT on AS severity assessment is still controversial . It is known that changes in blood pressure induce concomitant changes in transvalvular flow rate that results in over‐ or underestimation of AS severity.…”

Section: Introductionmentioning

confidence: 99%

“…It is known that changes in blood pressure induce concomitant changes in transvalvular flow rate that results in over‐ or underestimation of AS severity. The impact of HT on progression and prognosis in AS patients is also recognized . However, the effect of HT on already significantly changed and remodeled left ventricle is difficult to assess.…”

Section: Introductionmentioning

confidence: 99%

“…7 The impact of HT on AS severity assessment is still controversial. 8 It is known that changes in blood pressure induce concomitant changes in transvalvular flow rate that results in over-or underestimation of AS severity. The impact of HT on progression and prognosis in AS patients is also recognized.…”

mentioning

confidence: 99%

“…The impact of HT on progression and prognosis in AS patients is also recognized. 8 However, the effect of HT on already significantly changed and remodeled left ventricle is difficult to assess.…”

mentioning

confidence: 99%

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Right ventricular mechanics in patients with aortic stenosis and preserved ejection fraction: Is arterial hypertension a new player in the game?

Tadić

Cuspidi

Pencic

et al. 2019

J of Clinical Hypertension

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The purpose of this investigation was to evaluate the influence of aortic stenosis (AS) on right ventricular (RV) strain and particularly the importance of arterial hypertension on this association. This cross‐sectional study included 107 patients with moderate and severe AS (with and without hypertension) and preserved left ventricular ejection fraction (>50%) and 82 age‐matched normotensive and hypertensive controls who underwent comprehensive echocardiographic examination. AS patients were divided into normotensive and hypertensive groups. Left ventricle (LV) mass index gradually increased from the controls, across the moderate AS to the severe AS. There was a trend of reduction of RV global and layer‐specific longitudinal strain of the whole ventricle and RV free wall from the controls, across the moderate AS to the severe AS. RV global longitudinal strain, as well as layer‐specific RV longitudinal strains, was significantly lower in the patients with severe AS than the controls and the normotensive patients with moderate AS. Endocardial and epicardial RV strains were lower in hypertensive than in normotensive patients with moderate AS. In patients with severe AS, there was no difference between normotensive and hypertensive patients. LV mass index and mean aortic valve gradient were associated with RV global longitudinal strain in AS patients independently of systolic blood pressure, LV ejection fraction (EF), age, and body mass index (BMI). In conclusion, RV mechanics was deteriorated in the patients with moderate and severe AS. There was a trend of RV longitudinal strain worsening in the hypertensive patients with AS in comparison with their normotensive counterparts. Severity of AS, expressed by the mean AV gradient, was related with RV longitudinal strain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

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Right ventricular mechanics in patients with aortic stenosis and preserved ejection fraction: Is arterial hypertension a new player in the game?

Tadić

Cuspidi

Pencic

et al. 2019

J of Clinical Hypertension

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Additional Impact of Aortic Regurgitation on Left Ventricular Strain and Remodeling in Essential Hypertension Patients Evaluated Using MRI

Yan,

Yang,

et al. 2023

Magnetic Resonance Imaging

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BackgroundUnderstanding the impact of aortic regurgitation (AR) on hypertensive patients' hearts is important.PurposeTo assess left ventricular (LV) strain and structure in hypertensive patients and investigate the relationship with AR severity.Study TypeRetrospective.Population263 hypertensive patients (99 with AR) and 62 controls, with cardiac MRI data.Field Strength/SequenceBalanced steady‐state free precession (bSSFP) sequence at 3.0T.AssessmentAR was classified as mild, moderate, or severe based on echocardiographic findings. LV geometry was classified as normal, concentric remodeling, eccentric hypertrophy, or concentric hypertrophy based on MRI assessment of LV mass/volume ratio and LV Mass index (LVMI). LV global radial peak strain (GRPS), global circumferential peak strain (GCPS), and global longitudinal peak strain (GLPS) were obtained by post‐processing bSSFP cine datasets using commercial software.Statistical TestsANOVA, Kruskal–Wallis test, Spearman's correlation coefficients (r), chi‐square test, and multivariable linear regression analysis. A P value <0.05 was considered statistically significant.ResultsHypertensive patients with AR had significantly lower LV myocardial strain and higher LVMI than the group without AR (GRPS 26.25 ± 12.23 vs. 34.53 ± 9.85, GCPS −17.4 ± 5.84 vs. −20.57 ± 3.57, GLPS −9.86 ± 4.08 vs. −12.95 ± 2.94, LVMI 90.56 ± 38.56 vs.58.84 ± 17.55). Of the 99 patients with AR, 56 had mild AR, 26 had moderate AR and 17 had severe AR. The degree of AR was significantly negatively correlated to the absolute values of LV GRPS, GCPS and GLPS (r = −0.284 – −0.416). LV eccentric hypertrophy increased significantly with AR severity (no AR 21.3%, mild AR 42.9%, moderate AR 73.1%, severe AR 82.4%). In multivariable analysis, the degree of AR was an independent factor affecting LV global strain and LVMI even after considering confounding factors (β values for global myocardial strain were −0.431 to −0.484, for LVMI was 0.646).Data ConclusionIncreasing AR severity leads to decreased cardiac function and worse ventricular geometric phenotypes in hypertensive patients.Level of Evidence4Technical EfficacyStage 3

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On the Unique Functional Elasticity and Collagen Fiber Kinematics of Heart Valve Leaflets

Liao

Sacks

2018

Advances in Heart Valve Biomechanics

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Aortic Stenosis, Aortic Regurgitation and Arterial Hypertension

Abstract: Several lines of evidence support a detrimental association between HT and aortic valve disease. Therefore, HT should be promptly treated in aortic valvulopathy. Despite conventional wisdom, specific vasodilators can be used with caution in aortic stenosis.

Cited by 17 publications

References 98 publications

Right ventricular mechanics in patients with aortic stenosis and preserved ejection fraction: Is arterial hypertension a new player in the game?

Right ventricular mechanics in patients with aortic stenosis and preserved ejection fraction: Is arterial hypertension a new player in the game?

Additional Impact of Aortic Regurgitation on Left Ventricular Strain and Remodeling in Essential Hypertension Patients Evaluated Using MRI

On the Unique Functional Elasticity and Collagen Fiber Kinematics of Heart Valve Leaflets

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