P706Blood pressure rise does not interfere with left ventricular mass index regression two years after aortic valve replacement for calcific stenosis with coronary artery disease


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Abstract

Purpose: Arterial hypertension is present and medically treated in two thirds of patients with severe aortic stenosis at the time of surgery. The interaction of hypertension with left ventricular mass regression after aortic valve replacement is still equivocal. We aimed to assess the association between blood pressure (BP) and left ventricular mass index (LVMI) changes in patients two years after surgery for calcific aortic stenosis with coronary artery disease.Methods: We prospectively enrolled 122 consecutive patients with symptomatic aortic stenosis, mean gradient 46±15 mmHg, with significant coronary artery disease. Of those, 103 underwent surgery and 89 completed the two-year follow-up. We divided the patients in two groups either with or without BP rise (BP+ vs. BP-, respectively) according to the casual BP change between the preoperative and final examination. We compared their preoperative and final clinical and echocardiographic characteristics, including the LVMI difference and antihypertensives use, and sought for independent predictors of LVMI regressionResults: In the whole sample, the systolic BP rose from 142±18 to 150±18 mmHg, the diastolic BP from 80±10 to 84±8, (p<0.001 for both), while the LVMI regressed from 150±38 to 123±27 g/m2 (p <0.001). The BP+ patients (n=51) were older than the BP- patients (n=38), 71±6 vs. 68±7 yrs, p=0.016, were more often women (46 vs. 24%, p=0.025), were less often treated by the ACE inhibitors 39 vs. 63%, p=0.025), but did not differ significantly in the initial LVMI and its rate of regression, nor in the number of nonfatal cardiovascular events (8 vs. 7). In the whole sample, only the preoperative LVMI correlated strongly with LVMI regression (r=0.7, p<0.001), while the age, sex, preoperative mean gradient, BP change, pulse pressure and effective orifice area index did not predict the LVMI regression.Conclusion: Despite increasing medication with ACE inhibitors the systolic and diastolic BP rose in more than half of patients after aortic valve replacement for calcific stenosis with coronary artery disease. However, this adverse trend did not interfere with LVMI regression at two years follow-up.

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