P810The additional impact of systemic hypertension on left heart structure and function in patients with mild and moderate aortic stenosis

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Purpose: The aim of this study was to determine the additional effect of systemic hypertension on left ventricular (LV) and left atrial function in patients with insignificant aortic stenosis.Methods: 1109 patients were examined with Doppler echocardiography between 2005–2010 at Umeå University hospital and Skellefteå hospital. 79/1109 patients with a mean age of 73,7 ± 11,1 years were considered as having insignificant aortic stenosis, 62 patients with additional treated hypertension (Group I) and the remaining 17 patients without hypertension (Group II). There was no significant age or gender difference. None of these patients had coronary heart disease, more than mild valve disease, heart failure, pulmonary hypertension, previous cardiac intervention or other conditions which could affect LV or left atrial function. Clinical data and conventional echocardiographic measurements of cardiac structure and function were obtained.Results: The two patient groups had similar degree of aortic stenosis; peak pressure gradient 33 ± 9 mmHg in Group I and 33 ± 10 mmHg in Group II (p=0,9) and LV ejection fraction was not different between the two groups. Group I patients had significant structural and functional LV disturbances compared with group II: end-systolic diameter was smaller (27 ± 5 vs. 31 ± 7 mm, p=0,01) and basal septal segment thicker (13,3 ± 1,9 vs. 11,4 ± 1,7 mm, p=0,001). Furthermore, Group I patients had worse diastolic dysfunction with lower E/A (0,9 ± 0,2 vs. 1,1 ± 0,5, p=0,002). There was a tendency for larger left atrial diameter in Group I patients (40 ± 5 vs. 37 ± 6 mm, p=0,078) compared with Group II.Conclusion: Patients with insignificant aortic stenosis and additional hypertension had more structural and functional left ventricular abnormalities compared to those with isolated aortic stenosis. Thus, even in insignificant aortic stenosis, additional increase in afterload by systemic hypertension should be factored for in the management strategy in order to preserve left ventricular function.

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