P835Left ventricular function in renovascular hypertension after revascularization: comparison with essential hypertension


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Abstract

Background: In patients (pts) with renovascular hypertension (HTN) left ventricular hypertrophy (LVH) and diastolic dysfunction are predictors of cardiovascular events. Effective renal artery revascularization was associated with a reduction of LV mass and improvement in blood pressure control. We hypothesized that even after effective revascularization, impairment of LV function is worse in pts with renovascular HTN compared to pts with essential HTN (HTNE).Purpose. To compare LV function in hypertensive pts who underwent effective percutaneous renal angioplasty (PTRA) versus age matched pts with HTNE and similar LV mass.Methods: Forty hypertensive pts with normal LV ejection fraction who underwent PTRA were consecutively selected from our database. Patients with documented coronary artery disease, more than mild valvular stenosis or regurgitation and non-sinus rhythm were excluded and the 14 remaining pts formed the PTRA group. Fourteen age matched pts with HTNE, normal ejection fraction and similar LV mass index formed the HTNE group. A comprehensive echocardiogram was performed in all. LV diastolic function was graded according to ASE/EAE recommendations. LV filling pressures were assessed using the average E/E' ratio. Left ventricular 2D strain parameters, rotation and torsion were assessed by STE using a 2D strain software (Echopac).Results. There were no significant differences between groups regarding age (51±11 vs 53±8), body surface area (1.8±0.1 vs 1.8±0.2 m2), systolic blood pressure (138±13 vs 138±29 mmHg), diastolic blood pressure (77±9 vs 79±14mmHg), indexed LV mass (114±41 vs 115±41g/m2)(p>0.30 for all). Parameters of LV systolic function were similar in both groups: LV volumes (49±8 vs 45±14ml/m2; 18±6 vs 18±8 ml/m2), LVEF (65±9 vs 60±7%), global longitudinal strain (-19±2% vs -21±3%), peak systolic torsion (3.9±1 vs 3.5±1°/cm)(p>0.07 for all). Indexed LA volume (44±13 vs 32±8 ml/m2, p=0.014) and average E/E' ratio were higher (9.9±3.4 vs 7.4±1.6, p=0.036) in pts with PTRA than in pts with HTNE. Pts with PTRA had more severe diastolic dysfunction (p=0.04).Conclusions: In pts with renovascular HTN who underwent effective PTRA, parameters of LV systolic function were not significantly different from those of age matched pts with HTNE and similar LV mass. However, LV diastolic function impairment was more severe in pts with renovascular HTN. Further studies are needed to establish if exposure to hyperactive renin-angiotensin-aldosterone system can explain this finding and to assess long-term effects of renal revascularization on survival and cardiac function.

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