Impact of hypertension on left ventricular hypertrophy regression and exercise capacity in patients operated for aortic valve stenosis.

OBJECTIVES: To assess the influence of concomitant hypertension on left ventricular hypertrophy regression and exercise capacity in patients operated for aortic stenosis.

DESIGN: We performed echocardiography 1 week, 6- and 18-month postoperatively in 78 patients, aged 70 (28-86) years, who received Medtronic Hall (33), Biocor (8), Carpentier-Edwards S.A.V. (14) and Freestyle (23) prosthetic valves for severe aortic stenosis. Forty nine patients participated in treadmill tests with ergospirometry at the 6- and 18-month visits.

RESULTS: Left ventricular mass index was comparably reduced in normotensive and hypertensive patients (34 vs. 40 g/m2 after 6 months, and 43 vs. 46 g/m2 after 18 months, ns). In multiple regression analysis, adjusting for baseline left ventricular mass index, larger reduction in left ventricular mass index was associated with younger age and having a Freestyle prosthesis, but not with gender or history of hypertension (multiple R2=0.68, p < 0.05). Exercise capacity assessed as peak oxygen uptake increased from early to late evaluation in normotensive patients (VO2max 24.27 vs. 27.08 ml/kg/min, p < 0.05) while remained unchanged in hypertensive patients (VO2max 22.2 vs. 21.1 ml/kg/min). In multiple regression analysis, higher improvement in exercise capacity was predicted by male gender, younger age and absence of hypertension, while no independent association was found with Freestyle prosthesis (multiple R2 = 0.37, p < 0.05).

CONCLUSIONS: In patients operated for aortic stenosis, concomitant hypertension is associated with lack of improvement in exercise capacity in spite of early left ventricular hypertrophy reduction comparable to what is found in normotensive patients.