Determinants of left ventricular mass in aortic stenosis.
OBJECTIVE
There are many possible determinants of left ventricular (LV) mass, including the angiotensin-converting enzyme (ACE) genotype, which have rarely been compared in aortic stenosis (AS). The study aim was to investigate these determinants in patients with all grades of AS.


METHODS
Transthoracic echocardiography and an analysis of ACE genotype was performed in 91 patients with aortic valve thickening and a peak aortic velocity >2.0 m/s.


RESULTS
Univariate relationships were identified between LV mass index and effective orifice area (R = 0.22), and peak transaortic pressure difference (R = 0.36). LV mass index was similar for the ACE-II (152+/-37 g/m2), ACE-ID (145+/-46 g/m2) and ACE-DD (161+/-56 g/m2) genotypes. LV mass index was significantly greater in males (162+/-52 gm/m2) than in females (137+/-38 gm/m2; p = 0.014). The multivariate determinants varied according to the grade of AS: diastolic blood pressure (p = 0.028) in mild stenosis; peak transaortic pressure difference (p = 0.03) in moderate stenosis; and peak transaortic pressure difference (p <0.0001) and gender (p = 0.02) in severe stenosis. LV hypertrophy was present in 15 of 24 patients (63%) with mild AS, in 21 of 27 (78%) with moderate AS, and 32 of 40 (80%) with severe AS.


CONCLUSIONS
LV hypertrophy is common, even in mild AS, when it is independently related only to the systemic blood pressure. This suggests that antihypertensive agents should be considered early in the natural history of AS.
Chambers
John
J
Valve Study Group, Guy's and St Thomas' Hospitals, London, UK. jboydchambers@aol.com
Takeda
Scott
S
Rimington
Helen
H
Lambert-Hammill
Michelle
M
Shetty
Chandrasekhar
C
Wierzbicki
Anthony
A
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001024:Aortic Valve Stenosis / Q000235:genetics / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology; D004452:Echocardiography; D005260:Female; D005838:Genotype; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000235:genetics / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D007703:Peptidyl-Dipeptidase A / Q000235:genetics; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D012737:Sex Factors
D000959:Antihypertensive Agents; D007703:Peptidyl-Dipeptidase A