title: Load independent impairment of reverse remodeling after valve replacement in hypertensive aortic stenosis patients.
abstract: BACKGROUND
  We evaluated the impact of hypertension on the left ventricular mass regression in aortic stenosis after aortic valve replacement.
  
  
  METHODS
  We prospectively studied 135 patients with severe aortic stenosis at baseline and 1 year after surgery. In 32 patients we analyzed myocardial gene expression of collagen types I and III, connective tissue growth factor, transforming growth factor-β1, metalloproteinase-2 and its tissue inhibitor and compared its levels vs controls.
  
  
  RESULTS
  Seventy-six patients (56.3%) had a history of hypertension. Hypertensive patients were older, had higher Euroscore-II and NYHA class, with no differences in stenosis severity. At 1 year follow-up there was a median decrease of mass index of 14.2% (P25-75: -4.3%-30.4%; p<0.001). Mass regression was significantly higher in patients without hypertension, with a median decrease of 25.9% (P25-75: 12.0%-38.7%) vs 5.4% (P25-75: -12.5%-20.1%; p=0.001), despite similar increase in effective orifice area and no differences in valvuloarterial impedance. After 1 year, higher baseline left ventricular mass index (p=0.005) and the absence of hypertension (p=0.002) or diabetes (p=0.041) were the only independent predictors of mass regression higher than the median. Comparing with controls, aortic stenosis patients had an increased expression of collagen types I and III, but only hypertensive patients had higher relative expression of collagen type I vs III. In hypertensive patients TIMP2 expression was up-regulated and correlated with higher baseline left ventricular mass index (r=0.61; p=0.020).
  
  
  CONCLUSIONS
  In aortic stenosis, hypertension impairs mass regression one year after valve replacement, independently of total afterload. Differences in the expression of extracellular matrix remodeling genes might contribute to this finding.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Porto, Portugal. Electronic address: cristina.gavina@gmail.com.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gavina
authors.affiliation: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal.
authors.forename: Inês
authors.initials: I
authors.lastname: Falcão-Pires
authors.affiliation: Cardiology, Centro Hospitalar São João, Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Rodrigues
authors.affiliation: Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Benjamim
authors.initials: B
authors.lastname: Marinho
authors.affiliation: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal.
authors.forename: Nadia
authors.initials: N
authors.lastname: Gonçalves
authors.affiliation: Cardiology, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Lopes
authors.affiliation: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal; Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Mário Jorge
authors.initials: MJ
authors.lastname: Amorim
authors.affiliation: Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Almeida
authors.affiliation: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal; Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Pinho
authors.affiliation: Cardiology, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gonçalves
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Porto, Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Rocha-Gonçalves
authors.affiliation: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal; Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Adelino
authors.initials: A
authors.lastname: Leite-Moreira
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery*; D024042:Collagen Type I / Q000235:genetics; D024061:Collagen Type III / Q000235:genetics; D055513:Connective Tissue Growth Factor / Q000235:genetics; D005109:Extracellular Matrix / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D015870:Gene Expression / Q000502:physiology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000235:genetics; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D053773:Transforming Growth Factor beta1 / Q000235:genetics; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000235:genetics / Q000502:physiology*
chemical_list: C526317:CCN2 protein, human; D024042:Collagen Type I; D024061:Collagen Type III; D053773:Transforming Growth Factor beta1; D055513:Connective Tissue Growth Factor; D020778:Matrix Metalloproteinase 2
keywords: Aortic stenosis; Aortic valve replacement; Extracellular matrix; Hypertension; Left ventricular mass; Reverse remodeling