Impact of valvular regurgitation on left ventricular geometry and function in hypertensive patients with left ventricular hypertrophy: the LIFE study

Abstract

Mild-to-moderate aortic and mitral regurgitation are frequently detected by echocardiogram in asymptomatic hypertensive patients. Our goal was to assess the prevalence and impact of mild-to-moderate mitral and/ or aortic regurgitation on left ventricular (LV) structure and function in patients with hypertension and LV hypertrophy (LVH). Hypertensive patients with ECG LVH enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy were evaluated. Among 939 patients with needed LV measurements and Doppler data, 242 had mild (1 þ ) valvular regurgitation, and 51 patients had moderate (2 þ or 3 þ ) regurgitation of one or both valves. In analyses adjusting for gender, patients with mild mitral and/or aortic regurgitation had larger LV internal dimensions (5.25 vs 5.33 cm, Po0.05), higher LV mass indexed for body surface area (122 vs 125 g/m 2 , Po0.05) or height 2.7 (55.4 vs 57.3, Po0.05), and larger left atrial diameter. Patients with moderate regurgitation of one or both valves had larger LV chambers (5.25 vs 5.9 cm, Po0.001), greater mean LV mass (232 vs 248 g, Po0.001) and LV mass indexed for body surface area or height 2.7 , and higher Doppler stroke volume. Patients with moderate valvular regurgitation also had a higher prevalence of LVH due to an increased prevalence of eccentric LVH. There were no differences among groups defined by the presence and severity of valvular regurgitation in cardiac output, total peripheral resistance, or pulse pressure/stroke volume, indicating that the observed inter-group differences in LV geometry were not due to differences in the haemodynamic severity of hypertension. Hypertensive patients with mild-to-moderate mitral or aortic valvular insufficiency have additional LV structural and functional changes that may affect prognosis.

Sex-specific hemodynamic and non-hemodynamic determinants of aortic root size in hypertensive subjects with left ventricular hypertrophy

“…Mild aortic regurgitation was identified on the basis of the extent of diastolic turbulent flow in the LV, indicated by a variance signal, by a jet occupying o20% of the aortic annular diameter at its origin and extending less than halfway to the tip of the anterior mitral leaflet. 16 All the recordings were made by the same physician, who was unaware of other data relating to the subjects. The reproducibility of both acquiring and measuring LV mass and AoR size was determined in recordings obtained from 10 subjects.…”

Cardiac surgery and hypertension: a dangerous association that must be well known

“…The coexistence of hypertension and valvular regurgitation may apparently lead to impaired left ventricular geometry and function. Patients with moderate valvular regurgitation had significantly higher circumferential end systolic wall stress and lower left ventricular contractility when compared to patients without valvular regurgitation [54].…”

“…Besides aortic valve disorder, mild-to-moderate mitral regurgitation was frequently detected on routine echocardiography in asymptomatic hypertensive patients [54]. Hypertension may impact on the transvalvular regurgitant blood flow by increasing systemic resistance.…”

Predictive value of von Willebrand factor for adverse clinical outcome in hypertensive patients with mild-to-moderate aortic regurgitation

“…8 Hypertensive patients with mild-tomoderate AR had additional left ventricular structural and functional changes that may lead to deteriorated prognosis. 9 Therefore, we hypothesized that hypertensive patients with mild-to-moderate AR may have enhanced endothelial and/or left ventricular dysfunctions, and therefore, would be predisposed to thromboembolic events or worsening of cardiorenal functions. However, the natural history of such patients has not been the focus of study.…”