Impacto da hipertensão arterial no remodelamento ventricular, em pacientes com estenose aórtica
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Data
2011-09-01
Autores
Hueb, João Carlos [UNESP]
Vicentini, João T. R. [UNESP]
Roscani, Meliza Goi [UNESP]
Fusco, Daniéliso [UNESP]
Mattos, Ricaro [UNESP]
Zanatti, Silméia Garcia [UNESP]
Okoshi, Katashi [UNESP]
Matsubara, Beatriz B. [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Sociedade Brasileira de Cardiologia (SBC)
Resumo
FUNDAMENTO: A hipertrofia ventricular esquerda (HVE) é comum em pacientes com hipertensão arterial sistêmica (HAS) e estenose aórtica (EAo) e, com certa frequência, encontramos associação entre estas patologias. Mas, em tal situação, não está clara a importância de cada uma na HVE. OBJETIVO: 1 - Avaliar em pacientes portadores de EAo, submetidos previamente a estudo ecocardiográfico, a magnitude da HVE, nos casos de EAo isolada e associada à HAS; 2 - Avaliar o padrão de remodelamento geométrico nas duas situações. MÉTODOS: Estudo retrospectivo, observacional e transversal, incluindo 298 pacientes consecutivos, com EAo ao ecocardiograma. HVE foi considerada para massa miocárdica > 224g em homens e > 162g em mulheres. Os pacientes foram classificados como portadores de EAo leve (gradiente máximo < 30,0 mmHg), moderada (entre 30 e 50,0 mmHg) e grave (> 50,0 mmHg), além disso, foram separados em dois subgrupos: com e sem HAS. RESULTADOS: Nos três níveis de lesão aórtica, a massa ventricular esquerda foi maior na EAo associada à HAS do que na EAo isolada (EAo leve: 172 ± 45 vs 223 ± 73g, p < 0,0001; EAo moderada: 189 ± 77 vs 245 ± 81g, p = 0,0313; EAo grave: 200 ± 62 vs 252 ± 88g, p = 0,0372). Presença de HAS esteve associada a maior risco de HVE (OR = 2,1,IC95%:1,2-3,6; p = 0,012). Pacientes com EAo grave e HAS apresentaram predomínio de hipertrofia concêntrica, quando comparados com aqueles normotensos (p = 0,013). CONCLUSÃO: em pacientes com EAo, a presença de HAS foi um fator adicional de aumento da massa ventricular esquerda, interferindo também na geometria ventricular.
BACKGROUND: Left ventricular hypertrophy (LVH) is a marker of increased cardiovascular risk and is frequently associated with both arterial hypertension (AH) and aortic stenosis (AoS). Also, these two maladies may co-exit in a same patient. However, in these cases, it is not clear the impact of each one in LVH. OBJECTIVE: To evaluate LVH and ventricular geometry in patients with AS associated or not with arterial hypertension. METHODS: This was a retrospective, observational and transversal study, including 298 consecutive patients with echocardiographic diagnosis of AoS. LVH was defined as myocardial mass > 224g for men and > 162g for women. Patients were classified as having mild (peak gradient < 30 mmHg), moderate (between 30 and 50 mmHg) or severe (> 50 mmHg) AoS and separated into two subgroups: with and without hypertension. RESULTS: AH was associated with increased ventricular mass in all three levels of aortic stenosis (mild AS: 172 ± 45g vs 223 ± 73g, p < 0.0001 moderate AoS: 189 ± 77 g vs 245 ± 81g, p = 0.0313 severe AoS: 200 ± 62g vs 252 ± 88g, p = 0.0372), and increased risk of LVH (OR = 2.1 CI95%:1.2-3.6 p = 0.012). Regarding to geometric remodeling, hypertensive patients with severe AS presented a significant increase in frequency of concentric hypertrophy, when compared with those without hypertension (p = 0.013). CONCLUSION: Hypertension is an additional factor of increased left ventricular mass in patients with AS. Also, hypertension was influential in ventricular geometry.
BACKGROUND: Left ventricular hypertrophy (LVH) is a marker of increased cardiovascular risk and is frequently associated with both arterial hypertension (AH) and aortic stenosis (AoS). Also, these two maladies may co-exit in a same patient. However, in these cases, it is not clear the impact of each one in LVH. OBJECTIVE: To evaluate LVH and ventricular geometry in patients with AS associated or not with arterial hypertension. METHODS: This was a retrospective, observational and transversal study, including 298 consecutive patients with echocardiographic diagnosis of AoS. LVH was defined as myocardial mass > 224g for men and > 162g for women. Patients were classified as having mild (peak gradient < 30 mmHg), moderate (between 30 and 50 mmHg) or severe (> 50 mmHg) AoS and separated into two subgroups: with and without hypertension. RESULTS: AH was associated with increased ventricular mass in all three levels of aortic stenosis (mild AS: 172 ± 45g vs 223 ± 73g, p < 0.0001 moderate AoS: 189 ± 77 g vs 245 ± 81g, p = 0.0313 severe AoS: 200 ± 62g vs 252 ± 88g, p = 0.0372), and increased risk of LVH (OR = 2.1 CI95%:1.2-3.6 p = 0.012). Regarding to geometric remodeling, hypertensive patients with severe AS presented a significant increase in frequency of concentric hypertrophy, when compared with those without hypertension (p = 0.013). CONCLUSION: Hypertension is an additional factor of increased left ventricular mass in patients with AS. Also, hypertension was influential in ventricular geometry.
Descrição
Palavras-chave
Estenose da valva aórtica, hipertrofia ventricular esquerda, hipertensão, insuficiência cardíaca, Aortic valve stenosis, hypertrophy, left ventricular, hypertension, heart failure
Como citar
Arquivos Brasileiros de Cardiologia. Sociedade Brasileira de Cardiologia - SBC, v. 97, n. 3, p. 254-259, 2011.