The impact of arterial hypertension on left ventricular strain in patients with aortic stenosis and preserved ejection fraction

Objective The influence of arterial hypertension on aortic stenosis severity is still controversial. The aim of this study was to evaluate the influence of hypertension on LV strain in patients with moderate and severe aortic stenosis. Methods This cross-sectional study included 115 patients with moderate and severe aortic stenosis and preserved LV ejection fraction (>50%) and 89 age-matched normotensive and hypertensive controls who underwent comprehensive echocardiographic examination. Aortic stenosis patients were divided into normotensive and hypertensive groups. Results There was no significant difference in LV ejection fraction between hypertensive and normotensive aortic stenosis patients. LV mass index gradually increased with the grade of aortic stenosis. LV global longitudinal strain, as well as endocardial and epicardial longitudinal strains, was significantly lower in hypertensive patients with severe aortic stenosis than in their normotensive counterparts. There was no significant difference in LV global circumferential strain between normotensive and hypertensive patients with severe aortic stenosis. Among patients with moderate aortic stenosis, there was no difference in global longitudinal strain between normotensives and hypertensive patients, whereas circumferential was significantly lower in hypertensive patients. LV radial strain was reduced in patients with severe aortic stenosis than in control subjects. SBP and mean aortic valve gradient were associated with LV global longitudinal and circumferential strains in aortic stenosis patients independently of LV mass index, LVEF, age and BMI. Conclusion Hypertension had additional significant negative influence on LV mechanics in patients with significant aortic stenosis. Blood pressure was associated with LV global longitudinal and circumferential strains in aortic stenosis patients independently of main clinical and demographic characteristics.