Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Belgrade, Serbia.
Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
J Clin Hypertens (Greenwich). 2019 Apr;21(4):516-523. doi: 10.1111/jch.13513. Epub 2019 Mar 4.
The purpose of this investigation was to evaluate the influence of aortic stenosis (AS) on right ventricular (RV) strain and particularly the importance of arterial hypertension on this association. This cross-sectional study included 107 patients with moderate and severe AS (with and without hypertension) and preserved left ventricular ejection fraction (>50%) and 82 age-matched normotensive and hypertensive controls who underwent comprehensive echocardiographic examination. AS patients were divided into normotensive and hypertensive groups. Left ventricle (LV) mass index gradually increased from the controls, across the moderate AS to the severe AS. There was a trend of reduction of RV global and layer-specific longitudinal strain of the whole ventricle and RV free wall from the controls, across the moderate AS to the severe AS. RV global longitudinal strain, as well as layer-specific RV longitudinal strains, was significantly lower in the patients with severe AS than the controls and the normotensive patients with moderate AS. Endocardial and epicardial RV strains were lower in hypertensive than in normotensive patients with moderate AS. In patients with severe AS, there was no difference between normotensive and hypertensive patients. LV mass index and mean aortic valve gradient were associated with RV global longitudinal strain in AS patients independently of systolic blood pressure, LV ejection fraction (EF), age, and body mass index (BMI). In conclusion, RV mechanics was deteriorated in the patients with moderate and severe AS. There was a trend of RV longitudinal strain worsening in the hypertensive patients with AS in comparison with their normotensive counterparts. Severity of AS, expressed by the mean AV gradient, was related with RV longitudinal strain.
这项研究的目的是评估主动脉瓣狭窄（AS）对右心室（RV）应变的影响，特别是高血压对这种相关性的重要性。这项横断面研究纳入了 107 例中重度 AS（伴或不伴高血压）且左心室射血分数（EF）保留（>50%）的患者和 82 例年龄匹配的血压正常和高血压对照组，所有患者均接受了全面的超声心动图检查。AS 患者分为血压正常和高血压组。左心室（LV）质量指数逐渐从对照组，经过中度 AS 到重度 AS 增加。整个心室和 RV 游离壁的 RV 整体和层特异性纵向应变呈现出从对照组，经过中度 AS 到重度 AS 的趋势逐渐减少。与对照组和血压正常的中度 AS 患者相比，重度 AS 患者的 RV 整体纵向应变以及 RV 各层纵向应变明显更低。高血压患者的 RV 心内膜和心外膜应变比血压正常的中度 AS 患者更低。在重度 AS 患者中，血压正常和高血压患者之间没有差异。LV 质量指数和平均主动脉瓣梯度与 AS 患者的 RV 整体纵向应变独立于收缩压、LV EF、年龄和体重指数（BMI）相关。总之，中重度 AS 患者的 RV 力学受损。与血压正常的 AS 患者相比，高血压患者的 RV 纵向应变呈恶化趋势。平均 AV 梯度所表示的 AS 严重程度与 RV 纵向应变相关。
