Systemic Hypertension in Low-Gradient Severe Aortic Stenosis With Preserved Ejection Fraction

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Abstract
Background—: Low-gradient severe aortic stenosis with preserved ejection fraction is an increasingly recognized entity, and symptomatic patients may benefit from aortic valve replacement. However, systemic hypertension frequently coexists with low-gradient severe aortic stenosis, which itself may cause elevated left ventricular (LV) filling pressures with resultant symptoms of dyspnea. Methods and Results—: Symptomatic patients with hypertension (aortic systolic pressure >140 mm Hg) and low-gradient (mean gradient 2 ). All measures of afterload were reduced with nitroprusside ( P P 2 ; P =0.001) and mean gradient (27±5 to 29±6 mm Hg; P =0.02) increased with nitroprusside. Conclusions—: Systemic hypertension in low-gradient severe aortic stenosis with preserved ejection fraction is associated with elevated LV filling pressures and pulmonary hypertension. Treatment of hypertension with vasodilator therapy results in a lowering of the total LV afterload, with a decrease in LV filling pressures and pulmonary artery pressures. These findings have important implications for the management of patients with low-gradient severe aortic stenosis with preserved ejection fraction and hypertension.

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