INVERSE RELATIONSHIP BETWEEN AORTIC ROOT DIAMETER AND RENAL FUNCTION IN HYPERTENSIVE SUBJECTS

Abstract

Introduction: Dilatation of aortic root is associated with presence and severity of aortic regurgitation and risk for aortic dissection. Recent studies performed in general population suggest that enlarged aortic root diameter (ARD) may predict cardiovascular events in absence of aneurysmatic alterations. Little is known about the influence of renal function on ARD. Aim: To assess the relationships between glomerular filtration rate (GFR) and ARD in hypertensive subjects. Methods: We enrolled 611 hypertensive individuals (mean age: 52 ± 15 years; men 63 %) consecutively attending our outpatient nephrology and hypertension unit. Patients on dialysis treatment, with valvulopathy more than mild, bicuspid aortic valve, previous cardiovascular events and genetic aortic diseases were excluded. All the subjects underwent echocardiography. ARD was measured at the level of Valsalva’s sinuses by M-mode tracings, under twodimensional control. In line with the PAMELA study, ARD, ARD indexed to body surface area (ARD/BSA) and to height (ARD/H) were considered increased when they exceeded 3.8 cm, 2.1 cm/m2, 2.3 cm/m in men and 3.4 cm, 2.2 cm/m2, 2.2 cm/m in women, respectively. GFR was estimated by the CKD-EPI equation. Results: Estimated GFR (eGFR) was lower in subjects with values of ARD, ARD/BSA and ARD/H above the sexspecific cut-offs when compared to those with normal aortic root size (all p\0.0001). eGFR correlated significantly with ARD (r = -0.17), ARD/BSA (r = -0.43) and ARD/H (r = -0.40; all p\0.001). The associations of eGFR with ARD/BSA (b = -0.23) and ARD/H (b = - 0.17; all p\0.001) held in linear multiple regression analyses, after adjustment for various confounding factors. Conclusions: Our study seems to suggest that a reduced renal function may adversely influence ARD. This may contribute to explain the enhanced cardiovascular risk associated with renal insufficiency.