Patients with aortic valve sclerosis (AVS) have an increased risk of cardiovascular events. Patients with atherosclerotic renal artery stenosis (RAS) develop resistant hypertension and heart failure. We hypothesized AVS may be copresent with RAS in hypertensive patients.

Hypertensive patients with AVS (n = 167) underwent magnetic resonance (MR) angiography using nonenhanced steady-state free precession (SSFP) technique.

More than 75% luminal narrowing in the proximal region of main renal artery was regarded as significant RAS. Peak aortic jet velocity was obtained by Doppler echocardiography.

We measured brain natriuretic peptide (BNP), and estimated glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease equation.

• Unilateral or bilateral RAS was detected in 40 patients. AVS patients with RAS were older (78 ± 6 vs. 74 ± 8 years), and had higher levels of aortic jet velocity (162 ± 4 vs. 144 ± 3 cm/s), and lower levels of GFR (55 ± 13 vs. 62 ± 14 ml/min/1.73 m²) than those without RAS.
• Higher aortic jet velocity (odds ratio (OR) = 1.58, 95% confidence interval (CI) = 1.09–2.31) and lower GFR (OR = 0.54, 95% CI = 0.33–0.38) were associated with the presence of RAS, after being adjusted for age, systolic blood pressure, and BNP.

RAS was detected in hypertensive patients with AVS, particularly in patients with higher aortic jet velocity and lower GFR. Higher aortic jet velocity and lower GRF may be useful as a potential indicator for those needing assessment of RAS for risk stratification and deserves further study.

American Journal of Hypertension 2010; doi:10.1038/ajh.2009.222

aortic valve sclerosis, blood pressure, hypertension, MR renal angiography, renal artery stenosis

Aortic valve sclerosis (AVS) is associated with an increased risk of cardiovascular events in hypertensive patients with left ventricular hypertrophy,¹ and in the elderly general population,² in spite of its hemodynamically nonsignificant valvular lesion. The precise mechanism of this adverse outcome is not fully known; however, AVS may serve as a surrogate marker either for underlying atherosclerosis or some generalized systemic process, such as inflammation.³

Atherosclerotic renal artery stenosis (RAS) is prevalent in the elderly and in the hypertensive population, and develop resistant hypertension, ischemic nephropathy, and heart failure.⁴ The major cause of mortality in patients with RAS is cardiovascular diseases.⁴ Several clinical studies indicated RAS had relationships with systemic atherosclerosis, including coronary artery, peripheral artery, and carotid artery diseases.⁵ Both AVS and RAS share the common risk factors for their pathogenesis such as hypertension, activation of renin–angiotensin system and chronic inflammation.^5,6 These findings have led us to speculate that AVS may copresent with RAS in hypertensive patients, however, the association between these comorbidities have not been fully evaluated.

To test the hypothesis that AVS may be associated with RAS in hypertensive patients, we performed magnetic resonance (MR) angiography of renal artery and echocardiography in 167 medically treated hypertensive patients with AVS. We used MR angiography using nonenhanced three-dimensional steady-state free precession (SSFP) technique. This technique has been recently validated as having potential for the depiction of RAS without the need for contrast material.⁷

Masato Iida¹, Hisatosi Maeda², Mitsuru Yamamoto¹, Masatoshi Yamazaki¹, Haruo Honjo³, Itsuo Kodama³ and Kaichiro Kamiya³

1. ¹Department of Cardiology, Mitsubishi Nagoya Hospital, Nagoya, Japan
2. ²Department of Radiology, Mitsubishi Nagoya Hospital, Nagoya, Japan
3. ³Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan

Correspondence: Masato Iida, (masato2_iida@mhi.co.jp)

Received 21 July 2009; First Decision 29 August 2009; Accepted 26 October 2009; Published online 26 November 2009.