Abstract
BackgroundCardiac function and myocardial strain are affected by cardiac afterload, which is in part due to the stiffness of the aortic wall. In this study, we hypothesize that aortic pulse wave velocity (PWV) as a marker of aortic stiffness correlates with conventional clinical and biochemical markers of cardiac function and perioperative myocardial strain in aortic valve replacement (AVR).MethodsPatients undergoing AVR for aortic stenosis between June 2010 and August 2012 were recruited for inclusion in this study. PWV, NYHA class and left ventricular (LV) function were assessed pre-operatively. PWV was analysed both as a continuous and dichotomous variable according to age-standardized reference values. B-type natriuretic peptide (BNP) was measured pre-operatively, and at 3 h and 18-24 h after cardiopulmonary bypass (CPB). NYHA class, leg edema, and LV function were recorded at follow-up (409 ± 159 days).ResultsFifty-six patients (16 females) with a mean age of 71 ± 8.4 years were included, with 50 (89%) patients completing follow-up. The NYHA class of PWV-norm patients was significantly lower than PWV-high patients both pre- and post-operatively. Multiple logistic regression also highlighted PWV-cut off as an independent predictor of NYHA class pre- and post-operatively (OR 8.3, 95%CI [2.27,33.33] and OR 14.44, 95%CI [1.49,139.31] respectively). No significant relationship was observed between PWV and either LV function or plasma BNP.ConclusionIn patients undergoing AVR for aortic stenosis, PWV is independently related to pre- and post-operative NYHA class but not to LV function or BNP. These findings provisionally support the use of perioperative PWV as a non-invasive marker of clinical functional status, which when used in conjunction with biomarkers of myocardial strain such as BNP, may provide a holistic functional assessment of patients undergoing aortic valve surgery. However, in order for PWV assessment to be translated into clinical practice and utilised as more than simply a research tool, further validation is required in the form of larger prospective studies specifically designed to assess the relationship between PWV and these functional clinical outcomes.
Highlights
Cardiac function and myocardial strain are affected by cardiac afterload, which is in part due to the stiffness of the aortic wall
This study aims to assess the relationship between aortic pulse wave velocity (PWV) and: (a) pre- and post- operative cardiac function assessed by NHYA class and echocardiography; (b) pre- and post- operative B-type natriuretic peptide (BNP) as a marker of myocardial strain; (c) the need for post-operative inotropes; and (d) the development of post-operative arrhythmia
There was no significant difference between the PWVnorm and PWV-high groups in terms of age, gender, severity of pre-operative aortic stenosis, classical hemodynamic measurements or other clinical characteristics (Table 1)
Summary
Cardiac function and myocardial strain are affected by cardiac afterload, which is in part due to the stiffness of the aortic wall. We hypothesize that aortic pulse wave velocity (PWV) as a marker of aortic stiffness correlates with conventional clinical and biochemical markers of cardiac function and perioperative myocardial strain in aortic valve replacement (AVR). Healthy, elastic aorta, radial expansion during systole acts as a volume and pressure reservoir (“cushioning effect”). This is possible because the aorta, proximally, is richer in elastin than the rest of the arterial tree [1,2,3]. This property is of particular importance for coronary perfusion after aortic valve closure. The absence of diastolic augmentation reduces coronary flow during diastole and widens the pulse pressure (PP) [1,4]
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