Abstract
Valvular and arterial function are tightly intertwined, both in terms of structural changes and hemodynamics. While proximal valvulo-vascular coupling contributes to the cardiovascular consequences of aortic stenosis, less is known on how peripheral arterial stiffness relates to aortic valve disease. Previous studies have shown conflicting results regarding the impact of aortic valve replacement on arterial stiffness. The aim of the present study was therefore to determine predictors of arterial stiffness in patients with and without aortic valve disease undergoing cardiac surgery. Cardio ankle vascular index (CAVI) and carotid femoral pulse wave velocity (cfPWV) were measured to determine arterial stiffness the day before and 3 days after surgery for either ascending aortic or aortic valve disease. Stratification on indication for surgery revealed that CAVI was significantly lower in patients with aortic valve stenosis (n = 45) and aortic valve regurgitation (n=30) compared with those with isolated ascending aortic dilatation (n = 13). After surgery, a significant increased CAVI was observed in aortic stenosis (median 1.34, IQR 0.74–2.26, p < 0.001) and regurgitation (median 1.04, IQR 0.01–1.49, p = 0.003) patients while cfPWV was not significantly changed. Age, diabetes, low body mass index, low pre-operative CAVI, as well as changes in ejection time were independently associated with increased CAVI after surgery. The results of the present study suggest aortic valve disease as cause of underestimation of arterial stiffness when including peripheral segments. We report cardiovascular risk factors and pinpoint the hemodynamic aspect ejection time to be associated with increased CAVI after aortic valve surgery.
Highlights
Aortic valve stenosis (AVS), characterized by fibrosis and calcification of the aortic valve is preceded by sclerosis (AVSc) without significant hemodynamic consequences
The different measures of arterial and aortic stiffness, cardio ankle vascular index (CAVI), brachial ankle pulse wave velocity and carotid femoral pulse wave velocity (cfPWV) were significantly associated with each other and between the preand post-operative measures (Supplementary Materials 2, 3)
Post-operative CAVI was associated with age, diabetes and hypertension and inversely with body mass index (BMI), and heart rate (HR) (Supplementary Material 2)
Summary
Aortic valve stenosis (AVS), characterized by fibrosis and calcification of the aortic valve is preceded by sclerosis (AVSc) without significant hemodynamic consequences. Other studies have generated inconsistent results with unchanged arterial function after AVR measured with, non-invasive augmentation index [12], ASi [13], and cMRI in TAVI patients [11]. In contrast to some of the above-mentioned methods, cfPWV is a direct, non-invasive and validated method to determine aortic stiffness. It includes the aorta and is based on the propagation of the pulse wave generated by the LV, in which a stiffer artery yields a faster pulse wave. Only 3 previous studies have determined cfPWV before and after AVR of which 2 indicated increased cfPWV [14, 15] after AVR and 1 suggested unchanged cfPWV [16]
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