Abstract
Background and objectives: Endothelial dysfunction is associated with exercise intolerance and adverse cardiovascular events. Transcatheter aortic valve implantation (TAVI) is applied to treat elderly patients with severe aortic stenosis, but less is known about the impact of TAVI on endothelial dysfunction, which can be assessed by measuring flow-mediated vasodilation (FMD). In this parameter, a low value indicates impaired endothelial function. Materials and Methods: Vascular endothelial function was evaluated by FMD of the brachial artery just before and one week after TAVI. Factors associated with the normalization of FMD and their prognostic impact were investigated. Results: Fifty-one patients who underwent TAVI procedure (median 86 years old, 12 men) were included. FMD improved significantly from baseline to one week following TAVI (from 5.3% [3.7%, 6.7%] to 6.3% [4.7%, 8.1%], p < 0.001). Among 33 patients with baseline low FMD (≤6.0%), FMD normalized up to >6.0% following TAVI in 15 patients. Baseline higher cardiac index was independently associated with normalization of FMD following TAVI (odds ratio 11.8, 95% confidence interval 1.12–124; p < 0.04). Conclusions: Endothelial dysfunction improved following TAVI in many patients with severe aortic stenosis. The implication of this finding is the next concern.
Highlights
Severe aortic stenosis (AS) is associated with limited cardiac output, impaired functional capacity, and poor outcomes [1]
Patients who were admitted to our institute to receive Transcatheter aortic valve implantation (TAVI) between June 2015 and January 2019 were included in this prospective study
Vascular endothelial function was evaluated by flow-mediated vasodilatation (FMD) of the brachial artery just before and one week after TAVI
Summary
Severe aortic stenosis (AS) is associated with limited cardiac output, impaired functional capacity, and poor outcomes [1]. Transcatheter aortic valve implantation (TAVI) has demonstrated greater clinical outcomes than surgical aortic valve replacement (SAVR), and it has become realistic to treat elderly patients with AS far [2]. Compared to SAVR, TAVI is less invasive because it does not require thoracotomy and cardiopulmonary bypass and can preserve patients’ daily living activities. Vascular endothelial dysfunction develops early in the pre-stage of arteriosclerosis and its assessment is practical for the early detection of arteriosclerosis. One of the major indices of vascular endothelial function is flow-mediated vasodilatation (FMD). FMD consists of (1) increased blood flow after the release of ischemia due to cuff release,
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