Augmentation index predicts mortality in patients with aortic stenosis: an echo-tracking study

Area of Science:

• Cardiovascular Medicine
• Vascular Biology
• Biomedical Engineering

Background:

• Aortic stenosis (AS) shares pathological similarities with atherosclerosis.
• The impact of large artery mechanical properties on outcomes in AS patients remains underexplored.
• Understanding arterial stiffness in AS is crucial for prognostic assessment.

Purpose of the Study:

• To investigate the relationship between carotid artery stiffness/compliance and AS severity.
• To determine if local arterial stiffness is an independent predictor of mortality in AS patients.
• To assess the prognostic value of arterial stiffness in moderate to severe AS with preserved left ventricular ejection fraction (LVEF).

Main Methods:

• 133 patients with moderate to severe isolated AS and preserved LVEF were enrolled.
• Transthoracic echocardiography and high-definition echo-tracking ultrasound were used for carotid stiffness evaluation.
• Parameters including augmentation index (AIx) were calculated to assess stiffness and compliance.

Main Results:

• No significant association was found between carotid stiffness parameters and AS severity.
• Higher carotid AIx was observed in patients who died during follow-up (p=0.028).
• Carotid AIx independently predicted mortality in multivariate analysis (HR 1.048, p=0.001), even after adjusting for age and creatinine.

Conclusions:

• Carotid augmentation index (AIx) is independently associated with mortality in severe AS patients with normal LVEF.
• Arterial stiffness, as indicated by AIx, serves as a significant prognostic marker in this population.
• These findings underscore the role of arterial stiffness in reflecting long-term atherosclerotic burden and predicting outcomes.