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Arterial Stiffness in Aortic Stenosis and the Impact of Aortic Valve Replacement
Oscar Plunde1,2, Magnus Bäck1,2
1Translational Cardiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Insights
Arterial stiffness in aortic stenosis patients is often masked, impacting left ventricular load. Understanding this masked stiffness is crucial for accurate risk assessment and improved patient outcomes in aortic stenosis treatment.
Area of Science:
- Cardiology
- Vascular Physiology
Background:
- Aortic stenosis (AS) is a primary indication for interventional valve procedures.
- Heart failure in AS arises from increased left ventricular (LV) load, influenced by both stenosis severity and arterial stiffness.
- Valvulo-arterial impedance (Zva) quantifies combined load and predicts outcomes in AS.
Purpose of the Study:
- To review literature on assessing arterial stiffness in aortic stenosis.
- To explore how different measurement methods reveal or obscure masked arterial stiffness in AS.
- To discuss reasons for contradictory findings in previous studies.
Main Methods:
- Detailed literature review of studies assessing arterial stiffness in aortic stenosis patients.
- Analysis of various methods used to measure arterial stiffness.
- Examination of pre- and post-intervention data (surgical and transcatheter aortic valve replacement).
Main Results:
- Systemic arterial stiffness is paradoxically low in AS patients, increasing after valve replacement, suggesting masked stiffness.
- Existing studies on arterial stiffness in AS yield conflicting results due to methodological variations.
- Peripheral arterial segments may mask true arterial stiffness in AS.
Conclusions:
- Masked arterial stiffness in aortic stenosis requires careful consideration of measurement techniques.
- Methodological differences contribute to inconsistent findings in AS arterial stiffness research.
- A validated, non-invasive method for assessing arterial stiffness in AS could enhance pre-interventional risk stratification.
Abstract:
The most common cause for interventional valve treatment is aortic stenosis. A cardinal symptom of aortic stenosis is heart failure due to the increased load exerted on the left ventricle. However, the left ventricular load is not solely determined based on the degree of aortic stenosis but is also impacted by arterial stiffness. The combined load can be determined by valvulo-arterial impedance (Zva), which is associated with poor outcome in aortic stenosis. We recently demonstrated low measures of systemic arterial stiffness in patients with aortic stenosis, and that arterial stiffness was increased after surgical aortic valve replacement. The results indicated a masked arterial stiffness in aortic stenosis when using methods incorporating peripheral arterial segments. Available studies using several different methods to assess arterial stiffness in relatively small aortic stenosis cohorts examined before and after either surgical or transcatheter aortic valve replacement/intervention have generated contradictory results. In this commentary, we present a detailed literature review to explore how different methods and measures of arterial stiffness in aortic stenosis capture or not, a masked arterial stiffness in aortic stenosis and possible reasons for the observed results. Future studies validating a non-invasive reproducible method to assess arterial stiffness in aortic stenosis patients could potentially lead to an implementation in pre-interventional risk assessment for aortic stenosis.
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