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Pulse Wave Morphology Changes in Aortic Valve Stenosis Detected with Cardio-Ankle Vascular Index
Oscar Plunde1,2, Anders Franco-Cereceda3,4, Magnus Bäck1,4
1Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Insights
Cardio-ankle vascular index (CAVI) measures arterial stiffness. Following aortic valve replacement, CAVI increased, and pulse wave morphology changed, suggesting new insights for aortic stenosis assessment.
Area of Science:
- Cardiovascular medicine
- Vascular physiology
Background:
- Cardio-ankle vascular index (CAVI) quantifies systemic arterial stiffness.
- CAVI has been observed to increase post-aortic valve surgery.
- Changes in CAVI-derived pulse wave morphology following surgery remain under-explored.
Observation:
- A case study involved a 72-year-old female with severe aortic stenosis undergoing surgical aortic valve replacement.
- Pre-operative CAVI was 4.7, increasing to 9.35 post-surgery.
- Systolic upstroke pulse morphology shifted from flattened to a steeper pattern.
Findings:
- Aortic valve replacement for stenosis led to a significant increase in CAVI.
- Pulse wave morphology, specifically the systolic upstroke slope, demonstrated a notable change post-surgery.
- These findings correlate increased arterial stiffness with altered pulse wave characteristics.
Implications:
- The observed changes in CAVI and pulse wave morphology may offer new avenues for screening aortic valve stenosis.
- This could enhance the clinical utility of CAVI in managing patients with aortic valve disease.
- Further research is warranted to validate these findings in larger cohorts.
Background:
Cardio-ankle vascular index (CAV) is a measure of systemic arterial stiffness and has been shown to increase after aortic valve surgery. However, change in CAVI-derived pulse wave morphology has not previously been addressed.
Case Study:
A 72-year-old female was transferred to a large center for heart valve interventions for evaluation of her aortic stenosis. Few co-morbidities were detected on medical history, other than previous radiation treatment for breast cancer, and no signs of other concomitant cardiovascular disease. The patient was accepted for surgical aortic valve replacement due to severe aortic valve stenosis and arterial stiffness was assessed with CAVI, as part of an ongoing clinical study. The pre-operative CAVI was 4.7 which after surgery increased almost 100% to 9.35. In tandem, the slope of systolic upstroke pulse morphology captured from brachial cuffs was changed from a prolonged flattened pattern to a steeper.
Conclusion:
After aortic valve replacement surgery due to aortic valve stenosis, in addition to increased CAVI-derived measures of arterial stiffness, the slope of the CAVI-derived upstroke pulse wave morphology changes to a steeper slope. This finding could have implications in the future of aortic valve stenosis screening and utilization of CAVI.
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