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Arterial Properties and Ventricular-Arterial Interactions in Severe Aortic Stenosis: Impact on Prognosis
Edward R Horton1,2, Bryce V Johnson1,2, Mahesh Vidula1,2
1Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
In severe aortic stenosis, pressure-dependent arterial compliance predicts adverse outcomes like death and heart failure hospital admission. Traditional measures of pulsatile arterial load do not show this predictive power.
Area of Science:
- Cardiology
- Biomedical Engineering
- Vascular Physiology
Background:
- Systemic arterial properties significantly impact clinical outcomes in degenerative calcific aortic stenosis (AS).
- Previous studies linked lumped afterload parameters to adverse left ventricular remodeling and mortality in AS patients.
- Assessing pulsatile aortic pressure-flow relations, the gold standard for arterial load, was limited in prior research.
Purpose of the Study:
- To investigate the prognostic value of pressure-dependent arterial compliance in severe AS.
- To compare the predictive capabilities of pressure-dependent arterial compliance versus traditional pulsatile arterial load measures.
- To understand how arterial properties influence outcomes in patients with severe AS.
Main Methods:
- Retrospective study of 135 severe AS patients with simultaneous catheterization and echocardiogram.
- Utilized invasive aortic pressures and echocardiographic flow to assess pressure-flow and pressure-volume relations via Windkessel modeling and wave separation analyses.
- Employed Cox regression to determine the relationship between pulsatile load and time to death and heart failure hospital admission (DHFA).
Main Results:
- Total arterial compliance, adjusted for pressure dependence, independently predicted all-cause mortality (HR=0.80) and DHFA (HR=0.70).
- These associations remained significant after adjusting for demographic factors and comorbidities.
- Traditional pulsatile arterial parameters did not show independent predictive value for adverse outcomes.
Conclusions:
- Pressure-dependent arterial compliance is a significant predictor of adverse outcomes in severe AS.
- Traditional measures of pulsatile arterial load are less effective in predicting prognosis in this population.
- Accounting for pressure load on the arterial wall offers advantages for outcome prediction in AS patients, especially those with low mean pressure due to stenosis or ventricular dysfunction.
Background:
Systemic arterial properties contribute to clinical heterogeneity and outcomes in degenerative calcific aortic stenosis (AS). Lumped parameters of afterload have previously been associated with adverse left ventricular remodeling, mortality, and poor exercise tolerance in this population, but most studies did not assess pulsatile aortic pressure-flow relations, the gold standard method for assessing arterial load. Moreover, arterial compliance is highly dependent on nonpulsatile (mean) arterial pressure, which influences prognosis in this population.
Methods:
We retrospectively studied 135 patients with severe AS with same-day catheterization and echocardiogram. Invasive aortic pressures and echocardiographic flow waveforms were used to assess pressure-flow and pressure-volume relations using Windkessel modeling and wave separation analyses. We used Cox regression to assess the relationship between pulsatile load and time to death and heart failure hospital admission (DHFA).
Results:
Total arterial compliance accounting for pressure dependence was independently predictive of all-cause mortality (Hazard Ratio (HR) = 0.80, 95% confidence interval [CI] = 0.66-0.97; P = 0.023) and DHFA (HR = 0.70; 95% CI = 0.50-0.97; P = 0.031) even after adjustment for age, race, gender, body mass index, and comorbidities, whereas other arterial parameters were not.
Conclusions:
In patients with severe AS, pressure-dependent arterial compliance predicts adverse outcomes, whereas traditional pulsatile arterial load measures do not. Our findings suggest that methods accounting for pressure load on the arterial wall are advantageous in this population in which lower mean pressure can result from severe stenosis and ventricular dysfunction.
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