Exercise-induced brachial-ankle pulse wave velocity changes before and after transcatheter aortic valve replacement

Area of Science:

• Cardiovascular Medicine
• Vascular Physiology
• Interventional Cardiology

Background:

• Elevated arterial stiffness is a significant cardiovascular risk factor.
• Brachial-ankle pulse wave velocity (baPWV) quantifies arterial stiffness and is influenced by vascular endothelial function.
• Transcatheter aortic valve replacement (TAVR) is a treatment for severe aortic stenosis, and its impact on arterial stiffness, particularly under stress, requires further investigation.

Purpose of the Study:

• To evaluate changes in baPWV at rest and during exercise stress before and after TAVR.
• To assess the effect of TAVR on vascular endothelial function using a simple exercise stress test.

Main Methods:

• Forty patients with severe symptomatic aortic stenosis undergoing TAVR were enrolled.
• baPWV was measured at rest and immediately after a simple leg exercise protocol (plantar and dorsiflexion) at baseline and post-TAVR.
• Statistical analysis compared resting vs. post-exercise baPWV before and after TAVR.

Main Results:

• Resting and exercise stress baPWV significantly increased after TAVR.
• Before TAVR, post-exercise baPWV showed no significant change compared to resting baPWV.
• After TAVR, post-exercise baPWV significantly decreased compared to resting baPWV, indicating improved endothelial function.

Conclusions:

• TAVR acutely increases arterial stiffness, as evidenced by higher resting and exercise baPWV.
• Exercise stress testing after TAVR suggests preserved or improved vascular endothelial function, which was masked by the aortic stenosis before the procedure.