Changes in Cardiac-Arterial Coupling After Cardiac Surgery for Aortic Valve Disease

Aortic valve disease affects vascular and cardiac remodeling and function, with changes observed after cardiac surgery. Ventricular-arterial coupling (VAC), which reflects the interaction between the left ventricle and the arterial system, may be altered by aortic valve replacement (AVR). Therefore, this study aimed to determine changes in VAC and atrial-arterial coupling (AAC) in patients with aortic valve disease before and after AVR.

A total of 41 patients (median age 67 years, interquartile range (IQR) 62-71) undergoing AVR, including 24 (58.5%) with aortic stenosis (AS), were evaluated before and early (3 days) after cardiac surgery. Left atrial reservoir strain (LARS) and left ventricular (LV) global longitudinal strain (GLS) were assessed by echocardiography. Carotid-femoral pulse wave velocity (cfPWV), brachial-ankle-PWV (baPWV), and cardio-ankle vascular index (CAVI) were measured. VAC and AAC were defined as ratios of arterial stiffness to cardiac strain (CAVI/GLS, CAVI/LARS, baPWV/GLS, baPWV/LARS, cfPWV/GLS, cfPWV/LARS).

Atrial and ventricular strain and arterial stiffness significantly worsened after surgery. Ventricular-arterial uncoupling was reflected by a substantial increase in arterial stiffness to LV strain ratios (p < 0.001 for each). Moreover, AAC, measured as CAVI/LARS or PWV/LARS, significantly increased after surgery, with p < 0.001 for CAVI/LARS and baPWV/GLS, and p = 0.035 for cfPWV/LARS.

Worsened ventricular-arterial uncoupling can be detected early after cardiac surgery using novel measures of VAC, including ratios of peripheral arterial stiffness to cardiac deformation. This study extends these findings by demonstrating atrial-arterial uncoupling, suggesting a generalized cardiac-arterial uncoupling after valve surgery.