Evaluating Arterial Stiffness in Aortic Stenosis

In an ageing population, degenerative aortic stenosis (AS) and elevated arterial stiffness frequently coexist, imposing a combined valvular and pulsatile arterial afterload on the left ventricle (LV). Since the significance of arterial stiffness in the setting of AS is becoming increasingly recognised, there is greater emphasis on accurately evaluating this pulsatile LV load in the presence of severe AS and predicting the arterial response post transcatheter aortic valve replacement (TAVR).

Studies examining arterial stiffness in AS and after TAVR have yielded conflicting results. This review aims to comprehensively evaluate measures of arterial stiffness and pulsatile LV including pulse-wave velocity (PWV), augmentation index (AIx), arterial stiffness index (ASi), and aortic characteristic impedance (Zc); summarises current evidence on their interplay with AS and identifies key knowledge gaps, particularly the limited incorporation of simultaneous flow assessment.

PWV remains the most useful prognostic marker but appears pressure-dependent. AIx is confounded by multiple factors including ejection duration and contractility, especially post-TAVR. Zc best isolates proximal pulsatile load and may better reflect persistent afterload after AS correction. Future studies to validate a non-invasive index for pulsatile arterial load in AS may help guide pre-TAVR risk assessment.