Prognostic impact of arterial stiffness following transcatheter aortic valve replacement

• Published in: Journal of Cardiology Vol. 78; no. 1; pp. 37 - 43
• Main Authors: Tanaka, Tetsu, Asami, Masahiko, Yahagi, Kazuyuki, Ninomiya, Kai, Okuno, Taishi, Horiuchi, Yu, Komiyama, Kota, Tanaka, Jun, Yokozuka, Motoi, Miura, Sumio, Aoki, Jiro, Tanabe, Kengo
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.07.2021; Elsevier BV
• Subjects: Ankle Brachial Index; Aortic stenosis; Aortic Valve; Aortic Valve Stenosis; Arterial stiffness; Humans; Left ventricular afterload; Prognosis; Pulse Wave Analysis; Pulse wave velocity; Retrospective Studies; Risk Factors; Severity of Illness Index; Transcatheter Aortic Valve Replacement; Treatment Outcome; Vascular Stiffness; Ventricular Function, Left; Pulse wave velocity; Aortic stenosis; Arterial stiffness; Transcatheter aortic valve replacement; Left ventricular afterload
• ISSN: 0914-5087; 1876-4738; 1876-4738
• DOI: 10.1016/j.jjcc.2021.01.007

•Brachial-ankle pulse wave velocity (baPWV) is a marker of arterial stiffness.•Prognostic impact of baPWV after transcatheter aortic valve replacement is unknown.•High baPWV was associated with 1-year adverse clinical events.•In addition, high baPWV was associated with delayed left ventricular reverse remodeling.•Patients with increased arterial stiffness may need careful follow-up and management. Increased left ventricular (LV) afterload in patients with aortic stenosis consists of valvular and vascular loads; however, the effects of vascular load induced by arterial stiffness on clinical outcomes after transcatheter aortic valve replacement (TAVR) remain unclear. This study evaluated the prognostic value of brachial–ankle pulse wave velocity (baPWV) after TAVR. A retrospective study including 161 consecutive patients who underwent TAVR with a pre-procedural baPWV assessment was conducted. We investigated the association between baPWV and the 1-year composite outcome comprising all-cause death and rehospitalization related to heart failure. Echocardiographic measurements including the LV mass index (LVMi) and LV diastolic function at 1, 6, and 12 months after TAVR were assessed. Of the 161 patients, 31 patients experienced composite outcome within 1 year after TAVR. The receiver operating characteristic curve analysis revealed that the discriminating baPWV level to discern 1-year composite outcome was 1,639 cm/s, and all subjects were allocated to two groups based on the result. Baseline characteristics were comparable between the high baPWV (n = 72) and low baPWV groups (n = 89). The Kaplan–Meier curve revealed a significantly higher cumulative 1-year composite outcome in the high baPWV group than in the low baPWV group (31% vs. 10%; log-rank test, p<0.001). High baPWV was an independent predictor of the 1-year composite outcome (adjusted hazard ratio, 3.42; 95% confidence interval, 1.62–7.85; p = 0.002). Furthermore, post-procedural echocardiography revealed that the high baPWV group had less LVMi regression and higher E/e’ after TAVR compared to the low baPWV group. The delayed reversal in LVMi and diastolic function attributable to arterial stiffness might be linked to impaired clinical outcomes after TAVR. Higher baPWV could be associated with adverse clinical outcomes and delayed reverse LV remodeling after TAVR.