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. 2021 Mar 1;39(3):437-446.
doi: 10.1097/HJH.0000000000002648.

A novel method to assess valvulo-arterial load in patients with aortic valve stenosis

Sara L Hungerford  1   2   3 , Audrey I Adji  1   2   3   4 , Nicole K Bart  1   2   3 , Linda Lin  1 , Mayooran J Namasivayam  1   2   3 , Bruno Schnegg  1 , Andrew Jabbour  1   2   3 , Michael F O'Rourke  1   2   3 , Christopher S Hayward  1   2   3 , David W M Muller  1   2   3
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A novel method to assess valvulo-arterial load in patients with aortic valve stenosis

Sara L Hungerford et al. J Hypertens. .

Abstract

Introduction: Ventricular function in elderly patients with aortic stenosis is impeded both by restricted aortic flow and arterial stiffening. A number of patients continue to have exertional intolerance after relief of aortic valvular obstruction due to unrecognized ventriculo-arterial coupling mismatch.

Hypothesis: Quantification of valvulo-arterial load (VAL), using a simultaneous applanation tonometry/cardiac magnetic resonance (CMR) technique, can accurately assess the relative contributions of aortic stiffness and valve gradient in older patients with aortic stenosis.

Methods: Elderly patients with aortic stenosis underwent a simultaneous applanation tonometry/CMR protocol. CMR provided left ventricular volume and aortic flow simultaneously with radial applanation tonometry pressure acquisition. Central aortic pressure was derived by transformation of the radial applanation tonometry waveform. VAL was determined as the relationship of derived aortic pressure to CMR aortic flow in frequency domain (central illustration).

Results: Twenty patients (age 80 ± 9 years; 12 males; blood pressure 140/75 ± 20 mmHg) with aortic stenosis on transthoracic echocardiogram (16 severe; mean gradient 45 ± 16 mmHg; aortic valve area 0.8 ± 0.2 cm2) were enrolled. Derived aortic pressure and flow waveforms correlated well with invasive data. Increased VAL was significantly associated with advanced age (P = 0.04) and raised SBP (P < 0.01), irrespective of aortic stenosis severity.

Conclusion: Difficulties in the measurement and accuracy of ventriculo-arterial coupling means that it is not routinely measured in patients with aortic stenosis. We describe a new noninvasive index that provides an accurate assessment of valvular and arterial load on the left ventricle. VAL may help detect those at risk of ventriculo-arterial coupling mismatch and assist in selection of those most likely to benefit from an invasive procedure.

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References

    1. Katsanos S, Yiu KH, Clavel MA, Rodes-Cabau J, Leong D, van der Kley F, et al. Impact of valvuloarterial impedance on 2-year outcome of patients undergoing transcatheter aortic valve implantation. J Am Soc Echocardiogr 2013; 26:691–698.
    1. Dumesnil JG, Pibarot P. The obesity paradox in aortic stenosis: to be or not to be. J Am Coll Cardiol 2013; 62:1691–1693.
    1. Briand M, Dumesnil JG, Kadem L, Tongue AG, Rieu R, Garcia D, et al. Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment. J Am Coll Cardiol 2005; 46:291–298.
    1. Hachicha Z, Dumesnil JG, Pibarot P. Usefulness of the valvuloarterial impedance to predict adverse outcome in asymptomatic aortic stenosis. J Am Coll Cardiol 2009; 54:1003–1011.
    1. Lancellotti P, Donal E, Magne J, Moonen M, O’Connor K, Daubert JC, et al. Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay. Heart 2010; 96:1364–1371.

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