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. 2025 Jan 30;14(2):146.
doi: 10.3390/biology14020146.

Poor Sympathetic Compensation During Active Standing Increases the Risk of Morbidity-Mortality in the Post-Surgery of Patients with Severe Calcific Aortic Stenosis

Nydia Avila-Vanzzini  1 , Anayanci Santana-Ortiz  2 , Daniela Sánchez-Estrada  2 , Rashidi Springall  3 , Abel Lerma  1   4 , Héctor Herrera-Bello  5 , Martín Calderón-Juárez  6 , Claudia Lerma  1
Affiliations

Poor Sympathetic Compensation During Active Standing Increases the Risk of Morbidity-Mortality in the Post-Surgery of Patients with Severe Calcific Aortic Stenosis

Nydia Avila-Vanzzini et al. Biology (Basel). .

Abstract

(1) Background: Although all severe calcific aortic stenosis (SCAS) patients have decreased sympathetic compensation to active standing, it has not been studied in patients who underwent aortic valve replacement (AVR). The objective was to assess the association of the heart rate variability (HRV) response to an active orthostatic challenge before AVR with the risk of complications or death during the AVR postoperative period in patients with SCAS. (2) Methods: This observational study included 49 patients. The cardiac autonomic activity was assessed by HRV analysis during supine position and active standing (five minutes each). (3) Results: Twenty-four patients (48.9%) who presented outcomes (complication or death) had a greater left ventricular (LV) mass and a smaller magnitude of change during active standing in both the mean cardiac period and sympathetic predominance. Poor sympathetic compensation to active standing and LV mass were independently associated with the outcome odds ratio (OR) = 4.8 [(1.06, 21.8), p < 0.041] and 1.03 [(1.007, 1.062), p < 0.013], respectively. (4) Conclusions: In SCAS patients, poor sympathetic compensation in the face of orthostatic challenge and greater LV mass are associated with complications or death after AVR surgery. This approach offers an opportunity to find new criteria to reduce the surgical risk of these patients.

Keywords: aortic stenosis; aortic valve replacement; heart rate variability.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the study&rsquo;s design; the collection, analysis, or interpretation of data; the writing of the manuscript; or the decision to publish the results.

Figures

Figure 1
Figure 1
(A) Example of electrocardiogram recording with beat identification. Below is the RR interval with the trace where the previous electrocardiogram was taken, indicated by a gray rectangle. (B) Recorded RR intervals (over 20 min in length). In the first 10 min (supine position), the heart rate is lower, and the range of RR intervals is between 900 and 1100 ms. Starting at minute 10 (change to active standing), the heart rate is faster: RR intervals range between 700 and 900 ms. The blue rectangle marks the location of the measurement (a 5 min segment), and the red line inside shows the detrending line. Below is the detrended RR time series.
Figure 2
Figure 2
(A). Patient with sympathetic predominance in response to active standing. (B). Patient without sympathetic predominance in response to active standing. The red arrows indicate the change to an active standing position. The red lines indicate the limits of each selected interval in each position.
Figure 3
Figure 3
The proportion of patients with a sympathetic predominance (LF > 60 n.u) in the supine position and active standing as a function of the outcome (complications or death).
See this image and copyright information in PMC

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