Influenceof transcutaneousaortic valveimplantationon aortic stiffness: Correlationwithimprovement in left ventricular function indices

Abstract

Background:Transcatheteraorticvalveimplantation(TAVI)isa treatmentoptionforelderly withsevereaorticstenosis(AS).SevereASinelderlyisassociatedwithincreasedaortic stiffness.Carotidfemoralpulsewavevelocity(CF-PWV)isrobustsurrogateofaorticstiffness. TheeffectsofTAVIonaorticstiffnessasmeasuredbyCF-PWVinelderlywithsevereASare notknown.Objective:StudytheeffectofTAVIinpatientswithsevereASonaorticstiffness andleftventricular(LV)functionandthecorrelationbetweenaorticstiffnessandLVfunction indicesbeforeandafterTAVI.PatientsandMethods:WemeasuredCF-PWVin36 consecutivepatientsbeforeand4-monthsafterTAVI.Results:Aorticvalveareaincreased(1.71

±0.34cm2vs.0.74±0.20cm2,p<0.001)andmeanbloodpressuregradientacrosstheaortic valve(10±4torrvs.48±19torr,p< 0.001)decreasedafterTAVI.CF-PWV(11.3(9.5,14.6) m/s)didnotsignificantlychangeafterTAVIcomparedtobaseline(10.5(9.6,14.5)m/s,p= 0.17.CF-PWVatbaselinecorrelatedwithheartrate(r=0.56,p<0.001),Aorticregurgitation grade(r=-0.38,p=0.022),strokevolumeindex(r=-0.40,p=0.031)andgradeofLVdiastolic dysfunction(r=0.49,p=0.008).Conclusion:Aorticstiffnessdidnotchangesignificantlyin elderlywithsevereASafterTAVI,possiblythedamageistooadvancedandirreversibleinthis patientgroup.Nevertheless,aorticstiffnessaddstothehemodynamicloadinthesepatientsand isassociatedwithbothworsenedsystolicanddiastolicperformance.

Keywords:TAVI,aortic stenosis,arterial stiffness, pulsed wavevelocity, leftventricularfunction