Ageing, hypertension and aortic valve stenosis – Understanding the series circuit using cardiac magnetic resonance and applanation tonometry

Hungerford, S.; Adji, Audrey; Bart, N.; Lin, Lian Yu; Song, Ning; Jabbour, Andrew; O’Rourke, Michael; Hayward, Christopher; Müller, D.

doi:10.1016/j.ijchy.2021.100087

Cited by 3 publications

(3 citation statements)

References 40 publications

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“…Characteristic age-related changes in aortic flow velocity, pressure waveform and vascular impedance now well described [11,14]. Stiffer, older vessels lead to a faster velocity of pressure pulse and earlier timing of reflected pulse wave from the periphery, augmenting central aortic systolic pressure and yielding a greater afterload on the heart [10,11]. Systemic vascular resistance is higher, while the systemic impedance phase typically shows similar values for the first harmonic at all ages, then increases for all age groups, crossing zero to positive values later in elderly patients and also those with AS (around 3-4 Hz).…”

Section: Effects Of Vascular Aging In Patients With Aortic Stenosismentioning

confidence: 86%

“…where |Z in | = |P|÷|Q| is the modulus and θ = (βϕ) is the phase of the impedance [10,11]. Both the steady-state and pulsatile load contribute to the total hydraulic load of the systemic circulation [12].…”

Section: Defining Hydraulic Load Of the Human Circulationmentioning

confidence: 99%

“…With aging, the central elastic aorta progressively dilates, elongates and becomes tortuous with stiffened, thickened walls [13]. Characteristic age-related changes in aortic flow velocity, pressure waveform and vascular impedance now well described [11,14]. Stiffer, older vessels lead to a faster velocity of pressure pulse and earlier timing of reflected pulse wave from the periphery, augmenting central aortic systolic pressure and yielding a greater afterload on the heart [10,11].…”

Section: Effects Of Vascular Aging In Patients With Aortic Stenosismentioning

confidence: 99%

See 2 more Smart Citations

Perspective Chapter: Evolution of Techniques to Assess Vascular Impedance in Patients with Aortic Stenosis

Hungerford¹,

Nayya²,

Hansen³

et al. 2022

Aortic Stenosis - Recent Advances, New Perspectives and Applications

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Aortic stenosis (AS) once was conceptualized as a mechanical problem with a fixed left ventricular (LV) afterload because of an obstructive valve. With time, there has been growing recognition that AS functions more like a series circuit, with important contributions from the ventricle through to the vasculature. Emerging evidence suggests that higher blood pressure and increased arterial stiffness, synonymous with vascular aging, increases global LV afterload in patients with AS. This in turn, has adverse consequences on quality-of-life measures and survival. Although traditional methods have emphasized measurement of the transvalvular pressure gradient, focusing on valvular hemodynamics alone may be inadequate. By definition, total vascular load of the human circulation includes both steady and pulsatile components. Steady load is best represented by the systemic vascular resistance whereas pulsatile load occurs because of wave reflections and vascular stiffness, and is often referred to as the valvulo-arterial impedance. In the following Review, we evaluate existing and upcoming methods to assess vascular load in patients with AS in order to better understand the effects of vascular aging on this insidious disease process.

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Section: Effects Of Vascular Aging In Patients With Aortic Stenosismentioning

confidence: 86%

Section: Defining Hydraulic Load Of the Human Circulationmentioning

confidence: 99%

Section: Effects Of Vascular Aging In Patients With Aortic Stenosismentioning

confidence: 99%

See 1 more Smart Citation

Perspective Chapter: Evolution of Techniques to Assess Vascular Impedance in Patients with Aortic Stenosis

Hungerford¹,

Nayya²,

Hansen³

et al. 2022

Aortic Stenosis - Recent Advances, New Perspectives and Applications

View full text Add to dashboard Cite

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Arterial biomarkers in the evaluation, management and prognosis of aortic stenosis

et al. 2021

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Degenerative aortic valve stenosis is the most common primary valve disease and a significant cause of cardiovascular morbidity and mortality. In an era when new techniques for the management of aortic stenosis are gaining ground, the understanding of this disease is more important than ever to optimize treatment. So far, the focus has been placed on the assessment of the valve itself. However, the role that the arterial system plays in the pathogenesis and natural history of the disease needs to be further elucidated. Arteriosclerosis, when it coexists with a stenotic valve, augments the load posed on the left ventricle contributing to greater impairment of cardiovascular function. Arterial stiffness, a well-established predictor for cardiovascular disease and all-cause mortality, could play a role in the prognosis and quality of life of this population. Several studies using a variety of indices to assess arterial stiffness have tried to address the potential utility of arterial function assessment in the case of aortic stenosis. Importantly, reliable data identify a prognostic role of arterial biomarkers in aortic stenosis and stress their possible use to optimize timing and method of treatment. This review aims at summarizing the existing knowledge on the interplay between the heart and the vessels in the presence of degenerative aortic stenosis, prior, upon and after interventional management. Further, it discusses the evidence supporting the potential clinical application of arterial biomarkers for the assessment of progression, severity, management and prognosis of aortic stenosis.

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Interpretation of the central aortic pressure waveform in elderly patients with aortic stenosis

Hungerford

Adji

Kapur

2023

American Journal of Physiology-Heart and Circulatory Physiology

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The central aortic pressure waveform, whilst simple in form, is complex in its physiological interpretation. Although general agreement has been reached on the contour and mechanisms responsible for pressure waveforms in the ascending aorta of healthy humans, in recent years there has been increasing interest in the contour of the pressure wave in elderly patients with aortic valve stenosis (AS). As aortic valve leaflets succumb to fibrosis and calcification, they increase opposition to forward flow. This results in a protracted pressure rise and manifests as the classical finding of pulsus parvus et tardus. Equally, changes to arterial properties (including elasticity and geometry) and pulse wave velocity (PWV) with age, heart failure or hypertension can cause profound changes to the contour. Increased accessibility of methods to measure the central aortic pressure waveform, as well as the rapid uptake of transcatheter aortic valve implantation technologies, has created a renewed focus on better understanding characteristic perturbations to the waveform in elderly patients with AS. In this Review, we investigate the evolution of our understanding of the central aortic pressure waveform in varying AS disease states to highlight the importance of the physiologic and biologic basis for alterations in this waveform (Graphical Abstract).

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Ageing, hypertension and aortic valve stenosis – Understanding the series circuit using cardiac magnetic resonance and applanation tonometry

Cited by 3 publications

References 40 publications

Perspective Chapter: Evolution of Techniques to Assess Vascular Impedance in Patients with Aortic Stenosis

Perspective Chapter: Evolution of Techniques to Assess Vascular Impedance in Patients with Aortic Stenosis

Arterial biomarkers in the evaluation, management and prognosis of aortic stenosis

Interpretation of the central aortic pressure waveform in elderly patients with aortic stenosis

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