Aortic stiffness as a marker of cardiac function and myocardial strain in patients undergoing aortic valve replacement

Abstract

BackgroundCardiac function and myocardial strain are affected by cardiac afterload, which is in part due to the stiffness of the aortic wall. In this study, we hypothesize that aortic pulse wave velocity (PWV) as a marker of aortic stiffness correlates with conventional clinical and biochemical markers of cardiac function and perioperative myocardial strain in aortic valve replacement (AVR).MethodsPatients undergoing AVR for aortic stenosis between June 2010 and August 2012 were recruited for inclusion in this study. PWV, NYHA class and left ventricular (LV) function were assessed pre-operatively. PWV was analysed both as a continuous and dichotomous variable according to age-standardized reference values. B-type natriuretic peptide (BNP) was measured pre-operatively, and at 3 h and 18-24 h after cardiopulmonary bypass (CPB). NYHA class, leg edema, and LV function were recorded at follow-up (409 ± 159 days).ResultsFifty-six patients (16 females) with a mean age of 71 ± 8.4 years were included, with 50 (89%) patients completing follow-up. The NYHA class of PWV-norm patients was significantly lower than PWV-high patients both pre- and post-operatively. Multiple logistic regression also highlighted PWV-cut off as an independent predictor of NYHA class pre- and post-operatively (OR 8.3, 95%CI [2.27,33.33] and OR 14.44, 95%CI [1.49,139.31] respectively). No significant relationship was observed between PWV and either LV function or plasma BNP.ConclusionIn patients undergoing AVR for aortic stenosis, PWV is independently related to pre- and post-operative NYHA class but not to LV function or BNP. These findings provisionally support the use of perioperative PWV as a non-invasive marker of clinical functional status, which when used in conjunction with biomarkers of myocardial strain such as BNP, may provide a holistic functional assessment of patients undergoing aortic valve surgery. However, in order for PWV assessment to be translated into clinical practice and utilised as more than simply a research tool, further validation is required in the form of larger prospective studies specifically designed to assess the relationship between PWV and these functional clinical outcomes.

Changes in Aortic Pulse Wave Velocity and the Predictors of Improvement in Arterial Stiffness Following Aortic Valve Replacement

“…20) The second study (n = 12 patients) demonstrated that AVR in patients with AS was related with progressive improvement in similar 1-year aortic stiffness values comparable to that matched controls. Since the above aforementioned studies did not use PWV, our study is of clinical importance supporting the results of Kidhera et al, which found AVR has no effect on aortic stiffness 12,19 Our study indicates that PWV values correlated positively with mean aortic gradient and negatively with the AVA index preoperatively consistent with the results of study of Liu et al 11) By indicating this relation, our study advocates that AS and aortic stiffness are reflective of distinct spectrum of the same atherosclerotic disease. Unfortunately, due to relatively small sample size and different methodological assessments between our and previous studies, a larger study is needed to make a postoperatively.…”

Arterial Stiffness in Aortic Stenosis: Relationship with Severity and Echocardiographic Procedures Response

“…Liu et al [17] found a significant association between increased aortic pressure gradient and high PWV values. By contrast, Celik et al [18] and Kidher et al [19] did not found this correlation.…”

“…Only one previous study evaluated PWV in AVR subjects showing its correlation with NYHA class both pre and post-operatively but not with proBNP and EF [19]. Other analysis from the same study found that higher PWV was correlated with poor quality of life [26] and cognitive dysfunction [27] both pre and post-operatively and that it does not correlate with post-operatively acute kidney failure, a well know surgical AVR complication [28].…”

“…Since they share the same pathological process it might be expected that arterial stiffness evaluation could predict the severity of AS as well as the response to the procedures. Nevertheless to date little is know about the relation of arterial stiffness and AS [14][15][16][17][18][19]. With this background in mind we sought to determine wether Pulse Wave Velocity (PWV), i.e.…”

Effects of glutamine and valsartan on the brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide of patients with chronic heart failure

“…Upon severe wasting diseases such as trauma, heart failure, major surgery and cancer, human body begins to require a large amount of glutamine that, if not supplemented in time, will give rise to various diseases when exhausted. 11 , 12 Therefore, we herein analyzed the influences of glutamine and valsartan on the BNP and NT-proBNP of CHF patients.…”