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

Abstract

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.

Accessory Mitral Valve Tissue in the Internist’s Practice

“…Это может быть лентовидная структура в левом предсердии, простирающаяся от передней створки МК до межпредсердной перегородки, вызывающая фиксацию кончика створки, приводящую к тяжелой, эксцентричной митральной регургитации. Структура как бы «подтягивает» створку, что способствует свободному прохождению направленной назад струи [10,11]. Описывают также и вариант, когда хордообразная структура простирается от ЛЖ, а именно от папиллярной мышцы, через МК и прикрепляется затем к передней стенке левого предсердия.…”

New Evidence About Aortic Valve Stenosis and Cardiovascular Hemodynamics

“…Both hypertension and arterial stiffness are associated with discordantly graded AS, in particular the low flow-low gradient (LF-LG) severe AS [9,10]. There is growing interest in the evaluation of stiffness of the arterial tree in the natural history and prognosis of AS, as well as for the elucidation of the effects that surgical and trans-catheter management of AS have on arterial biomarkers [11]. The interplay between AS and functional arterial properties provides significant insights into the pathophysiology of the disease.…”

The Impact of Left Ventricular Performance and Afterload on the Evaluation of Aortic Valve Stenosis: A 1D Mathematical Modeling Approach

“…However, despite its broad use in clinical practice, very few studies have explored the interaction between the aortic TPG and the hemodynamic environment in which the measurement is performed [ 31 , 32 , 33 ]. It is known that compliance and elastance are important indexes responsible for the main physiological changes in biological tissues, and they are also used to interpret the progression of a disease or the outcomes of the treatments [ 34 , 35 , 36 ]. As a flow-dependent measure, physiological determinants of the cardiac output (systolic and diastolic ventricular function, arterial compliance, vascular resistance, and wave reflections) are expected to have an important impact on the aortic TPG, and thus, they should be taken seriously under consideration when interpreting measurements [ 34 , 37 , 38 , 39 ].…”

“…It is known that compliance and elastance are important indexes responsible for the main physiological changes in biological tissues, and they are also used to interpret the progression of a disease or the outcomes of the treatments [ 34 , 35 , 36 ]. As a flow-dependent measure, physiological determinants of the cardiac output (systolic and diastolic ventricular function, arterial compliance, vascular resistance, and wave reflections) are expected to have an important impact on the aortic TPG, and thus, they should be taken seriously under consideration when interpreting measurements [ 34 , 37 , 38 , 39 ]. Furthermore, aortic stenosis generally coexists with arterial stiffening, which further increases the left ventricular afterload [ 31 , 38 ], and they are both the consequences of similar pathophysiological progress [ 34 ].…”

“…As a flow-dependent measure, physiological determinants of the cardiac output (systolic and diastolic ventricular function, arterial compliance, vascular resistance, and wave reflections) are expected to have an important impact on the aortic TPG, and thus, they should be taken seriously under consideration when interpreting measurements [ 34 , 37 , 38 , 39 ]. Furthermore, aortic stenosis generally coexists with arterial stiffening, which further increases the left ventricular afterload [ 31 , 38 ], and they are both the consequences of similar pathophysiological progress [ 34 ]. Clinical and experimental data show that, particularly in low flow states (either because of decreased myocardial contractility or increased afterload), the TPG may be low despite the presence of severe aortic stenosis, leading to diagnostic inaccuracies and therapeutic delays [ 40 , 41 , 42 , 43 , 44 , 45 ].…”