Blood Pressure and Arterial Load After Transcatheter Aortic Valve Replacement for Aortic Stenosis

Lindman, Brian R.; Otto, Catherine M.; Douglas, Pamela S.; Hahn, Rebecca T.; Elmariah, Sammy; Weissman, Neil J.; Stewart, William J.; Ayele, Girma Minalu; Zhang, Feifan; Zajarías, Alan; Maniar, Hersh S.; Jilaihawi, Hasan; Blackstone, Eugene H.; Chinnakondepalli, Khaja; Tuzcu, E. Murat; Leon, Martin B.; Pîbarot, Philippe

doi:10.1161/circimaging.116.006308

Cited by 49 publications

(59 citation statements)

References 46 publications

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“…The authors also noted the contradictory nature of an association between increased BP and improved outcomes, especially in elderly patients with the most arterial stiffness. In 2017, Lindman et al showed that higher systolic BP is associated with improved overall, but this study was limited to 1 year post-TAVR 18. In this study, we extended the period of HTN and outcome monitoring to better associate new onset or worsening HTN with improved outcomes.…”

Section: Introductionmentioning

confidence: 96%

The development or worsening of hypertension after transcatheter aortic valve replacement (TAVR) improves short-term and long-term patient outcomes

2018

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Section: Introductionmentioning

confidence: 96%

The development or worsening of hypertension after transcatheter aortic valve replacement (TAVR) improves short-term and long-term patient outcomes

2018

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“…However, in a recent published abstract by Alrifai et al pre-operative beta blocker use did not improve the overall mortality (3). Similarity, Lindman et al found no survival benefit at 1 year in patients after TAVR (4). In this trial, we aim to further characterize the impact of beta-adrenergic blockade on clinical outcomes following TAVR.…”

Section: Introductionmentioning

confidence: 57%

How to improve prognostic value of popular risk scores used in acute coronary syndrome – A single center experience in a long term follow-up

Grabowski¹,

Filipiak‬²,

Opolski³

et al. 2018

Curr Res Cardiol

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Klinkhammer B. Beta blocker use is associated with an improvement in intermediate overall survival after Transcatheter Aortic Valve Replacement (TAVR). Curr Res Cardiol 2018;5(3):34-7. BACKGROUND: Despite initially concerns about their use, beta-adrenergic blockers (BB) have been associated with improved outcomes in patients with uncorrected aortic stenosis. However, the effect of beta blockers on outcomes after transcatheter aortic valve replacement (TAVR) is unknown. PURPOSE: To elucidate the effect of beta blockers on patient-specific outcomes after TAVR. METHODS: A retrospective cohort study of 339 consecutive patients who underwent a TAVR for severe aortic stenosis was performed to determine the effect of beta blockers on outcomes after TAVR. RESULTS: Despite a greater prevalence of several significant comorbidities and a higher predicted surgical risk, beta-adrenergic blockers are associated with an improve in overall survival at 1 year (83% vs. 67%, p =0.0398). The use of beta blocker was also associated with a reduction of major adverse cardiovascular and cerebrovascular events in the short-term (30 days-6 months) time period (23% vs. 39%, p =0.0208) CONCLUSION: This study gives evidence to suggest that beta blockers are associated with an improvement of overall survival in the intermediate time period. This finding suggests that TAVR may be a compelling indication for use of a beta blocker.

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“…In this issue of Circulation: Cardiovascular Imaging, Lindman et al 8 explore the relationships among post-TAVR systolic blood pressure (SBP) and arterial load and survival in a cohort of 2141 prohibitive-or high-surgical risk patients enrolled in the PARTNER I trial (Placement of Aortic Transcatheter Valve; NCT 00530894) or continued access registry. Lower SBP (100-129 versus 130-170 mm Hg) and higher total and pulsatile (but not resistive) arterial load were associated with an increased 30-day to 1-year all-cause mortality.…”

Section: See Article By Lindman Et Almentioning

confidence: 99%

“…Lindman et al 8 have redrawn the clinician's attention to the evaluation and management of blood pressure in elderly, prohibitive-, or high-surgical risk patients after TAVR. Their findings suggest that lower SBP may be a marker for reduced survival in this cohort and may best be avoided if possible and as circumstances and drug choices allow.…”

Section: See Article By Lindman Et Almentioning

confidence: 99%

“…8,14 Understanding the factors that summate into a single measurement of blood pressure may be more important than routinely recognized. Manipulating these factors, and finding the sweet spot for arterial load after aortic valve intervention, would seem to depend critically on the optimization of vascular health in the decades leading up to the procedure.…”

Section: See Article By Lindman Et Almentioning

confidence: 99%

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Blood Pressure, Arterial Load, and Survival After Transcatheter Aortic Valve Replacement

O’Gara

2017

Circ: Cardiovascular Imaging

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Editorialby guest on May 11, 2018 http://circimaging.ahajournals.org/ Downloaded from 2 O'Gara BP, Arterial Load, and Survival After TAVR and greater longevity could have been confounded. 12 A single blood pressure determination in elderly patients 30 days after TAVR may not provide enough information from which to draw firm conclusions on causality.The current study's observations on the differential effects of total, pulsatile, and resistive arterial loads, and their interactions with SBP, are important reminders of the complex ventricular-valvular-arterial interactions that ensue in an elderly, predominantly hypertensive patient cohort after relief of aortic valve obstruction. [13][14][15] The deleterious effects of increased arterial stiffness and pulsatile load in this population are vastly underappreciated although likely not remediable with medical therapy in advanced age.Blood pressure management in patients with AS can be challenging for clinicians and patients. A reluctance to reduce preload or arterial resistance for fear of precipitating hypotension in the setting of a fixed cardiac output usually dominates the clinical picture despite the known long-term deleterious consequences of elevated impedances in series. Low diastolic blood pressure levels (<70 mm Hg) may be particularly hazardous in the context of reduced coronary flow reserve, especially under conditions of increased myocardial oxygen demand. High diastolic blood pressure levels (>90 mm Hg), on the contrary, are consistently associated with adverse outcomes across a range of cardiovascular conditions, including AS. 16 International practice guidelines recommend treatment for hypertension in patients with AS. 17,18 Data from the SEAS trial (Simvastatin and Ezetimibe in Aortic Stenosis) describe a J-shaped relationship between blood pressure and outcomes and suggest that a target blood pressure of 130 to 139/70 to 90 be considered for patients with asymptomatic mild-to-moderate AS. 16 The optimal range for systemic blood pressure in patients with severe AS, however, has not been established. The picture is further clouded by individual variation in dose-response relationships, polypharmacy, drug side effects, drug-drug interactions, and patient comorbidities.Lindman et al 8 have redrawn the clinician's attention to the evaluation and management of blood pressure in elderly, prohibitive-, or high-surgical risk patients after TAVR. Their findings suggest that lower SBP may be a marker for reduced survival in this cohort and may best be avoided if possible and as circumstances and drug choices allow. Other studies have shown that SBP increases in ≈50% of patients after TAVR possibly in relation to higher postprocedural stroke volume and cardiac output, 13 but more likely as a consequence of stiffer (less compliant) vascular behavior that is unmasked by the relief of the upstream valvular obstruction.14 Higher SBP may be a good thing, but apparently not when it is accompanied by signs of reduced vascular compliance. 8,14 Understanding the fac...

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Blood Pressure and Arterial Load After Transcatheter Aortic Valve Replacement for Aortic Stenosis

Cited by 49 publications

References 46 publications

The development or worsening of hypertension after transcatheter aortic valve replacement (TAVR) improves short-term and long-term patient outcomes

The development or worsening of hypertension after transcatheter aortic valve replacement (TAVR) improves short-term and long-term patient outcomes

How to improve prognostic value of popular risk scores used in acute coronary syndrome – A single center experience in a long term follow-up

Blood Pressure, Arterial Load, and Survival After Transcatheter Aortic Valve Replacement

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