Importance of Increased Arterial Resistance in Risk Prediction in Patients with Cardiovascular Risk Factors and Degenerative Aortic Stenosis

Abstract

Background: Cardiovascular disease is a leading cause of heart failure (HF) and major adverse cardiac and cerebral events (MACCE). Objective: To evaluate impact of vascular resistance on HF and MACCE incidence in subjects with cardiovascular risk factors (CRF) and degenerative aortic valve stenosis (DAS). Methods: From January 2016 to December 2018, in 404 patients with cardiovascular disease, including 267 patients with moderate-to-severe DAS and 137 patients with CRF, mean values of resistive index (RI) and pulsatile index (PI) were obtained from carotid and vertebral arteries. Patients were followed-up for 2.5 years, for primary outcome of HF and MACCE episodes. Results: RI and PI values in patients with DAS compared to CRF were significantly higher, with optimal cut-offs discriminating arterial resistance of ≥0.7 for RI (sensitivity: 80.5%, specificity: 78.8%) and ≥1.3 for PI (sensitivity: 81.3%, specificity: 79.6%). Age, female gender, diabetes, and DAS were all independently associated with increased resistance. During the follow-up period, 68 (16.8%) episodes of HF-MACCE occurred. High RI (odds ratio 1.25, 95% CI 1.13–1.37) and PI (odds ratio 1.21, 95% CI 1.10–1.34) were associated with risk of HF-MACCE. Conclusions: An accurate assessment of vascular resistance may be used for HF-MACCE risk stratification in patients with DAS.

Clinical Significance of Carotid Intima-Media Complex and Carotid Plaque Assessment by Ultrasound for the Prediction of Adverse Cardiovascular Events in Primary and Secondary Care Patients

“…The SCORE risk correlated better with CIMT, while the FRS and QRISK seemed more specific for increased arterial stiffness parameters [ 100 ]. Of note, arterial stiffness proved its clinical value for MACCE in various clinical scenarios, e.g., in patients with aortic valve stenosis [ 103 ].…”

A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients—A Review: Part I—Epidemiology, Risk Factors, and Atherosclerosis-Related Diversities in Elderly Patients

“…Each of these elements: decreased arterial compliance, increased vessel stiffness measured using PWV or RI, endothelial dysfunction, switching of smooth muscle cells to proliferation, and the appearance of atherosclerotic plaques and calcifications are prognostic factors for increased mortality due to stroke, myocardial infarction (MI), or circulatory failure, as well as all-cause mortality [ 29 , 30 ]. It is assumed that PWV values above 9 m/s and RI above 0.7 indicate a two- to threefold increase in cardiovascular risk [ 30 ].…”

Serum and Vascular Stiffness Biomarkers Associated with the Severity of Degenerative Aortic Valve Stenosis and Cardiovascular Outcomes

“…Herein, a contemporary approach to stratify cardiovascular risk and timing of intervention could be improved through the implementation of more complex work-ups. Further research might be focused on the evaluation of serum biomarkers associated with calcific DAS and imaging modalities, like magnetic resonance imaging, 3D printing, or vascular stiffness (VS) parameters [ 5 , 6 , 7 , 8 , 9 , 10 ].…”