<p>Short-term changes of blood pressure and aortic stiffness in older patients after transcatheter aortic valve implantation</p>

Abstract

Background Both aortic valve stenosis and aortic stiffness are moderators of arterio ventricular coupling and independent predictors of cardiovascular morbidity and mortality. Studies on the effect of transcatheter aortic valve implantation (TAVI) on aortic functional properties are limited. We performed a study to investigate the possible short-term changes in aortic stiffness and other aortic functional properties after TAVI in older patients. Methods TAVI Care&Cure is an observational ongoing study including consecutive patients undergoing a TAVI procedure. Central and peripheral hemodynamic measurements were measured non invasively 1 day before (T-1) and 1 day after (T+1) TAVI using a validated oscillometric method using a brachial cuff (Mobil-O-Graph). Results 40 patients were included. Mean aortic valve area at baseline was 0.76±0.24 cm 2 . Indices of severity of aortic valve stenosis improved significantly. Systolic blood pressure (SBP) dropped by 8.5%, from 130.3±22.9 mmHg to 119.5±15.8 mmHg ( p =0.005). Diastolic blood pressure (DBP) dropped by 13.1% from 74.8±14.5 mmHg to 65.0±11.3 mmHg ( p <0.001). The arterial pulse wave velocity (aPWV) decreased from 12.05±1.99 m/s to 11.6±1.56 m/s ( p =0.006). Patients with high aPWV at baseline showed a significantly larger reduction in SBP in comparison to patients with low aPWV: – 20.3 mmHg (−14.1%) vs – 3.1 mmHg (−2.6%), respectively ( p =0.033). The same trend was found for the DBP: −16.2 (−20.4%) vs −4.5 mmHg (−6.3%) for high vs low aPWV at baseline ( p =0.037). Conclusion We found short-term changes in blood pressure and aortic stiffness after TAVI. The amplitude of the changes was the largest in patients with elevated aortic stiffness at baseline.

Arterial Stiffness in Aortic Stenosis and the Impact of Aortic Valve Replacement

“… Nemes et al 2007 10 12 SAVR, 58% male, mean age 65 ↓SBP ↓ 21, 180 and 365 ASi Gradual decreased ASi with time Vavuranakis et al 2012 11 30 TAVI, 47% male, mean age 80 ↑ MAP ⇔ SBP ⇔ 7–8 ASi No significant Δstiffness nor aortic distensibility Vizzardi et al 2014 12 15 TAVI, 40% male, mean age 83 ⇔ ↓ 180 and 365 ASi Sustained decreased stiffness after 12 months and increased distensibility Cantürk et al 2017 14 38 SAVR, 78% male, mean age 59 ⇔ ⇔ 90 PWV (MOG) Baseline PWV was associated with MPG and AVA. Goudzwaard et al 2019 15 40 TAVI, 58% male, mean age 80 ↓ ↓ 1 PWV and AIx with MOG ΔPWV was inversely correlated with baseline PWV Yotti et al 2015 18 23 TAVI, 63% male, mean age 79 ↑ SBP, DBP, MAP ↑ 0 Invasive AIx ↑ Vascular load after TAVI Pagolatou et al 2020 19 33 TAVI, 49% male, mean age 84 ↑ aortic BP ↓ AIx 1 Invasive AIx Müller et al 2018 20 50 TAVI,...…”

“…Two studies used this method of which one noted decreased oPWV 1 day after TAVI and another unchanged oPWV 90 days after SAVR. 14 , 15 However, concerns have been raised based on a study showing that 99.1% of the variation in oPWV was explained by age and systolic blood pressure. 16 Also, a considerable discrepancy between oPWV and cfPWV was observed in a Marfan cohort 17 indicating that oPWV may need validation in specific populations.…”

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

“…As for those who experienced a reduction in PWV, this could be attributed to the impressive reduction of approximately 8.5 mmHg in MBP that was observed as well [24]. Also, results from the TAVI Care&Cure study in the Netherlands showed a reduction in aortic PWV 24h post-TAVI as assessed by Mobil-O-Graph, a finding in all probability driven principally by blood pressure reduction too [47].…”

“…In accordance with these acute findings, but also providing long-term results, we recently showed in a cohort of 90 patients undergoing TAVI that the arterial system exhibits an increase of stiffness as assessed by cfPWV and brachial-ankle PWV (baPWV) in response to the acute relief of the obstruction, which is retained in the long term after approximately 1 year of follow-up [35]. However, there are a few, smaller studies indicating no effect or even a decrease in stiffness after intervention [24,47]. These findings must be interpreted with caution; issues on sample size, as well as pressure dependency, might explain the discrepancy.…”

“…The majority of studies show that AIx significantly improves immediately or shortly after TAVI [35,36,47,48] (Tables 2 and 4). This finding may depict changes in peripheral vascular resistance, as the restoration of stroke volume leads to the resolution of peripheral vasoconstriction.…”