Systemic blood pressure in severe aortic stenosis: Haemodynamic correlates and long‐term prognostic impact

Maeder, Micha T.; Rickli, Hans; Weber, Lukas; Weilenmann, Daniel; Ammann, Peter; Joerg, Lucas; Haager, Philipp K.; Rigger, Johannes; Chronis, Joannis; Brenner, Roman

doi:10.1002/ehf2.14192

Cited by 3 publications

(2 citation statements)

References 31 publications

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“…The haemodynamic consequences of AS, which exhibited the most pronounced increase over the age of 85 years in the KUNIUMI cohort, 19 may be decisive for a trajectory towards HF. Right and left heart catheterization in 477 patients undergoing aortic valve replacement (AVR) because of severe AS identified that the lowest mean arterial pressure quartile exhibited lower systemic vascular resistance and lower valvulo‐arterial impedance, which may facilitate preserved stroke volume and filling pressures despite reduced left ventricular performance 21 . Nevertheless, low mean arterial pressure was associated with a worse prognosis after AVR, 21 suggesting insufficient left ventricular reserve for a beneficial response to AVR.…”

Section: Valvular Heart Diseasementioning

confidence: 99%

“…Right and left heart catheterization in 477 patients undergoing aortic valve replacement (AVR) because of severe AS identified that the lowest mean arterial pressure quartile exhibited lower systemic vascular resistance and lower valvulo‐arterial impedance, which may facilitate preserved stroke volume and filling pressures despite reduced left ventricular performance 21 . Nevertheless, low mean arterial pressure was associated with a worse prognosis after AVR, 21 suggesting insufficient left ventricular reserve for a beneficial response to AVR. Left heart catheterization before and after transcatheter aortic valve implantation (TAVI) demonstrated that haemodynamic changes and improved ventricular function were immediate 22 .…”

Section: Valvular Heart Diseasementioning

confidence: 99%

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A year in heart failure: updates of clinical and preclinical findings

et al. 2023

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We witnessed major advances in the management of heart failure (HF) in 2022. Results of recent clinical and preclinical investigations aid preventive strategies, diagnostic efforts, and therapeutic interventions, and collectively, they hold promises for a more effective HF care for the near future. Accordingly, currently available information extends the 2021 European Society of Cardiology guidelines and provides a solid background for the introduction of improved clinical approaches in the number of HF‐related cases. Elaboration on the relationships between epidemiological data and risk factors lead to better understanding of the pathophysiology of HF with reduced ejection fraction and HF with preserved ejection fraction. The clinical consequences of valvular dysfunctions are increasingly interpreted not only in their haemodynamic consequences but also in association with their pathogenetic factors and modern corrective treatment possibilities. The influence of coronavirus disease 2019 pandemic on the clinical care of HF appeared to be less intense in 2022 than before; hence, this period allowed to refine coronavirus disease 2019 management options for HF patients. Moreover, cardio‐oncology emerges as a new subdiscipline providing significant improvements in clinical outcomes for oncology patients. Furthermore, the introduction of state‐of‐the‐art molecular biologic methods, multi‐omic approaches forecast improved phenotyping and precision medicine for HF. All above aspects are addressed in this article that highlights a selection of papers published in ESC Heart Failure in 2022.

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Section: Valvular Heart Diseasementioning

confidence: 99%

Section: Valvular Heart Diseasementioning

confidence: 99%

A year in heart failure: updates of clinical and preclinical findings

et al. 2023

View full text Add to dashboard Cite

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Systemic blood pressure in severe aortic stenosis: Haemodynamic correlates and long‐term prognostic impact

et al. 2022

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Aims Blood pressure (BP) targets in patients with aortic stenosis (AS) are controversial. This study sought to describe the haemodynamic profile and the clinical outcome of severe AS patients with low versus high central meaarterial pressure (MAP). Methods and results Patients with severe AS ( n = 477) underwent right and left heart catheterization prior to aortic valve replacement (AVR). The population was divided into MAP quartiles. The mean systolic BP, diastolic BP, and MAP in the entire population were 149 ± 25, 68 ± 11, and 98 ± 14 mmHg. Patients in the lowest MAP quartile had the lowest left ventricular ejection fraction (LVEF), systemic vascular resistance, and valvulo‐arterial impedance, whereas there were no significant differences in mean right atrial pressure, mean pulmonary artery wedge pressure, pulmonary vascular resistance, and stroke volume index across MAP quartiles. However, left ventricular stroke work index (LVSWI) was lowest in patients in the lowest and highest in those in the highest MAP quartile. After a median (interquartile range) post‐AVR follow‐up of 3.7 (2.6–5.2) years, mortality was highest in patients in the lowest MAP quartile [hazard ratio 3.08 (95% confidence interval 1.21–7.83); P = 0.02 for lowest versus highest quartile]. In the multivariate analysis, lower MAP [hazard ratio 0.78 (95% confidence interval 0.62–0.99) per 10 mmHg increase; P = 0.04], higher mean right atrial pressure and lower LVEF were independent predictors of death. Conclusions In severe AS patients, lower MAP reflects lower systemic vascular resistance and valvulo‐arterial impedance, which may help to preserve stroke volume and filling pressures despite reduced left ventricular performance, and lower MAP is a predictor of higher long‐term post‐AVR mortality.

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Arterial Properties and Ventricular–Arterial Interactions in Severe Aortic Stenosis: Impact on Prognosis

Horton,

Johnson,

Vidula

et al. 2024

American Journal of Hypertension

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Background Systemic arterial properties contribute to clinical heterogeneity and outcomes in degenerative calcific aortic stenosis (AS). Lumped parameters of afterload have previously been associated with adverse left ventricular remodeling, mortality, and poor exercise tolerance in this population, but most studies did not assess pulsatile aortic pressure-flow relations, the gold standard method for assessing arterial load. Moreover, arterial compliance is highly dependent on non-pulsatile (mean) arterial pressure, which influences prognosis in this population. Methods We retrospectively studied 135 patients with severe AS with same-day catheterization and echocardiogram. Invasive aortic pressures and echocardiographic flow waveforms were used to assess pressure-flow and pressure-volume relations using Windkessel modeling and wave separation analyses. We used Cox regression to assess the relationship between pulsatile load and time to death and heart failure hospital admission (DHFA). Results Total arterial compliance accounting for pressure-dependence (PD-TAC) was independently predictive of all-cause mortality (HR=0.80, 95%CI=0.66-0.97; p=0.023) and DHFA (HR=0.70; 95%CI=0.50-0.97; p=0.031) even after adjustment for age, race, gender, BMI, and comorbidities, while other arterial parameters were not. Conclusions In patients with severe AS, pressure-dependent arterial compliance predicts adverse outcomes, while traditional pulsatile arterial load measures do not. Our findings suggest that methods accounting for pressure load on the arterial wall are advantageous in this population in which lower mean pressure can result from severe stenosis and ventricular dysfunction.

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Systemic blood pressure in severe aortic stenosis: Haemodynamic correlates and long‐term prognostic impact

Cited by 3 publications

References 31 publications

A year in heart failure: updates of clinical and preclinical findings

A year in heart failure: updates of clinical and preclinical findings

Systemic blood pressure in severe aortic stenosis: Haemodynamic correlates and long‐term prognostic impact

Arterial Properties and Ventricular–Arterial Interactions in Severe Aortic Stenosis: Impact on Prognosis

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