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Sigala E, Terentes-Printzios D, Gardikioti V, Baikoussis NG, Koumallos N, Katsaros A, Lozos V, Kouerinis I, Triantafillou K, Filis K, Tsioufis K, Vlachopoulos C. The Effect of Surgical Aortic Valve Replacement on Arterial Stiffness: Does the Valve Type Matter? J Pers Med 2024; 14:509. [PMID: 38793090 PMCID: PMC11122145 DOI: 10.3390/jpm14050509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Despite the increasing use of transcatheter aortic valve procedures, many patients still require surgical aortic valve replacement (SAVR). Assessing arterial properties in patients undergoing SAVR for aortic valve stenosis can be challenging, and the existing evidence is inconclusive. Our study aimed to investigate the impact of SAVR on vascular stiffness and the quality of life, as well as the different effects of valve type on arterial properties. Methods: We included 60 patients (mean age 70.25 ± 8.76 years, 65% men) with severe symptomatic aortic stenosis who underwent SAVR. Arterial stiffness (cfPWV, baPWV) and vascular parameters (AIx@75, central pressures, SEVR) were measured at baseline, pre-discharge, and 1-year post-operation. The QOL was assessed using the generic questionnaire-short-form health survey 36 (SF-36) pre-operatively and at 1 year. Results: Post-SAVR, cfPWV increased immediately (7.67 ± 1.70 m/s vs. 8.27 ± 1.92 m/s, p = 0.009) and persisted at 1 year (8.27 ± 1.92 m/s vs. 9.29 ± 2.59 m/s, p ≤ 0.001). Similarly, baPWV (n = 55) increased acutely (1633 ± 429 cm/s vs. 2014 ± 606 cm/s, p < 0.001) and remained elevated at 1 year (1633 ± 429 cm/s vs. 1867 ± 408 cm/s, p < 0.001). Acute decrease in Alx@75 (31.16 ± 10% vs. 22.48 ± 13%, p < 0.001) reversed at 1 year (31.16 ± 10% vs. 30.98 ± 9%, p = 0.71). SEVR improved (136.1 ± 30.4% vs. 149.2 ± 32.7%, p = 0.01) and persisted at 1 year (136.1 ± 30.4% vs. 147.5 ± 30.4%, p = 0.01). SV had a greater cfPWV increase at 1 year (p = 0.049). The QOL improved irrespective of arterial stiffness changes. Conclusions: After SAVR, arterial stiffness demonstrates a persistent increase at 1-year, with valve type having a slight influence on the outcomes. These findings remain consistent despite the perceived QOL.
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Affiliation(s)
- Evangelia Sigala
- First Department of Cardiology, Hippokration Hospital, 11527 Athens, Greece
| | | | | | | | - Nikolaos Koumallos
- Department of Cardiac Surgery, Hippokration Hospital, 11527 Athens, Greece (N.K.)
| | - Andreas Katsaros
- Department of Cardiac Surgery, Hippokration Hospital, 11527 Athens, Greece (N.K.)
| | - Vasileios Lozos
- Department of Cardiac Surgery, Hippokration Hospital, 11527 Athens, Greece (N.K.)
| | - Ilias Kouerinis
- Department of Cardiac Surgery, Hippokration Hospital, 11527 Athens, Greece (N.K.)
| | | | - Konstantinos Filis
- First Department of Surgery, Hippokration Hospital, 11527 Athens, Greece;
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Çelikbudak Orhon C, Stergiopulos N, Noble S, Giannakopoulos G, Müller H, Adamopoulos D. The Impact of Left Ventricular Performance and Afterload on the Evaluation of Aortic Valve Stenosis: A 1D Mathematical Modeling Approach. Bioengineering (Basel) 2023; 10:425. [PMID: 37106613 PMCID: PMC10136235 DOI: 10.3390/bioengineering10040425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
The transaortic valvular pressure gradient (TPG) plays a central role in decision-making for patients suffering from severe aortic stenosis. However, the flow-dependence nature of the TPG makes the diagnosis of aortic stenosis challenging since the markers of cardiac performance and afterload present high physiological interdependence and thus, isolated effects cannot be measured directly in vivo. We used a validated 1D mathematical model of the cardiovascular system, coupled with a model of aortic stenosis, to assess and quantify the independent effect of the main left ventricular performance parameters (end-systolic (Ees) and end-diastolic (Eed) elastance) and principal afterload indices (total vascular resistance (TVR) and total arterial compliance (TAC)) on the TPG for different levels of aortic stenosis. In patients with critical aortic stenosis (aortic valve area (AVA) ≤ 0.6 cm2), a 10% increase of Eed from the baseline value was associated with the most important effect on the TPG (-5.6 ± 0.5 mmHg, p < 0.001), followed by a similar increase of Ees (3.4 ± 0.1 mmHg, p < 0.001), in TAC (1.3 ±0.2 mmHg, p < 0.001) and TVR (-0.7 ± 0.04 mmHg, p < 0.001). The interdependence of the TPG left ventricular performance and afterload indices become stronger with increased aortic stenosis severity. Disregarding their effects may lead to an underestimation of stenosis severity and a potential delay in therapeutic intervention. Therefore, a comprehensive evaluation of left ventricular function and afterload should be performed, especially in cases of diagnostic challenge, since it may offer the pathophysiological mechanism that explains the mismatch between aortic severity and the TPG.
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Affiliation(s)
- Cemre Çelikbudak Orhon
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland
| | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland
| | - Stéphane Noble
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Department of Internal Medicine, Division of Cardiology, Hopitaux Universitaires de Genève (HUG), 1205 Geneva, Switzerland
| | - Georgios Giannakopoulos
- Department of Internal Medicine, Division of Cardiology, Hopitaux Universitaires de Genève (HUG), 1205 Geneva, Switzerland
| | - Hajo Müller
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Department of Internal Medicine, Division of Cardiology, Hopitaux Universitaires de Genève (HUG), 1205 Geneva, Switzerland
| | - Dionysios Adamopoulos
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Department of Internal Medicine, Division of Cardiology, Hopitaux Universitaires de Genève (HUG), 1205 Geneva, Switzerland
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New Evidence About Aortic Valve Stenosis and Cardiovascular Hemodynamics. High Blood Press Cardiovasc Prev 2022; 29:231-237. [PMID: 35438477 PMCID: PMC9050777 DOI: 10.1007/s40292-022-00520-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/27/2022] Open
Abstract
Aortic stenosis (AS) is the most common degenerative valvular disease in western word. In patients with severe AS, small changes in aortic valve area can lead to large changes in hemodynamics. The correct understanding of cardiac hemodynamics and its interaction with vascular function is of paramount importance for correct identification of severe AS and to plan effective strategies for its treatment. In the current review with highlight the importance of pressure recovery phenomenon and valvular arterial impedance as novel tools in the evaluation of patients with aortic stenosis.
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Association of Increased Vascular Stiffness with Cardiovascular Death and Heart Failure Episodes Following Intervention on Symptomatic Degenerative Aortic Stenosis. J Clin Med 2022; 11:jcm11082078. [PMID: 35456171 PMCID: PMC9024730 DOI: 10.3390/jcm11082078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 12/04/2022] Open
Abstract
Background. The resistive (RI) and pulsatile (PI) indices are markers of vascular stiffness (VS) which are associated with outcomes in patients with cardiovascular disease. We aimed to assess whether VS might predict incidence of cardiovascular death (CVD) and heart failure (HF) episodes following intervention on degenerative aortic valve stenosis (DAS). Methods. The distribution of increased VS (RI ≥ 0.7 and PI ≥ 1.3) from supra-aortic arteries was assessed in patients with symptomatic DAS who underwent aortic valve replacement (AVR, n = 127) or transcatheter aortic valve implantation (TAVI, n = 119). During a 3-year follow-up period (FU), incidences of composite endpoint (CVD and HF) were recorded. Results. Increased VS was found in 100% of TAVI patients with adverse event vs. 88.9% event-free TAVI patients (p = 0.116), and in 93.3% of AVR patients with event vs. 70.5% event-free (p = 0.061). Kaplan–Mayer free-survival curves at 1-year and 3-year FU were 90.5% vs. 97.1 % and 78% vs. 97.1% for patients with increased vs. lower VS. (p = 0.014). In univariate Cox analysis, elevated VS (HR 7.97, p = 0.04) and age (HR 1.05, p = 0.024) were associated with risk of adverse outcomes; however, both failed in Cox multivariable analysis. Conclusions. Vascular stiffness is associated with outcome after DAS intervention. However, it cannot be used as an independent outcome predictor.
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Mazur P, Kopytek M, Ząbczyk M, Undas A, Natorska J. Towards Personalized Therapy of Aortic Stenosis. J Pers Med 2021; 11:1292. [PMID: 34945764 PMCID: PMC8708539 DOI: 10.3390/jpm11121292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 12/18/2022] Open
Abstract
Calcific aortic stenosis (CAS) is the most common cause of acquired valvular heart disease in adults with no available pharmacological treatment to inhibit the disease progression to date. This review provides an up-to-date overview of current knowledge of molecular mechanisms underlying CAS pathobiology and the related treatment pathways. Particular attention is paid to current randomized trials investigating medical treatment of CAS, including strategies based on lipid-lowering and antihypertensive therapies, phosphate and calcium metabolism, and novel therapeutic targets such as valvular oxidative stress, coagulation proteins, matrix metalloproteinases, and accumulation of advanced glycation end products.
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Affiliation(s)
- Piotr Mazur
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55902, USA;
- Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St, 31-202 Kraków, Poland; (M.K.); (M.Z.); (A.U.)
| | - Magdalena Kopytek
- Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St, 31-202 Kraków, Poland; (M.K.); (M.Z.); (A.U.)
- Center for Research and Medical Technologies, John Paul II Hospital, 31-202 Kraków, Poland
| | - Michał Ząbczyk
- Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St, 31-202 Kraków, Poland; (M.K.); (M.Z.); (A.U.)
- Center for Research and Medical Technologies, John Paul II Hospital, 31-202 Kraków, Poland
| | - Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St, 31-202 Kraków, Poland; (M.K.); (M.Z.); (A.U.)
- Center for Research and Medical Technologies, John Paul II Hospital, 31-202 Kraków, Poland
| | - Joanna Natorska
- Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St, 31-202 Kraków, Poland; (M.K.); (M.Z.); (A.U.)
- Center for Research and Medical Technologies, John Paul II Hospital, 31-202 Kraków, Poland
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