Publication

Arterial Wave Reflection and Aortic Valve Stenosis: Diagnostic Challenges and Prognostic Significance

Nikolaos Stergiopoulos, Georgios Rovas, Vasiliki Bikia, Stamatia Zoi Pagoulatou
2022
Journal Articles

Résumé

IntroductionArterial wave reflection is an important component of the left ventricular afterload, affecting both pressure and flow to the aorta. The aim of the present study was to evaluate the impact of wave reflection on transvalvular pressure gradients (TPG), a key parameter for the evaluation of aortic valve stenosis (AS), as well as its prognostic significance in patients with AS undergoing a transcatheter aortic valve replacement (TAVR). Materials and MethodsThe study population consisted of 351 patients with AS (mean age 84 +/- 6 years, 43% males) who underwent a complete hemodynamic evaluation before the TAVR. The baseline assessment included right and left heart catheterization, transthoracic echocardiography, and a thorough evaluation of the left ventricular afterload by means of wave separation analysis. The cohort was divided into quartiles according to the transit time of the backward pressure wave (BWTT). Primary endpoint was all-cause mortality at 1 year. ResultsEarly arrival of the backward pressure wave was related to lower cardiac output (Q1: 3.7 +/- 0.9 lt/min vs Q4: 4.4 +/- 1.0 lt/min, p < 0.001) and higher aortic systolic blood pressure (Q1: 132 +/- 26 mmHg vs Q4: 117 +/- 26 mmHg, p < 0.001). TPG was significantly related to the BWTT, patients in the arrival group exhibiting the lowest TPG (mean TPG, Q1: 37.6 +/- 12.7 mmHg vs Q4: 44.8 +/- 14.7 mmHg, p = 0.005) for the same aortic valve area (AVA) (Q1: 0.58 +/- 0.35 cm(2) vs 0.61 +/- 0.22 cm(2), p = 0.303). In multivariate analysis, BWTT remained an independent determinant of mean TPG (beta 0.3, p = 0.002). Moreover, the prevalence of low-flow, low-gradient AS with preserved ejection fraction was higher in patients with early arterial reflection arrival (Q1: 33.3% vs Q4: 14.9%, p = 0.033). Finally, patients with early arrival of the reflected wave (Q1) exhibited higher all-cause mortality at 1 year after the TAVR (unadjusted HR: 2.33, 95% CI: 1.17-4.65, p = 0.016). ConclusionEarly reflected wave arrival to the aortic root is associated with poor prognosis and significant aortic hemodynamic alterations in patients undergoing a TAVR for AS. This is related to a significant decrease in TPG for a given AVA, leading to a possible underestimation of the AS severity.

Source officielle

Nikolaos Stergiopoulos, Georgios Rovas, Vasiliki Bikia, Stamatia Zoi Pagoulatou
2022
Journal Articles

Résumé

Source officielle

Proximité ontologique

Health sciences

Cardiologie: Maladie cardiovasculaire

Concepts associés (32)

Sténose aortique

Aortic stenosis (AS or AoS) is the narrowing of the exit of the left ventricle of the heart (where the aorta begins), such that problems result. It may occur at the aortic valve as well as above and below this level. It typically gets worse over time. Symptoms often come on gradually with a decreased ability to exercise often occurring first. If heart failure, loss of consciousness, or heart related chest pain occur due to AS the outcomes are worse. Loss of consciousness typically occurs with standing or exercising.

Insuffisance aortique

L'insuffisance aortique (IA), parfois appelée régurgitation aortique ou fuite aortique, est une maladie valvulaire cardiaque correspondant à un défaut d'étanchéité des valves aortiques du cœur qui provoque un flux sanguin rétrograde au cours de la diastole, de l'aorte vers le ventricule gauche. L'insuffisance aortique peut être due à des anomalies de la valve aortique et/ou de l'anneau aortique et/ou de l'aorte ascendante (le début de l'aorte). Si elle est associée avec un rétrécissement aortique, on parle alors de « maladie aortique ».

Cathétérisme cardiaque

Le cathétérisme cardiaque est une méthode d'exploration hémodynamique relativement ancienne. Elle consiste à introduire une sonde dans les différentes cavités cardiaques pour mesurer des pressions et le taux de saturation en oxygène du sang. Cette méthode date de plus d'un siècle et a été introduite par Auguste Chauveau. Il obtient les premiers enregistrements de pression des cavités cardiaques en introduisant un cathéter par la veine jugulaire dans le cœur d'un cheval.

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