Acute Effects of Transcatheter Aortic Valve Replacement on Central Aortic Hemodynamics in Patients With Severe Aortic Stenosis
- 1 June 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Hypertension
- Vol. 75 (6), 1557-1564
- https://doi.org/10.1161/hypertensionaha.119.14385
Abstract
Severe aortic stenosis induces abnormalities in central aortic pressure, with consequent impaired organ and tissue perfusion. Relief of aortic stenosis by transcatheter aortic valve replacement (TAVR) is associated with both a short- and long-term hypertensive response. Counterintuitively, patients who are long-term normotensive post-TAVR have a worsened prognosis compared with patients with hypertension, yet the underlying mechanisms are not understood. We investigated immediate changes in invasively measured left ventricular and central aortic pressure post-TAVR in patients with severe aortic stenosis using aortic reservoir pressure, wave intensity analysis, and indices of aortic function. Fifty-four patients (mean age 83.6±6.2 years, 50.0% female) undergoing TAVR were included. We performed reservoir pressure and wave intensity analysis on invasively acquired pressure waveforms from the ascending aorta and left ventricle immediately pre- and post-TAVR. Following TAVR, there were increases in systolic, diastolic, mean, and pulse aortic pressures (all PP=0.30) whereas excess pressure increased 47% (29.0±10.9 versus 42.6±15.5 mm Hg, P3 au, P3 au, P=0.01) and forward expansion wave energies (43.2±27.3 versus 82.8±53.1, ×103 au, P<0.001). Subendocardial viability ratio improved with aortic function effectively unchanged post-TAVR. Increased central aortic pressure following TAVR relates to increased transmitted power and energy to the proximal aorta with increased excess pressure but unchanged reservoir pressure. These changes provide a potential mechanism for the improved prognosis associated with relative hypertension post-TAVR.Keywords
This publication has 20 references indexed in Scilit:
- Relationship of aortic excess pressure obtained using pressure-only reservoir pressure analysis to directly measured aortic flow in humansPhysiological Measurement, 2018
- The development or worsening of hypertension after transcatheter aortic valve replacement (TAVR) improves short-term and long-term patient outcomesHeart Asia, 2018
- Pathophysiological coronary and microcirculatory flow alterations in aortic stenosisNature Reviews Cardiology, 2018
- Blood Pressure and Arterial Load After Transcatheter Aortic Valve Replacement for Aortic StenosisCirculation: Cardiovascular Imaging, 2017
- Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk PatientsThe New England Journal of Medicine, 2016
- Nano-analytical electron microscopy reveals fundamental insights into human cardiovascular tissue calcificationNature Materials, 2013
- Post-Procedural Hypertension Following Transcatheter Aortic Valve ImplantationJACC: Cardiovascular Interventions, 2013
- Arterial reservoir-excess pressure and ventricular workMedical & Biological Engineering & Computing, 2012
- Aortic stiffness affects the coronary blood flow response to percutaneous coronary interventionAmerican Journal of Physiology-Heart and Circulatory Physiology, 2006
- Time-domain representation of ventricular-arterial coupling as a windkessel and wave systemAmerican Journal of Physiology-Heart and Circulatory Physiology, 2003