Depressed Systemic Arterial Compliance is Associated with the Severity of Heart Failure Symptoms in Moderate-to-Severe Aortic Stenosis: a Cross-Sectional Retrospective Study

Abstract

Background: Patients with aortic stenosis (AS) may develop heart failure even in the absence of severe valve stenosis. Our aim was to assess the contribution of systemic arterial properties and the global left ventricular afterload to graded heart failure symptoms in AS.Methods: We retrospectively reviewed medical records of 157 consecutive subjects (mean age, 71±10 years; 79 women and 78 men) hospitalized owing to moderate-to-severe degenerative AS. Exclusion criteria included more than mild aortic insufficiency or disease of another valve, atrial fibrillation, coronary artery disease, severe respiratory disease or anemia. Heart failure symptoms were graded by NYHA class at admission. Systemic arterial compliance (SAC) and valvulo-arterial impedance (Zva) were derived from routine echocardiography and blood pressure.Results: Sixty-one patients were asymptomatic, 49 presented mild (NYHA II) and 47 moderate-to-severe (NYHA III-IV) heart failure symptoms. Mild symptoms were associated with lower SAC and transvalvular gradients, while more severe exercise intolerance coincided with older age, lower systolic blood pressure, smaller aortic valve area and depressed ejection fraction. By multiple ordinal logistic regression, the severity of heart failure symptoms was related to older age, depressed ejection fraction and lower SAC. Each decrease in SAC by 0.1 ml/m² per mmHg was associated with an increased adjusted odds ratio (OR) of a patient being in one higher category of heart failure symptoms graded as no symptoms, mild exercise intolerance and advanced exercise intolerance (OR: 1.16 [95% CI, 1.01-1.35], P=0.045).Conclusions: Depressed SAC may enhance exercise intolerance irrespective of stenosis severity or left ventricular systolic function in moderate-to-severe AS. This finding supports the importance of non-valvular factors for symptomatic status in AS.

Predicting changes in flow category in patients with severe aortic stenosis and preserved left ventricular ejection fraction on medical therapy

“…It may also represent an indirect measure of afterload and has been found to be reduced in patients with poorly controlled systolic hypertension . Patients with reduced SAC were found to have poorer prognosis in the context of severe AS, with more severe LV dysfunction . We found that despite normal LVEF, SAC was reduced in patients who switched from normal‐flow to low‐flow AS and conversely increased in patients who switched from low‐flow to normal‐flow AS.…”

Increased Left Ventricular Diastolic Stiffness Is Associated With Heart Failure Symptoms in Aortic Stenosis Patients With Preserved Ejection Fraction

“…24 SAC has also been associated with the severity of HF symptoms in moderate to severe AS. 25 Zva can estimate global LV hemodynamic load as the sum of valvular and arterial loads. It has been recently reported that Zva was associated with syncope in AS patients with preserved EF.…”

Bilateral Moyamoya Disease in a 2-Year-Old Pakistani Male Treated with Bilateral Encephaloduroarteriosynangiosis: A Positive Outcome

“…The disease predominantly affects children and often presents with stroke or recurrent transient ischemic attacks that are commonly accompanied by paralysis affecting one side of the body, muscle weakness, and seizures [8]. Medical management may involve drugs such as antiplatelet agents which are generally given to prevent thrombosis, but the mainstay of treatment remains surgery [9]. …”

“…Many surgical procedures have been described to restore blood flow, among them two are mostly discussed in literature; first is known as the indirect procedure, including encephaloduroarteriosynangiosis (EDAS), while the second is the direct method which includes superficial temporal artery and middle cerebral artery (STA-MCA) bypass. Combined approaches including both direct and indirect methods have shown good results and are of prime significance [9]. …”