Reduced Systemic Arterial Compliance Impacts Significantly on Left Ventricular Afterload and Function in Aortic Stenosis

Abstract

Reduced SAC is a frequent occurrence in elderly patients with AS, where it independently contributes to increased afterload and decreased LV function. Systemic arterial compliance should be taken into consideration when evaluating these patients with regard to diagnosis and treatment.

Impact of Vascular Hemodynamics on Aortic Stenosis Evaluation: New Insights Into the Pathophysiology of Normal Flow—Small Aortic Valve Area—Low Gradient Pattern

“…rAC is a major contributor to the development of systolic hypertension, contributing to LV afterload and decreased coronary flow during diastole, and it has been shown to be a strong predictor of LV dysfunction and adverse events 30, 31, 32, 33, 34. Patients with AS already have increased LV afterload because of valvular stenosis, and it has been demonstrated that rAC has a significant additive effect and contributes to LV dysfunction and occurrence of adverse outcomes 22, 35. In the present study, we showed that rAC induces a marked reduction in MG and V peak for any AS severity, even if flow is stable and even in the absence of hypertension.…”

New concepts in valvular hemodynamics: Implications for diagnosis and treatment of aortic stenosis

“…This 'pseudonormalization' phenomenon probably explains the underestimation of the prevalence of hypertension reported in previous studies. Hence, in our study, 22% of the patients with abnormally low SAC had a systolic arterial pressure below 140 mmHg and would thus have been falsely classified as having normal systemic arterial hemodynamics (25). This pseudonormalization phenomenon is highly insidious because, based on the indices currently used in clinical practice, patients having concomitantly severe AS and severely reduced arterial compliance could be considered as having only moderate AS and no or mild hypertension, when, in fact, they have a markedly increased LV afterload as a result of the double (valvular plus arterial) load and they are thus at higher risk of developing LV dysfunction and symptoms.…”

“…As mentioned, AS and hypertension are the two most frequent cardiovascular diseases after CAD in the western world, and 30% to 40% of patients with AS concomitantly have hypertension (22)(23)(24)(25). The interaction between valvular and arterial hemodynamics may affect the evaluation of AS severity and the ensuing clinical conduct (15,(26)(27)(28).…”

“…Although significant AS and hypertension may often coexist in the same patient, their combined impact on the occurrence of LV dysfunction, symptoms and adverse outcomes is not well understood. Recently, we performed animal and clinical studies to specifically examine the interaction between AS and hypertension, as well as their impact on LV afterload and function (25,29). Hypertension may be caused by an increase in systemic vascular resistance (ie, systolodiastolic hypertension), a decrease in systemic arterial compliance (SAC) (ie, systolic hypertension) or both abnormalities.…”

Outcomes in Asymptomatic Severe Aortic Stenosis With Preserved Ejection Fraction Undergoing Rest and Treadmill Stress Echocardiography

“…Therefore, objective and reproducible parameters that identify early LV dysfunction, before a drop in LVEF could potentially allow more appropriate timing of surgery and in turn, allow improved survival. Over the past decade, the relationship between global LV load and abnormal LV systolic performance in AS patients, even in those with preserved LVEF has become more apparent, and the use of novel echocardiographic measures of LV load (Zva)19, 20, 45 and LV systolic performance (LV‐GLS)18, 30, 46 have been proposed as potential markers of early dysfunction, providing incremental prognostic utility.…”