Clinical Validation of Non-invasive Simulation-Based Determination of Vascular Impedance, Wave Intensity, and Hydraulic Work in Patients Undergoing Transcatheter Aortic Valve Replacement

Purpose The impact of Aortic Stenosis (AS) on the left ventricle (LV) extends beyond the influence of the pressure drop across the stenotic valve, but also includes the additional serial afterload imposed by the vascular system. Aortic input impedance is the gold standard for comprehensively studying the contribution of the vascular system to total myocardial afterload, but in the past measurement has been challenging arising from the need for invasive catheterization or specialized equipment to precisely record time-resolved blood pressure and flow signals. The goal of this work was to develop and validate a novel simulation-based method for determining aortic input impedance using only clinically available echocardiographic data and a simple blood pressure measurement. Methods A simulation-based method to determine vascular impedance was developed using echocardiographic data and a brachial blood pressure measurement. Simulation-based impedance was compared to impedance calculated from echocardiographic flow data and pressure data from a non-invasive central pressure measurement device. Results In validation analysis comparing patient-specific simulation-based vascular impedance to non-invasively measured impedance, correlation between methods across a range of vascular parameters varied between R 2 = 0.40 and 0.99. A tendency was seen toward underestimation of pressure waveforms in point-by-point comparison of measured and simulated waveforms with an overall mean difference of 4.01 mmHg. Conclusions Requiring only non-invasive clinical data that are widely available, simulation-based vascular impedance has the potential to allow for easier, more widespread, and larger-scale investigation of the effect of vascular impedance on total LV afterload.