Key result
Greater arterial wave reflection magnitude was associated with higher myocardial extracellular mass and predicted a smaller improvement in quality of life following aortic valve replacement (R=-0.51; P=0.0026).
Why the study?
The role of arterial load in severe aortic stenosis is increasingly recognized, but patterns of pulsatile load and their implications in this population were unknown.
Are arterial properties associated with left ventricular remodeling, fibrosis, and clinical course in patients with severe aortic stenosis undergoing AVR?
Observational (n=38)
Are arterial properties associated with left ventricular remodeling, fibrosis, and clinical course in patients with severe aortic stenosis undergoing AVR?
Effect estimate: R = -0.51
p-value: p=0.0026
Arterial wave reflections are associated with myocardial interstitial volume expansion and predict less improvement in quality of life after surgical aortic valve replacement in severe aortic stenosis.
Wave reflection magnitude was associated with limited QoL gains after AVR; leaves open whether arterial modulation improves remodeling or outcomes in severe AS.
Background The role of arterial load in severe aortic stenosis is increasingly recognized. However, patterns of pulsatile load and their implications in this population are unknown. We aimed to assess the relationship between the arterial properties and both (1) left ventricular remodeling and fibrosis and (2) the clinical course of patients with severe aortic stenosis undergoing aortic valve replacement ( AVR ). Methods and Results We enrolled 38 participants with symptomatic severe aortic stenosis scheduled to undergo surgical AVR . Aortic root characteristic impedance, wave reflections parameters (reflection magnitude, reflected wave transit time), and myocardial extracellular mass were measured with cardiac magnetic resonance imaging and arterial tonometry Cardiac magnetic resonance imaging was repeated at 6 months in 30 participants. A reduction in cellular mass (133.6 versus 113.9 g; P =0.002) but not extracellular mass (42.3 versus 40.6 g; P =0.67) was seen after AVR . Participants with higher extracellular mass exhibited greater reflection magnitude (0.68 versus 0.54; P =0.006) and lower aortic root characteristic impedance (56.3 versus 96.9 dynes/s per cm 5 ; P =0.006). Reflection magnitude was a significant predictor of smaller improvement in the quality of life (Kansas City Cardiomyopathy Questionnaire score) after AVR ( R =−0.51; P =0.0026). The 6‐minute walk distance at 6 months after AVR was positively correlated with the reflected wave transit time ( R =0.52; P =0.01). Conclusions Consistent with animal studies, arterial wave reflections are associated with interstitial volume expansion in severe aortic stenosis and predict a smaller improvement in quality of life following AVR . Future trials should assess whether wave reflections represent a potential therapeutic target to mitigate myocardial interstitial remodeling and to improve the clinical status of this patient population.
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Chirinos et al. (2018) conducted an observational in Symptomatic severe aortic stenosis (n=38). Arterial wave reflections was evaluated on Improvement in quality of life (Kansas City Cardiomyopathy Questionnaire score) after AVR (R = -0.51, p=0.0026). Greater arterial wave reflection magnitude was associated with higher myocardial extracellular mass and predicted a smaller improvement in quality of life following aortic valve replacement (R=-0.51; P=0.0026).
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