Key result
Increased vascular stiffness was associated with a nearly 8-fold higher risk of cardiovascular death and heart failure episodes following aortic valve intervention (HR 7.97), though it failed to remain an independent predictor in multivariable analysis.
Why the study?
Resistive and pulsatile indices mark vascular stiffness and relate to cardiovascular disease outcomes, but whether vascular stiffness predicts cardiovascular death and heart failure after intervention for degenerative aortic valve stenosis was unclear.
Does increased vascular stiffness predict cardiovascular death and heart failure episodes in patients following intervention for symptomatic degenerative aortic stenosis?
Cohort (n=246)
Yes
Does increased vascular stiffness predict cardiovascular death and heart failure episodes in patients following intervention for symptomatic degenerative aortic stenosis?
Increased vascular stiffness is associated with adverse outcomes after intervention for degenerative aortic stenosis in univariate analysis, but is not an independent predictor.
Answers are grounded in this paper and cite their sources.
Vascular stiffness should not yet inform post-aortic valve risk assessment; leaves open its independent prognostic value in degenerative aortic stenosis.
Background. The resistive (RI) and pulsatile (PI) indices are markers of vascular stiffness (VS) which are associated with outcomes in patients with cardiovascular disease. We aimed to assess whether VS might predict incidence of cardiovascular death (CVD) and heart failure (HF) episodes following intervention on degenerative aortic valve stenosis (DAS). Methods. The distribution of increased VS (RI ≥ 0.7 and PI ≥ 1.3) from supra-aortic arteries was assessed in patients with symptomatic DAS who underwent aortic valve replacement (AVR, n = 127) or transcatheter aortic valve implantation (TAVI, n = 119). During a 3-year follow-up period (FU), incidences of composite endpoint (CVD and HF) were recorded. Results. Increased VS was found in 100% of TAVI patients with adverse event vs. 88.9% event-free TAVI patients (p = 0.116), and in 93.3% of AVR patients with event vs. 70.5% event-free (p = 0.061). Kaplan–Mayer free-survival curves at 1-year and 3-year FU were 90.5% vs. 97.1 % and 78% vs. 97.1% for patients with increased vs. lower VS. (p = 0.014). In univariate Cox analysis, elevated VS (HR 7.97, p = 0.04) and age (HR 1.05, p = 0.024) were associated with risk of adverse outcomes; however, both failed in Cox multivariable analysis. Conclusions. Vascular stiffness is associated with outcome after DAS intervention. However, it cannot be used as an independent outcome predictor.
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Baran et al. (2022) conducted a cohort in Symptomatic Degenerative Aortic Stenosis (n=246). Increased vascular stiffness (Resistive Index ≥ 0.7 and Pulsatile Index ≥ 1.3) vs. Lower vascular stiffness was evaluated on Composite of cardiovascular death and heart failure episodes requiring hospital readmission (HR 7.97, 95% CI 1.10-57.9, p=0.04). Increased vascular stiffness was associated with a nearly 8-fold higher risk of cardiovascular death and heart failure episodes following aortic valve intervention (HR 7.97), though it failed to remain an independent predictor in multivariable analysis.
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