What is the clinical evidence from this study?

Study design: Observational. Population: Aortic stenosis (n=208). Intervention: Reduced systemic arterial compliance vs. Normal systemic arterial compliance. Primary outcome: Left ventricular dysfunction.

What question did this study set out to answer?

To determine the extent to which reduced systemic arterial compliance affects global afterload and left ventricular function in patients with aortic stenosis.

August 26, 2026Journal of the American College of Cardiology489 citationsOpen Access

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

MBMartin Briand JDJean G. Dumesnil LKLyes Kadem

Key Result

In patients with severe aortic stenosis, low systemic arterial compliance was associated with higher prevalences of LV diastolic (94% vs 82%) and systolic (31% vs 16%) dysfunction.

Key Points

To determine the extent to which reduced systemic arterial compliance affects global afterload and left ventricular function in patients with aortic stenosis.
Assessed 208 patients presenting with at least moderate aortic stenosis.
Calculated systemic arterial compliance as the ratio of stroke volume index to arterial pulse pressure and measured global afterload using valvulo-arterial impedance.
Categorized patients into four groups based on aortic stenosis severity (moderate vs. severe) and arterial compliance status (normal vs. low) to analyze left ventricular dysfunction via multivariate models.
Diastolic and systolic dysfunction were observed in 60% and 6% of patients with moderate stenosis/normal compliance (n = 77), 86% and 12% with moderate stenosis/low compliance (n = 50), 82% and 16% with severe stenosis/normal compliance (n = 45), and 94% and 31% with severe stenosis/low compliance (n = 36).
While energy loss index and systemic arterial compliance were independent predictors in baseline multivariate models, valvulo-arterial impedance was the sole hemodynamic parameter independently associated with left ventricular dysfunction when included.

Study Design

Type

Observational (n=208)

Structured PICO

Does reduced systemic arterial compliance impact left ventricular afterload and function in patients with aortic stenosis?

Population

208 patients with at least moderate aortic stenosis evaluated for the impact of systemic arterial compliance on left ventricular function.

Outcome

Left ventricular (LV) diastolic and systolic dysfunctionsurrogate

Reduced systemic arterial compliance significantly increases global afterload and worsens left ventricular function in patients with aortic stenosis, highlighting the clinical utility of measuring valvulo-arterial impedance.

Abstract

OBJECTIVES: We sought to determine to what extent systemic arterial compliance (SAC) might impact on afterload and left ventricular (LV) function in patients with aortic stenosis (AS). BACKGROUND: Although AS and reduced SAC may often coexist in the same patient, their relative impact on LV function is not well understood. METHODS: Systemic arterial compliance was calculated as the ratio of stroke volume index to arterial pulse pressure in 208 patients with at least moderate AS. As a measure of global afterload, we calculated the valvulo-arterial impedance (Zva), which theoretically accounts for the effects of both AS and SAC. RESULTS: Patients were divided into four groups: group 1, moderate AS and normal SAC (n = 77; 37%); group 2, moderate AS and low SAC (n = 50; 24%); group 3, severe AS and normal SAC (n = 45; 22%); and group 4, severe AS and low SAC (n = 36; 17%). The prevalences of LV diastolic and systolic dysfunction were 60% and 6% in group 1, 86% and 12% in group 2, 82% and 16% in group 3, and 94% and 31% in group 4. In multivariate analysis excluding Zva, energy loss index and SAC were both independent predictors of LV dysfunction, but when Zva was entered into the analyses, it became the only hemodynamic variable to be independently associated with LV dysfunction. CONCLUSIONS: 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.

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