Aortic valve stenosis: low systemic arterial compliance tied to increased cardiovascular and all-cause mortality

  • Bahlmann E & al.
  • Heart
  • 15 May 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with aortic valve stenosis (AS) without diabetes and known cardiovascular disease (CVD), low systemic arterial compliance (SAC) is associated with higher CV and all-cause mortality independent of well-known prognosticators.

Why this matters

  • Findings highlight the importance of hypertension and arterial function assessments in addition to stenosis severity in the evaluation of patients with AS.

Study design

  • A prospective study of 1641 patients with asymptomatic mild-moderate AS who were enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study.
  • SAC was evaluated using stroke volume index/central pulse pressure ratio, and all patients were divided into 2 groups: low SAC (lower tertile, SAC2/mmHg; n=545) and normal SAC (n=1096).
  • Main outcomes: CV and all-cause mortality.
  • Funding: MSP Singapore Company, LLC, Singapore.

Key results

  • Low SAC at baseline was independently associated with older age, female sex, hypertension, obesity, presence of a small aortic root, lower mean aortic gradient, and energy loss index (P<.01 for all>
  • In Cox regression analysis adjusted for confounders, low SAC was associated with increased CV (HR, 2.13; 95% CI, 1.34-3.40) and all-cause mortality (HR, 1.71; 95% CI, 1.23-2.38) (P=.001 for both).
  • In univariable Cox analyses, low SAC was associated with higher CV and all-cause mortality in patients with systolic blood pressure:
    • ≥130 mmHg (HR, 2.22; 95% CI, 1.42-3.48; P=.001 and HR, 1.71; 95% CI, 1.38-2.64; P<.001 respectively>

Limitations

  • Study did not include patients with atherosclerotic disease or diabetes.