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Pulsatile energy consumption as a surrogate marker for vascular afterload improves with time post transcatheter aortic valve replacement in patients with aortic stenosis

Hypertension Research volume 46, pages 730–741 (2023)Cite this article

Abstract

The effect of arterial stiffening on elevated pulsatile left ventricular afterload patients with aortic stenosis (AS) is pronounced beyond systemic hypertension. Circulatory afterload pulsatile efficiency (CAPE) is a marker of vascular function, defined as the ratio of steady state energy consumption (SEC) to maintain systemic circulation and pulsatile energy consumption (PEC). Twenty patients aged 80 ± 7 years were assessed at baseline and a median of 60 days post transcatheter aortic valve replacement (TAVR), with pulsatile vascular load calculated using simultaneous radial applanation tonometry derived aortic pressure and cardiac magnetic resonance phase-contrast imaging derived ascending aortic flow. Eight out of 20 patients had a reduction in PEC post TAVR, and the reduction of PEC correlated strongly with the number of days post TAVR (R = 0.62, P < 0.01). Patients assessed within the 100 days of TAVR had a rise in their PEC when compared to baseline (0.19 ± 0.09 vs 0.14 ± 0.08 W, P = 0.04). Baseline PEC correlated moderately with baseline SEC (R = 0.49, P = 0.03), and a high baseline PEC was predictive of post TAVR PEC reduction (R = 0.54, P =0.01). Overall, no significant differences were found between baseline and post TAVR for systolic aortic pressure (131 ± 20 vs 131 ± 20 mmHg), systemic vascular resistance (1894 ± 493 vs 2015 ± 519 dynes.s/cm5), aortic valve ejection time (337 ± 22 vs 324 ± 34 ms) or aortic characteristic impedance (120 ± 48 vs 107 ± 41 dynes.s/cm5). Improved flow profiles after TAVR likely unmask the true vascular properties by altering ventriculo-valvulo-arterial coupling, leading to downstream vascular remodelling secondary to flow conditioning, and results in eventual improvement of pulsatile afterload as reflected by our proposed index of CAPE.

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Acknowledgements

We would like to thank Dr. Mark Butlin from Macquarie University for his contribution to maintain our working equipment, and the staff at the Advanced Cardiac Imaging Centre at St Vincent’s Hospital, Sydney for their support of the study.

Funding

NS is supported by a Cardiac Society of Australia and New Zealand Research Scholarship and an Australian Government Department of Education Research and Training Programme grant.

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Author notes

  1. These authors contributed equally: Ning Song, Audrey I. Adji

Authors and Affiliations

  1. St Vincent’s Hospital, Sydney, NSW, Australia

    Ning Song, Audrey I. Adji, Sara L. Hungerford, Mayooran J. Namasivayam, Christopher S. Hayward, Andrew Jabbour & David W. M. Muller

  2. UNSW Health and Medicine, Sydney, NSW, Australia

    Ning Song, Audrey I. Adji, Sara L. Hungerford, Mayooran J. Namasivayam, Christopher S. Hayward, Andrew Jabbour & David W. M. Muller

  3. Victor Chang Cardiac Research Institute, Sydney, NSW, Australia

    Audrey I. Adji, Sara L. Hungerford, Mayooran J. Namasivayam, Christopher S. Hayward & Andrew Jabbour

  4. Macquarie Medical School, Sydney, NSW, Australia

    Audrey I. Adji

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Correspondence to Ning Song.

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DWMM has been an advisory board member for Medtronic and Boston Scientific; has been a consultant to Abbott Vascular, Medtronic; has received research grant support from Abbott Vascular and Medtronic; and is a proctor for Medtronic and Abbott Vascular.

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Song, N., Adji, A.I., Hungerford, S.L. et al. Pulsatile energy consumption as a surrogate marker for vascular afterload improves with time post transcatheter aortic valve replacement in patients with aortic stenosis. Hypertens Res 46, 730–741 (2023). https://doi.org/10.1038/s41440-022-01127-4

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