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Valvular heart disease
Original research article
Low systemic arterial compliance is associated with increased cardiovascular morbidity and mortality in aortic valve stenosis
  1. Edda Bahlmann1,
  2. Dana Cramariuc2,
  3. Sahrai Saeed2,
  4. John B Chambers3,
  5. Christoph A Nienaber4,
  6. Karl-Heinz Kuck1,
  7. Mai Tone Lønnebakken5,
  8. Eva Gerdts
  1. 1 Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
  2. 2 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
  3. 3 Department of Cardiology, Cardiothoracic Centre, Guys and St Thomas Hospital, London, UK
  4. 4 Department of Cardiology, Imperial College, the Royal Brompton and Harefield Trust, Cardiology and Aortic Centre, London, UK
  5. 5 Department of Clinical Science, University of Bergen, Bergen, Norway
  1. Correspondence to Dr Edda Bahlmann; e.bahlmann{at}asklepios.com

Abstract

Objective Lower systemic arterial compliance (SAC) is associated with increased cardiovascular morbidity and mortality in hypertension, but this has not been assessed in a prospective study in aortic valve stenosis (AS).

Methods Data from 1641 patients (38% women) with initially asymptomatic mild-moderate AS enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study was used. Median follow-up was 4.3 years. SAC was assessed from Doppler stroke volume index to central pulse pressure ratio and considered low if ≤0.64 mL/m², corresponding to the lower tertile in the population. The association of SAC with outcome was assessed in Cox regression analysis and reported as HR and 95% CI.

Results Low SAC at baseline was characterised by older age, female sex, hypertension, obesity, presence of a small aortic root, lower mean aortic gradient and more severe AS by effective aortic valve area (all p<0.01). In Cox regression analysis adjusting for factors, low SAC was associated with higher HRs for cardiovascular death (HR 2.13(95% CI 1.34 to 3.40) and all-cause mortality (HR 1.71(95% CI 1.23 to 2.38)), both p=0.001). The results did not change when systolic or diastolic blood pressure, other measures of AS severity or presence of discordantly graded AS were included in subsequent models. Presence of low SAC did not improve mortality prediction in reclassification analysis.

Conclusions In patients with AS without diabetes and known cardiovascular disease, but a high prevalence of hypertension, low SAC was associated with higher cardiovascular and all-cause mortality independent of well-known prognosticators.

Trial registration number NCT00092677; Post-results.

  • echocardiography
  • aortic stenosis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/heartjnl-2018-314386

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    Footnotes

    • Contributors All authors have contributed to the planning, conduct and reporting of the work described in the article and take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. EG is responsible for the overall content as guarantor.

    • Funding The Simvastatin Ezetimibe in Aortic Stenosis (SEAS) echocardiography core laboratory was supported by the MSP Singapore Company, LLC, Singapore, a partnership between Merck & Co., Inc and the Schering-Plough Corporation.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Low SAC in asymptomatic mild to moderate AS characterises a subgroup of patients with increased mortality. Furthermore, low SAC identifies patients who are prone to develop low flow severe AS subtypes during stenosis progression independent of the mean transvalvular gradient. The findings emphasise the importance of assessing hypertension and arterial function in addition to stenosis severity in evaluation of patients with AS.

    • Patient consent for publication Obtained.