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.
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.
Authors: Alex J Barker; Pim van Ooij; Krishna Bandi; Julio Garcia; Mazen Albaghdadi; Patrick McCarthy; Robert O Bonow; James Carr; Jeremy Collins; S Chris Malaisrie; Michael Markl Journal: Magn Reson Med Date: 2013-10-02 Impact factor: 4.668
Authors: Vitantonio Di Bello; Cristina Giannini; Marco De Carlo; Maria Grazia Delle Donne; Carmela Nardi; Caterina Palagi; Cuono Cucco; Frank Lloyd Dini; Fabio Guarracino; Mario Marzilli; Anna Sonia Petronio Journal: Int J Cardiovasc Imaging Date: 2011-01-08 Impact factor: 2.357
Authors: Mackram F Eleid; Paul Sorajja; Hector I Michelena; Joseph F Malouf; Christopher G Scott; Patricia A Pellikka Journal: Circulation Date: 2013-09-18 Impact factor: 29.690