Low systemic arterial compliance is associated with increased cardiovascular morbidity and mortality in aortic valve stenosis

Edda Bahlmann, Dana Cramariuc, Sahrai Saeed, John B Chambers, Christoph A Nienaber, Karl-Heinz Kuck, Mai Tone Lønnebakken, Eva Gerdts, Edda Bahlmann, Dana Cramariuc, Sahrai Saeed, John B Chambers, Christoph A Nienaber, Karl-Heinz Kuck, Mai Tone Lønnebakken, Eva Gerdts

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.

Keywords: aortic stenosis; echocardiography.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Kaplan-Meier plot of event-free survival from cardiovascular death (A) and all-cause mortality; (B) in groups of patients with low and normal SAC at baseline. SAC, systemic arterial compliance.
Figure 2
Figure 2
Receiver-operating characteristic curves comparing the univariable associations of SAC, stroke volume index, central pulse pressure and valvuloarterial impedance at baseline with all-cause mortality. na, not applicable; SAC, systemic arterial  compliance; SVi, stroke volume index.

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