서정숙, 김유리, 조성원, 김혜란, 지효원, 정연주, 김대희, 송종민, 강덕현, 송재관 |
Background: We sought to investigate the hemodynamic impact of increased systemic arterial compliance (SAC) in patients with aortic stenosis (AS) requiring valve replacement (AVR).
Methods: The study cohort includes 453 consecutive patients (247 males; mean age, 63.9±10.9 years). Besides, SAC (stroke volume index [SVi]/pulse pressure), an index of valvular-arterial impedence was calculated ([systolic arterial pressure+transvalvular pressure gradient at pressure recovery]/SVi, ZVA). In patients with normal LVEF (EF≥50%, n=362), low flow AS was defined as SVi<22 ml/m2.04.
Results: In all patients, ZVA showed stronger correlation (r=0.601) with pre-AVR LV mass index/LV end-diastolic volume index (LVMI/LVEDVI) than conventional markers of hemodynamic severity including aortic valve area (AVA, r=0.061), maximal velocity (Vmax, r=0.211) and mean pressure gradient (PG, r=0.194). Low flow AS was diagnosed in 203 patients (56.1%) and, despite similar AVA, Vmax and PG, they showed higher mean age, higher prevalence of female gender, smaller body surface area, higher LVMI/LVEDVI, lower SAC, and higher ZVA than those with normal flow AS.
Conclusions: AS is not an isolated disease strictly limited to the aortic valve but often rather a systemic disease entity often including increased rigidity of the aorta.
|