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CLINICAL RESEARCH: VALVULAR DISEASE

Reduced Systemic Arterial Compliance Impacts Significantly on Left Ventricular Afterload and Function in Aortic Stenosis

Implications for Diagnosis and Treatment

Martin Briand, MS^_*, Jean G. Dumesnil, MD, FACC^_*, Lyes Kadem, Eng, PhD^_*,, Antonio G. Tongue, MD^_*, Régis Rieu, Eng, PhD, Damien Garcia, Eng, PhD and Philippe Pibarot, DVM, PhD, FACC^_*,_*

^_* Research Group in Valvular Heart Diseases, Research Center of Laval Hospital/Quebec Heart Institute, Department of Medicine, Laval University, Sainte-Foy, Quebec, Canada
Laboratoire de Biomécanique Cardiovasculaire, Institut de Recherche sur les Phénomènes Hors Équilibre, Marseille, France
Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada

Manuscript received July 16, 2004; revised manuscript received September 28, 2004, accepted October 4, 2004.

^_* Reprint requests and correspondence: Dr. Philippe Pibarot, Laval Hospital, 2725 Chemin Sainte-Foy, Sainte-Foy, Quebec, Canada, G1V-4G5 (Email: philippe.pibarot{at}med.ulaval.ca).

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 (Z_va), 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 Z_va, energy loss index and SAC were both independent predictors of LV dysfunction, but when Z_va 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.

Abbreviations and Acronyms   AS = aortic stenosis   BP = blood pressure   EOA = effective orifice area   ELI = energy loss index   LV = left ventricle/ventricular   PP = pulse pressure   SAC = systemic arterial compliance   SAP = systolic arterial pressure   SV = stroke volume   SVi = stroke volume index   Zva = valvulo-arterial impedance

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