This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2004.10.081v1 46/2/291    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Briand, M. Articles by Pibarot, P. Search for Related Content PubMed PubMed Citation Articles by Briand, M. Articles by Pibarot, P. Related Collections Related Article

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

Related Article

Severe Calcific Aortic Stenosis: Left Ventricular Afterload and its Quantification

Kirk L. Peterson
J. Am. Coll. Cardiol. 2005 46: 299-301. [Full Text] [PDF]

This article has been cited by other articles:

				M. Rosca, J. Magne, A. Calin, B. A. Popescu, L. A. Pierard, and P. Lancellotti Impact of aortic stiffness on left ventricular function and B-type natriuretic peptide release in severe aortic stenosis Eur Heart J Cardiovasc Imaging, November 1, 2011; 12(11): 850 - 856. [Abstract] [Full Text] [PDF]

				N. Haruki, M. Takeuchi, K. Kaku, H. Yoshitani, H. Kuwaki, M. Tamura, H. Abe, M. Okazaki, A. Tsutsumi, and Y. Otsuji Comparison of acute and chronic impact of adaptive servo-ventilation on left chamber geometry and function in patients with chronic heart failure Eur J Heart Fail, October 1, 2011; 13(10): 1140 - 1146. [Abstract] [Full Text] [PDF]

				B. R. Lindman, S. V. Arnold, J. A. Madrazo, A. Zajarias, S. N. Johnson, J. E. Perez, and D. L. Mann The Adverse Impact of Diabetes Mellitus on Left Ventricular Remodeling and Function in Patients With Severe Aortic Stenosis Circ Heart Fail, May 1, 2011; 4(3): 286 - 292. [Abstract] [Full Text] [PDF]

				F. Levy, J. Luc Monin, D. Rusinaru, H. Petit-Eisenmann, C. Lelguen, C. Chauvel, C. Adams, D. Metz, F. Leleu, P. Gueret, et al. Valvuloarterial impedance does not improve risk stratification in low-ejection fraction, low-gradient aortic stenosis: results from a multicentre study Eur Heart J Cardiovasc Imaging, May 1, 2011; 12(5): 358 - 363. [Abstract] [Full Text] [PDF]

				P. Lancellotti and J. Magne Valvuloarterial impedance in aortic stenosis: look at the load, but do not forget the flow Eur Heart J Cardiovasc Imaging, May 1, 2011; 12(5): 354 - 357. [Full Text] [PDF]

				N. Jander, J. Minners, I. Holme, E. Gerdts, K. Boman, P. Brudi, J. B. Chambers, K. Egstrup, Y. A. Kesaniemi, W. Malbecq, et al. Outcome of Patients With Low-Gradient "Severe" Aortic Stenosis and Preserved Ejection Fraction Circulation, March 1, 2011; 123(8): 887 - 895. [Abstract] [Full Text] [PDF]

				G. Cioffi, P. Faggiano, E. Vizzardi, L. Tarantini, D. Cramariuc, E. Gerdts, and G. de Simone Prognostic effect of inappropriately high left ventricular mass in asymptomatic severe aortic stenosis Heart, February 15, 2011; 97(4): 301 - 307. [Abstract] [Full Text] [PDF]

				P. Lancellotti, E. Donal, J. Magne, M. Moonen, K. O'Connor, J.-C. Daubert, and L. A. Pierard Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay Heart, September 1, 2010; 96(17): 1364 - 1371. [Abstract] [Full Text] [PDF]

				P. Lancellotti, E. Donal, J. Magne, K. O'Connor, M. L. Moonen, B. Cosyns, and L. A. Pierard Impact of global left ventricular afterload on left ventricular function in asymptomatic severe aortic stenosis: a two-dimensional speckle-tracking study Eur Heart J Cardiovasc Imaging, July 1, 2010; 11(6): 537 - 543. [Abstract] [Full Text] [PDF]

				R. Rajani, H. Rimington, and J. B. Chambers Treadmill exercise in apparently asymptomatic patients with moderate or severe aortic stenosis: relationship between cardiac index and revealed symptoms Heart, May 1, 2010; 96(9): 689 - 695. [Abstract] [Full Text] [PDF]

				A. Page, J. G. Dumesnil, M. A. Clavel, K. L. Chan, K. K. Teo, J. W. Tam, P. Mathieu, J. P. Despres, P. Pibarot, and on behalf of the ASTRONOMER Investigators Metabolic Syndrome Is Associated With More Pronounced Impairment of Left Ventricle Geometry and Function in Patients With Calcific Aortic Stenosis: A Substudy of the ASTRONOMER (Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin) J. Am. Coll. Cardiol., April 27, 2010; 55(17): 1867 - 1874. [Abstract] [Full Text] [PDF]

				J. G. Dumesnil and P. Pibarot Reply. J. Am. Coll. Cardiol., March 16, 2010; 55(11): 1165 - 1166. [Full Text] [PDF]

				A. Vahanian and C. M. Otto Risk stratification of patients with aortic stenosis Eur. Heart J., February 2, 2010; 31(4): 416 - 423. [Abstract] [Full Text] [PDF]

				J. G. Dumesnil, P. Pibarot, and B. Carabello Paradoxical low flow and/or low gradient severe aortic stenosis despite preserved left ventricular ejection fraction: implications for diagnosis and treatment Eur. Heart J., February 1, 2010; 31(3): 281 - 289. [Abstract] [Full Text] [PDF]

				D. Cramariuc, E. Gerdts, E. S. Davidsen, L. Segadal, and K. Matre Myocardial deformation in aortic valve stenosis: relation to left ventricular geometry Heart, January 15, 2010; 96(2): 106 - 112. [Abstract] [Full Text] [PDF]

				M. K. Poulsen, J. E. Henriksen, J. Dahl, A. Johansen, O. Gerke, W. Vach, T. Haghfelt, P. F. Hoilund-Carlsen, H. Beck-Nielsen, and J. E. Moller Left Ventricular Diastolic Function in Type 2 Diabetes Mellitus: Prevalence and Association With Myocardial and Vascular Disease Circ Cardiovasc Imaging, January 1, 2010; 3(1): 24 - 31. [Abstract] [Full Text] [PDF]

				V. Delgado, L. F. Tops, R. J. van Bommel, F. van der Kley, N. A. Marsan, R. J. Klautz, M. I.M. Versteegh, E. R. Holman, M. J. Schalij, and J. J. Bax Strain analysis in patients with severe aortic stenosis and preserved left ventricular ejection fraction undergoing surgical valve replacement Eur. Heart J., December 2, 2009; 30(24): 3037 - 3047. [Abstract] [Full Text] [PDF]

				Z. Hachicha, J. G. Dumesnil, and P. Pibarot Usefulness of the Valvuloarterial Impedance to Predict Adverse Outcome in Asymptomatic Aortic Stenosis J. Am. Coll. Cardiol., September 8, 2009; 54(11): 1003 - 1011. [Abstract] [Full Text] [PDF]

				D. Cramariuc, G. Cioffi, A. E. Rieck, R. B. Devereux, E. M. Staal, S. Ray, K. Wachtell, and E. Gerdts Low-Flow Aortic Stenosis in Asymptomatic Patients: Valvular-Arterial Impedance and Systolic Function From the SEAS Substudy J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 390 - 399. [Abstract] [Full Text] [PDF]

				P. Pibarot and J. G. Dumesnil Aortic Stenosis: Look Globally, Think Globally J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 400 - 403. [Full Text] [PDF]

				W. K. Laskey, W. G. Kussmaul III, and A. Noordergraaf Systemic Arterial Response to Exercise in Patients With Aortic Valve Stenosis Circulation, February 24, 2009; 119(7): 996 - 1004. [Abstract] [Full Text] [PDF]

				H. Baumgartner, J. Hung, J. Bermejo, J. B. Chambers, A. Evangelista, B. P. Griffin, B. Iung, C. M. Otto, P. A. Pellikka, and M. Quinones Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice Eur Heart J Cardiovasc Imaging, January 1, 2009; 10(1): 1 - 25. [Full Text] [PDF]

				E. B. Savage, R. S. Farivar, and E. J. Okum Cardiac Surgical Physiology Card. Surg. Adult, January 1, 2008; 3(2008): 51 - 76. [Full Text]

				P. Pibarot and J. G Dumesnil Assessment of aortic stenosis severity: check the valve but don't forget the arteries! Heart, July 1, 2007; 93(7): 780 - 782. [Full Text] [PDF]

				Z. Hachicha, J. G. Dumesnil, P. Bogaty, and P. Pibarot Paradoxical Low-Flow, Low-Gradient Severe Aortic Stenosis Despite Preserved Ejection Fraction Is Associated With Higher Afterload and Reduced Survival Circulation, June 5, 2007; 115(22): 2856 - 2864. [Abstract] [Full Text] [PDF]

				N. C Van Pelt, R. A H Stewart, M. E Legget, G. A Whalley, S. P Wong, I. Zeng, M. Oldfield, and A. J Kerr Longitudinal left ventricular contractile dysfunction after exercise in aortic stenosis Heart, June 1, 2007; 93(6): 732 - 738. [Abstract] [Full Text] [PDF]

				K. K Stout and C. M Otto Pregnancy in women with valvular heart disease Heart, May 1, 2007; 93(5): 552 - 558. [Abstract] [Full Text] [PDF]

				K. K. Stout and C. M. Otto Indications for Aortic Valve Replacement in Aortic Stenosis J Intensive Care Med, January 1, 2007; 22(1): 14 - 25. [Abstract] [PDF]

				C. M. Otto Valvular Aortic Stenosis: Disease Severity and Timing of Intervention J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2141 - 2151. [Abstract] [Full Text] [PDF]

				J. G. Dumesnil and P. Pibarot Prosthesis-patient mismatch and clinical outcomes: The evidence continues to accumulate J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 952 - 955. [Full Text] [PDF]

				K. L. Peterson Severe Calcific Aortic Stenosis: Left Ventricular Afterload and its Quantification J. Am. Coll. Cardiol., July 19, 2005; 46(2): 299 - 301. [Full Text] [PDF]