Background

Patients with degenerative aortic stenosis (AS) are often older and have systemic hypertension and atherosclerosis, which all lead to increased aortic stiffness. We aimed to assess the determinants of carotid-femoral pulse wave velocity (cf-PWV), a direct measure of aortic stiffness, and its association with revealed symptoms and clinical outcome in patients with AS.

Methods

We included 103 asymptomatic patients aged 66.6 ± 13.2 years (range 27–85 years, 69% males) with moderate (n = 50) and severe (n = 53) AS. All underwent a comprehensive echocardiography, exercise treadmill test (ETT) and assessment of aortic stiffness derived from cf-PWV by applanation tonometry.

Results

The mean cf-PWV was 10.6 ± 3.1 m/s and resting brachial blood pressure (BP) 139 ± 20/79 ± 11 mmHg. Increased cf-PWV (≥10 m/s) was found in 44% (n = 45) patients. Patients with moderate and severe AS had a similar degree of aortic stiffness (cf-PWV 10.7 ± 3.3 vs. 10.5 ± 3.0 m/s, p = 0.698). In a univariate logistic regression analysis, higher cf-PWV was not associated with revealed symptoms (odds ratio [OR] for 1SD higher cf-PWV 1.12; 95% CI 0.62–2.04, p = 0.706). In a multivariable linear regression analysis, age, resting brachial systolic BP and diabetes were associated with higher cf-PWV independent of antihypertensive treatment and left ventricular ejection fraction. The event-free survival was significantly lower in patients with cf-PWV ≥10 m/s compared to those with cf-PWV <10 m/s (p = 0.015).

Conclusion

Increased cf-PWV was common in patients with moderate or severe AS, and was associated with higher cardiovascular disease burden and impaired prognosis. cf-PWV did not correlate with the severity of AS or the frequencies of revealed symptoms by ETT.

中文翻译：

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中度或重度主动脉瓣狭窄患者主动脉僵硬度的决定因素和临床意义。

背景

退行性主动脉瓣狭窄 (AS) 患者通常年龄较大，患有全身性高血压和动脉粥样硬化，这些都会导致主动脉僵硬度增加。我们旨在评估颈股动脉脉搏波速度 (cf-PWV) 的决定因素，这是一种直接测量主动脉僵硬度的方法，以及它与 AS 患者所揭示的症状和临床结果的关联。

方法

我们纳入了 103 名年龄为 66.6 ± 13.2 岁（范围 27-85 岁，69% 为男性）患有中度（n = 50）和重度（n = 53）AS 的无症状患者。所有人都接受了全面的超声心动图、运动踏车试验 (ETT) 和通过压平眼压计评估源自 cf-PWV 的主动脉僵硬度。

结果

平均 cf-PWV 为 10.6 ± 3.1 m/s，静息肱动脉血压 (BP) 为 139 ± 20/79 ± 11 mmHg。在 44% (n = 45) 的患者中发现 cf-PWV (≥10 m/s) 增加。中度和重度 AS 患者的主动脉僵硬程度相似（cf-PWV 10.7 ± 3.3 vs. 10.5 ± 3.0 m/s，p = 0.698）。在单变量逻辑回归分析中，较高的 cf-PWV 与显露症状无关（1SD 较高 cf-PWV 的优势比 [OR] 为 1.12；95% CI 0.62–2.04，p = 0.706）。在多变量线性回归分析中，年龄、静息肱动脉收缩压和糖尿病与较高的 cf-PWV 相关，与抗高血压治疗和左心室射血分数无关。与 cf-PWV <10 m/s 的患者相比，cf-PWV ≥10 m/s 的患者的无事件生存期显着降低（p = 0.015）。

结论

增加的 cf-PWV 在中度或重度 AS 患者中很常见，并且与更高的心血管疾病负担和预后受损有关。cf-PWV 与 AS 的严重程度或 ETT 显示症状的频率无关。