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Hypertension and transcatheter aortic valve replacement: parallel or series?

Authors Tiwari N, Madan N

Received 16 June 2018

Accepted for publication 24 October 2018

Published 23 November 2018 Volume 2018:11 Pages 81—91


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Editor who approved publication: Professor Turgay Celik

Nidhish Tiwari,1,2 Nidhi Madan3

1Department of Internal Medicine, Jacobi Medical Center, Bronx, NY, USA; 2Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; 3Department of Cardiology, Rush University Medical Center, Chicago, IL, USA

Abstract: Aortic stenosis (AS) is the most common valvular heart disease in the elderly and it causes significant morbidity and mortality. Hypertension is also highly prevalent in elderly patients with AS, and AS patients with hypertension have worse outcomes. Accurate assessment of AS severity and understanding its relationship with arterial compliance has become increasingly important as the options for valve management, particularly transcatheter interventions, have grown. The parameters used for quantifying stenosis severity have traditionally mainly focused on the valve itself. However, AS is now recognized as a systemic disease involving aging ventricles and stiff arteries rather than one limited solely to the valve. Over the last decade, valvuloarterial impedance, a measure of global ventricular load, has contributed to our understanding of the pathophysiology and course of AS in heterogeneous patients, even when segregated by symptoms and severity. This review summarizes our growing understanding of the interplay between ventricle, valve, and vessel, with a particular emphasis on downstream vascular changes after transcatheter aortic valve replacement and the role of valvuloarterial impedance in predicting left ventricular changes and prognosis in patients with various transvalvular flow patterns.

Keywords: aortic stenosis, transcatheter aortic valve replacement, global ventricular load, ventriculoarterial coupling, arterial compliance, valvuloarterial impedance

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