Short-term changes of blood pressure and aortic stiffness in older patients after transcatheter aortic valve implantation
Received 5 April 2019
Accepted for publication 29 June 2019
Published 2 August 2019 Volume 2019:14 Pages 1379—1386
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Richard Walker
Jeannette A Goudzwaard,1 Eleonora Disegna,1 Marjo JAG de Ronde-Tillmans,2 Mattie J Lenzen,2 Peter PT de Jaegere,2 Francesco US Mattace-Raso1
1Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands; 2Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
Background: Both aortic valve stenosis and aortic stiffness are moderators of arterio ventricular coupling and independent predictors of cardiovascular morbidity and mortality. Studies on the effect of transcatheter aortic valve implantation (TAVI) on aortic functional properties are limited. We performed a study to investigate the possible short-term changes in aortic stiffness and other aortic functional properties after TAVI in older patients.
Methods: TAVI Care&Cure is an observational ongoing study including consecutive patients undergoing a TAVI procedure. Central and peripheral hemodynamic measurements were measured non invasively 1 day before (T-1) and 1 day after (T+1) TAVI using a validated oscillometric method using a brachial cuff (Mobil-O-Graph).
Results: 40 patients were included. Mean aortic valve area at baseline was 0.76±0.24 cm2. Indices of severity of aortic valve stenosis improved significantly. Systolic blood pressure (SBP) dropped by 8.5%, from 130.3±22.9 mmHg to 119.5±15.8 mmHg (p=0.005). Diastolic blood pressure (DBP) dropped by 13.1% from 74.8±14.5 mmHg to 65.0±11.3 mmHg (p<0.001). The arterial pulse wave velocity (aPWV) decreased from 12.05±1.99 m/s to 11.6±1.56 m/s (p=0.006). Patients with high aPWV at baseline showed a significantly larger reduction in SBP in comparison to patients with low aPWV: – 20.3 mmHg (−14.1%) vs – 3.1 mmHg (−2.6%), respectively (p=0.033). The same trend was found for the DBP: −16.2 (−20.4%) vs −4.5 mmHg (−6.3%) for high vs low aPWV at baseline (p=0.037).
Conclusion: We found short-term changes in blood pressure and aortic stiffness after TAVI. The amplitude of the changes was the largest in patients with elevated aortic stiffness at baseline.
Keywords: aortic valve stenosis, aortic stiffness, blood pressure levels, TAVI