Hypertension and transcatheter aortic valve replacement: parallel or series?

Figures & data

Figure 1 Direct and indirect effects of age on ventricular valvular vessel interactions.

Abbreviations: ECM, extracellular matrix; LV, left ventricle.

Table 1 Prevalence and prognosis and percentage of patients with severe AS

	High gradient (mean >40 mmHg)	Low gradient (mean <40 mmHg)
Normal flow (SV >35 mL/m^2) A) Prevalence B) Prognosis (2-year survival rates)	30%–62.7% 44% ± 6% (highest rates of surgery)	15.3%–38% 83% ± 6% (best prognosis)
Low flow (SV <35 mL/m^2) A) Prevalence B) Prognosis (2-year survival rates)	8%–13.2% 30% ± 12%	8.8%–24% 27% ± 13% (worst prognosis) (lowest rates of surgery)

Abbreviations: AS, aortic stenosis; SV, stroke volume.

Table 2 Hemodynamic changes post TAVR

First author, year	Time post TAVR	Techniques used for measuring hemodynamic parameters	SBP	MAP	Pulse pressure	Cardiac output/cardiac index	LVEF	Stroke volume/SVi (indexed)	ZVa
Giannini,^Citation18 2012	Within 10–15 minutes	Invasive (cardiac catheterization) and Echocardiography	↑	↓	↑	↑(Mild)	↑	↑ (Mild)	↓
Di Bello,^Citation19 2012	Within 10–15 minutes	Invasive hemodynamics and Echocardiography	↑	↓	↑	↑	↑	↑
Yotti,^Citation15 2015	30 minutes	Invasive (high fidelity sensors and wave intensity analyses)	↑	↑	↑	↓		↓	No acute change
Perlman,^Citation16 2013	5 days	TTE	↑		↑	↑		↑
Vavuranakis,^Citation21 2012	7 days	TTE	↓	↓	↑
Lindman,^Citation43 2017	30 days and 6 months	TTE	↑		↑			↑	↓
Katsanos,^Citation22 2013	30 days and 1 year	TTE						No significant change	↓

Abbreviations: LVEF, left ventricular ejection fraction; MAP, mean arterial pressure; SBP, systolic blood pressure; SVi, stroke volume indexed to body surface area; TAVR, transcatheter aortic valve replacement; TTE, transthoracic echocardiography; ZVa, valvuloarterial impedance.

Table 3 Hemodynamic changes post SAVR

First author, year	Time post SAVR	Technique used for measuring hemodynamic parameters	SBP	MAP	Pulse pressure	Cardiac output/cardiac index	LVEF	Stroke volume/SVi (indexed)	ZVa
Pagel,^Citation25 2014	15 minutes after cardiopulmonary bypass	TEE	No change	No change	No change	No change	No change	No change	↓
Ito,^Citation26 2017	Before discharge and 6 months post procedure	TTE		No change					↓

Abbreviations: LVEF, left ventricular ejection fraction; MAP, mean arterial pressure; SAVR, surgical aortic valve replacement; SBP, systolic blood pressure; SVi, stroke volume indexed to body surface area; TEE, trans-esophageal echocardiography; TTE, transthoracic echocardiography; ZVa, valvuloarterial impedance.

Table 4 Studies of valvuloarterial impedance (Z_va) in aortic stenosis patients

First author, year	Total number of patients studied, N	Severity of AS in study population at baseline	Baseline LVEF, % (mean ± SD)	Mean follow-up		Technique	Main findings (ZVa values are described in mmHg/ml/m^2)
ZVa and cardiac remodeling in AS
Jang,^Citation29 2016	453	Severe	58.7±12.1	3.5 years		TTE	Pre-SAVR ZVa (mean of 5.9) correlated with decrease in LV mass index
Ito,^Citation26 2017	23	Severe	61.5±11.5	26.5±10.7 months		TTE	Post TAVR ZVa (from 5.05 pre-procedure to 3.12 post-procedure) predicted LV mass index regression
Maréchaux,^Citation13 2010	82	AV stenosis, defined by peak aortic velocity >2.5 m/s	64±7	–		TTE with 2-D speckle tracking	Higher ZVa associated with impairment in global longitudinal strain
Lancellotti,^Citation30 2010	173	Severe	66.5±7.3	–		TTE with 2-D speckle tracking	High ZVa (≥5) associated with worse circumferential strain
Holmes,^Citation32 2015	82	Severe	66±9	33±17 months		TTE with 2-D speckle tracking	High LV apical rotation (torsion) associated with high ZVa (5.03) and poor survival.
Cramariuc,^Citation31 2009	1,591	AS defined as AV thickening accompanied by a peak transaortic velocity ≥2.5 and≤4.0 m/s	66±7	–		TTE	High ZVa (≥4.48) was associated with decreased stress- corrected midwall shortening
ZVa in Asymptomatic AS patients
Ramamurthi,^Citation34 2013	215	Moderate and severe		–		TTE	Higher number of symptomatic patients had increased ZVa (>5) compared with asymptomatic patients
Zito,^Citation35 2011	52	Severe	61±5	11±7.5 months		TTE	ZVa (>4.7) predicted onset of symptoms (dyspnea, angina, syncope), AVR, death
Lancellotti,^Citation36 2010	163	Moderate to severe	66+9	20±19 months		TTE	ZVa (≥4.9) predicted onset of symptoms, AVR, death
Hachicha,^Citation37 2009	544	At least moderate, defined as peak velocity >2.5 m/s	66±7	2.5±1.8 years		TTE	Higher ZVa (≥3.5) was associated with increased mortality when compared with ZVa <3.5
Rieck,^Citation33 2012	1,418	Mild to moderate	66±7	43±14 months		TTE	High ZVa (>5) predicted increased major cardiovascular events and aortic valve events, but did not predict survival
Magne,^Citation38 2015	676	Severe, defined as AV area ≤1 cm^2, derived from cardiac catheterization using Gorlin equation	72±10	4.5±2.9 years	Cardiac catheterization		High ZVa (>5) was significantly associated with increased mortality
ZVa and Symptoms
Harada,^Citation42 2013	451	Moderate to severe	62.6±10.3	–	TTE		Higher ZVa (≥4.7) was associated with increased risk of syncope
Kruszelnicka et al, 2015^Citation40	157	Moderate to severe	52.3±12	–	TTE		Mean ZVa by HF class: No symptoms: 5.1 NYHA II: 5.2 NYHA III-IV: 5.7 Each decrease in SAC by 0.1 mL/m^2 per mmHg was associated with an increased adjusted odds ratio of a patient being in one higher category of NYHA class
ZVa and mortality
Lindman,^Citation43 2017	2,141	Severe	54±11	30 days to 1 year	TTE		Increased risk of mortality with every 1 unit increase in ZVa (baseline mean ZVa 3.99)
Giannini,^Citation18 2012	102	Severe	48.9±10.3	6 months post TAVR	TTE		Increased mortality with higher baseline ZVa (8.13 vs 6.41)
Kobayashi,^Citation23 2017	128	Severe	54±13	376 days	TTE		High baseline ZVa (>5) was associated with higher mortality
Katsanos,^Citation22 2013	116	Severe	54±14	25 months	TTE		Baseline ZVa (≥5) associated with increased all-cause mortality
Katayama,^Citation44 2015	177	Severe	65±6.5	5 years post SAVR	TTE		Baseline high ZVa (≥4.3) was not associated with overall mortality.
ZVa in low flow, low gradient AS
Ngiam,^Citation47 2017	203	Severe	64±12.5	3±2 years		TTE	High initial ZVa (>4.7) was associated with switch from normal flow to low flow category
Herrmann,^Citation48 2015	77	Any AS (non- severe and severe)	Any LVEF	3.3±1.7 years		TTE with 2D speckle tracking	ZVa was elevated at baseline in the LF–LG group compared with NF/LG and HG/AS groups (LF/LG, 3.2±0.8; NF/LG, 2.2±0.5; HG/AS, 2.2±0.9)
Mizia-Stec,^Citation49 2011	44	Severe AS	>50	–		TTE	ZVa was higher in patients with SVI <35 mL/m^2 (7.60) compared with those with SVI ≥35 mL/m^2 (4.06)
Levy,^Citation51 2011	184	Severe low flow low gradient	29±7	5 years		TTE, DSE	ZVa was higher in patients with contractile reserve vs without on DSE (5.8 vs 5.3), however, failed to distinguish pseudo vs true severe AS nor predict mortality after AVR
Lancellotti,^Citation30 2010	173	Severe AS	66.5±7.3	–		TTE with 2D speckle tracking	Higher prevalence of elevated ZVa (≥5) in low flow group compared with normal flow
Hachicha,^Citation50 2007	512	Severe	65±7.5	25±19 months		TTE	Higher ZVa (>5.5) was associated with increased mortality

Abbreviations: AS, aortic stenosis; AV, aortic valve; DSE, dobutamine stress echocardiography; HG/AS, high gradient, aortic stenosis; LF–LG, low flow, low gradient; LV, left ventricle; LVEF, left ventricular ejection fraction; NF/LG, normal flow, low gradient; SAVR, surgical aortic valve replacement; TAVR, transcatheter aortic valve replacement; TTE, transthoracic echocardiography; ZVa, valvuloarterial impedance.

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