Patients with aortic stenosis exhibit early improved endothelial function following transcatheter aortic valve replacement: The eFAST study. (1st June 2021)

• Record Type: Journal Article
• Authors: Comella, Andrea; Michail, Michael; Chan, Jasmine; Cameron, James D.; Gooley, Robert; Mathur, Anthony; Hughes, Alun D.; Brown, Adam J.
• Is Part Of: International journal of cardiology. Volume 332(2021)
• Page Start: 143
• Page End: 147
• Publication Date: 2021-06-01
• Subjects: Transcatheter aortic valve replacement -- Aortic stenosis -- Endothelial dysfunction -- Flow mediated dilatation; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.03.062
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Patients with severe aortic stenosis (AS) exhibit systemic endothelial dysfunction, which can be associated with myocardial ischaemia in absence of obstructive coronary disease. Transcatheter aortic valve replacement (TAVR) is used to treat severe AS in patients with high or prohibitive surgical risk. However, it remains unknown whether endothelial function recovers post-TAVR. We therefore sought to assess the early and late changes in flow-mediated dilation (FMD), a measure of endothelial function, following TAVR. Methods: Patients undergoing TAVR for severe AS had ultrasound assessment of brachial endothelial-independent and -dependent FMD. Measurements were performed pre-TAVR, at early follow-up (<48 h post-TAVR) and late follow-up (4–6 weeks post-TAVR). Results: 27 patients (mean age 82.0 ± 7.0; 33.3% female) were recruited; 37.0% had diabetes mellitus and 59.3% had hypertension. Brachial artery FMD increased from 4.2 ± 1.6% (pre-TAVR) to 9.7 ± 3.5% at early follow-up ( p < 0.0001). At late follow-up, improvement compared with early follow-up was sustained (8.7 ± 1.9%, p = 0.27). Resting brachial arterial flow velocities decreased significantly at late follow-up (11.24 ± 5.16 vs. 7.73 ± 2.79 cm/s, p = 0.003). Concordantly, at late follow-up, there was decrease in resting wall shear stress (WSS; 14.8 ± 7.8 vs. 10.6 ± 4.8dyne/cm2, p = 0.01), peak WSS (73.1 ± 34.1 vs. 58.8 ± 27.8dyne/cm2, p = 0.03) and cumulative WSS (3543 ± 1852 vs. 2504 ± 1089dyne·s/cm 2, p = 0.002). Additionally, a favourable inverse correlation between cumulative WSS and FMD was restored at late follow-up ( r = −0.21 vs. r = 0.49). Conclusion: Endothelial function in patients with AS improves early post-TAVR and this improvement is sustained. This likely occurs as a result of improved arterial haemodynamics, leading to lower localised WSS and release of vasoactive mediators that may also alleviate myocardial ischaemia. Highlights: Endothelial dysfunction is common in patients with severe aortic stenosis. This study demonstrates early improvements in endothelial function post-TAVR. Importantly, improvements in endothelial function are sustained at late follow up. Improved endothelial function is likely related to the altered haemodynamics.