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Brachial artery diameter has a predictive value in the improvement of flow-mediated dilation after aortic valve replacement for aortic stenosis

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Abstract

Aortic stenosis (AS) is the most common valvular disease and aortic valve replacement (AVR) is one of its most effective interventions. AS affects not only the left ventricle, but also vascular function beyond the stenotic valve, which can lead to various types of vascular dysfunction. However, research evaluating the effect of AS on aortic vascular function is limited. In this study, we investigated clinical meaning to evaluate endothelial function in subjects with AS. From April 2011 to April 2012, 20 consecutive adult patients with degenerative AS (mean age, 74.7 ± 7.4 years; range 50–83 years) who underwent AVR at our institution were included in the study. We measured flow-mediated dilation (FMD) to evaluate the effect of AS on endothelial function. The difference between brachial artery diameter (BAD) before (4.0 ± 0.7 mm) and after AVR (3.9 ± 0.6 mm) was not significant (p = 0.043), but FMD significantly improved after AVR (from 3.1 ± 1.8 to 6.0 ± 2.7 %, p < 0.0001). We also analyzed FMD × BAD index, endogenous vasodilatory capability independent of BAD, resulting that it also significantly increased after AVR (12.3 ± 7.0–22.5 ± 9.3, p < 0.0001). We divided patients into two groups by pre- to post-AVR change in FMD (ΔFMD); large-ΔFMD group [ΔFMD >3.0 % (median value)] and small-ΔFMD group (ΔFMD <3.0 %). There were no significant changes in age, blood pressure, heart rate, B-type natriuretic peptide, or echocardiographic parameters in either group. In contrast, BAD was significantly larger in the small ΔFMD group (4.3 ± 0.7 mm) than in the large ΔFMD group (3.7 ± 0.7 mm) (p = 0.030). In addition, cardio-thoracic ratio was significantly greater in the small ΔFMD group (58.4 ± 7.1 %) than in the large ΔFMD group (53.7 ± 4.6 %) (p = 0.048). Receiver operating characteristic curve analysis of BAD to differentiate large and small ΔFMD demonstrated an area under the curve of 0.750 (p = 0.059) and that optimal cutoff for BAD was 4.28 mm (70 % sensitivity, 80 % specificity). AVR in subjects with AS is associated with a significant improvement in FMD in the brachial artery. Measurement of the BAD may be helpful in distinguishing whether the impairment of FMD in AS derives from a stenotic valve or vascular remodeling.

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References

  1. Blais C, Pibarot P, Dumesnil JG, Garcia D, Chen D, Durand LG (2001) Comparison of valve resistance with effective orifice area regarding flow dependence. Am J Cardiol 88:45–52

    Article  CAS  PubMed  Google Scholar 

  2. Bermejo J, Odreman R, Feijoo J, Moreno MM, Gomez-Moreno P, Garcia-Fernandez MA (2003) Clinical efficacy of Doppler-echocardiographic indices of aortic valve stenosis: a comparative test-based analysis of outcome. J Am Coll Cardiol 41:142–151

    Article  PubMed  Google Scholar 

  3. Bonow RO, Carabello B, De Leon AC Jr., Edmunds LH Jr., Fedderly BJ, Freed MD, Gaasch WH, Mckay CR, Nishimura RA, O’gara PT, O’rourke RA, Rahimtoola SH, Ritchie JL, Cheitlin MD, Eagle KA, Gardner TJ, Garson A Jr., Gibbons RJ, Russell RO, Ryan TJ, Smith SC Jr. (1998) Guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). Circulation 98:1949–1984

  4. Briand M, Dumesnil JG, Kadem L, Tongue AG, Rieu R, Garcia D, Pibarot P (2005) Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment. J Am Coll Cardiol 46:291–298

    Article  PubMed  Google Scholar 

  5. Garcia D, Barenbrug PJ, Pibarot P, Dekker AL, Van Der Veen FH, Maessen JG, Dumesnil JG, Durand LG (2005) A ventricular-vascular coupling model in presence of aortic stenosis. Am J Physiol Heart Circ Physiol 288:H1874–H1884

    Article  CAS  PubMed  Google Scholar 

  6. Rieck AE, Cramariuc D, Boman K, Gohlke-Barwolf C, Staal EM, Lonnebakken MT, Rossebo AB, Gerdts E (2012) Hypertension in aortic stenosis: implications for left ventricular structure and cardiovascular events. Hypertension 60:90–97

    Article  CAS  PubMed  Google Scholar 

  7. Yamaura Y, Nishida T, Watanabe N, Akasaka T, Yoshida K (2004) Relation of aortic valve sclerosis to carotid artery intima-media thickening in healthy subjects. Am J Cardiol 94:837–839

    Article  PubMed  Google Scholar 

  8. Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS (1999) Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 341:142–147

    Article  CAS  PubMed  Google Scholar 

  9. Aronow WS, Ahn C, Shirani J, Kronzon I (1998) Comparison of frequency of new coronary events in older persons with mild, moderate, and severe valvular aortic stenosis with those without aortic stenosis. Am J Cardiol 81:647–649

    Article  CAS  PubMed  Google Scholar 

  10. Takata M, Amiya E, Watanabe M, Omori K, Imai Y, Fujita D, Nishimura H, Kato M, Morota T, Nawata K, Ozeki A, Watanabe A, Kawarasaki S, Hosoya Y, Nakao T, Maemura K, Nagai R, Hirata Y, Komuro I (2013) Impairment of flow-mediated dilation correlates with aortic dilation in patients with Marfan syndrome. Heart Vessels. doi:10.1007/s00380-013-0393-

    Google Scholar 

  11. Kodali SK, Moses JW (2012) Coronary artery disease and aortic stenosis in the transcatheter aortic valve replacement era: old questions, new paradigms: the evolving role of percutaneous coronary intervention in the treatment of patients with aortic stenosis. Circulation 125:975–977

    Article  PubMed  Google Scholar 

  12. Watanabe S, Amiya E, Watanabe M, Takata M, Ozeki A, Watanabe A, Kawarasaki S, Nakao T, Hosoya Y, Omori K, Maemura K, Komuro I, Nagai R (2013) Simultaneous heart rate variability monitoring enhances the predictive value of flow-mediated dilation in ischemic heart disease. Circ J 77:1018–1025

    Article  CAS  PubMed  Google Scholar 

  13. Mizia-Stec K, Gasior Z, Mizia M, Haberka M, Holecki M, Zwolińska W, Katarzyna K, Skowerski M (2007) Flow-mediated dilation and gender in patients with coronary artery disease: arterial size influences gender differences in flow-mediated dilation. Echocardiography 10:1051–1057

    Article  Google Scholar 

  14. Freeman RV, Otto CM (2005) Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies. Circulation 111:3316–3326

    Article  PubMed  Google Scholar 

  15. Otto CM, Kuusisto J, Reichenbach DD, Gown AM, O’brien KD (1994) Characterization of the early lesion of ‘degenerative’ valvular aortic stenosis. Circulation 90:844–853

    Article  CAS  PubMed  Google Scholar 

  16. Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM (1997) Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol 29:630–634

    Article  CAS  PubMed  Google Scholar 

  17. Gotoh T, Kuroda T, Yamasawa M, Nishinaga M, Mitsuhashi T, Seino Y, Nagoh N, Kayaba K, Yamada S, Matsuo H (1995) Correlation between lipoprotein (a) and aortic valve sclerosis assessed by echocardiography (the JMS Cardiac Echo and Cohort Study). Am J Cardiol 76:928–932

    Article  CAS  PubMed  Google Scholar 

  18. Rossi A, Faggiano P, Amado AE, Cicoira M, Bonapace S, Franceschini L, Dini FL, Ghio S, Agricola E, Temporelli PL, Vassanelli C (2013) Mitral and aortic valve sclerosis/calcification and carotid atherosclerosis: results from 1065 patients. Heart Vessels. doi:10.1007/s00380-013-0433-z

    Google Scholar 

  19. Chenevard R, Bechir M, Hurlimann D, Ruschitzka F, Turina J, Luscher TF, Noll G (2006) Persistent endothelial dysfunction in calcified aortic stenosis beyond valve replacement surgery. Heart 92:1862–1863

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Poggianti E, Venneri L, Chubuchny V, Jambrik Z, Baroncini LA, Picano E (2003) Aortic valve sclerosis is associated with systemic endothelial dysfunction. J Am Coll Cardiol 41:136–141

    Article  PubMed  Google Scholar 

  21. Schumm J, Luetzkendorf S, Rademacher W, Franz M, Schmidt-Winter C, Kiehntopf M, Figulla HR, Brehm BR (2011) In patients with aortic stenosis increased flow-mediated dilation is independently associated with higher peak jet velocity and lower asymmetric dimethylarginine levels. Am Heart J 161:893–899

    Article  CAS  PubMed  Google Scholar 

  22. Rosca M, Magne J, Calin A, Popescu BA, Pierard LA, Lancellotti P (2011) Impact of aortic stiffness on left ventricular function and B-type natriuretic peptide release in severe aortic stenosis. Eur J Echocardiogr 12:850–856

    Article  PubMed  Google Scholar 

  23. Fang ZY, Marwick TH (2002) Vascular dysfunction and heart failure: epiphenomenon or etiologic agent? Am Heart J 143:383–390

    Article  CAS  PubMed  Google Scholar 

  24. Hildick-Smith DJ, Shapiro LM (2000) Coronary flow reserve improves after aortic valve replacement for aortic stenosis: an adenosine transthoracic echocardiography study. J Am Coll Cardiol 36:1889–1896

    Article  CAS  PubMed  Google Scholar 

  25. Chiu JJ, Chien S (2011) Effects of disturbed flow on vascular endothelium: pathophysiological basis and clinical perspectives. Physiol Rev 91:327–387

    Article  PubMed  Google Scholar 

  26. Cheng C, Tempel D, Van Haperen R, Van Der Baan A, Grosveld F, Daemen MJ, Krams R, De Crom R (2006) Atherosclerotic lesion size and vulnerability are determined by patterns of fluid shear stress. Circulation 113:2744–2753

    Article  PubMed  Google Scholar 

  27. Phinikaridou A, Hua N, Pham T, Hamilton JA (2013) Regions of low endothelial shear stress colocalize with positive vascular remodeling and atherosclerotic plaque disruption: an in vivo magnetic resonance imaging study. Circ Cardiovasc Imaging 6:302–310

    Article  PubMed  Google Scholar 

  28. Holubkov R, Karas RH, Pepine CJ, Rickens CR, Reichek N, Rogers WJ, Sharaf BL, Sopko G, Merz CN, Kelsey SF, Mcgorray SP, Reis SE (2002) Large brachial artery diameter is associated with angiographic coronary artery disease in women. Am Heart J 143:802–807

    Article  PubMed  Google Scholar 

  29. Dibble CT, Shimbo D, Barr RG, Bagiella E, Chahal H, Ventetuolo CE, Herrington DM, Lima JA, Bluemke DA, Kawut SM (2012) Brachial artery diameter and the right ventricle: the Multi-Ethnic Study of Atherosclerosis-right ventricle study. Chest 142:1399–1405

    Article  PubMed Central  PubMed  Google Scholar 

  30. Fukuta H, Ohte N, Brucks S, Carr JJ, Little WC (2007) Contribution of right-sided heart enlargement to cardiomegaly on chest roentgenogram in diastolic and systolic heart failure. Am J Cardiol 99:62–67

    Article  PubMed  Google Scholar 

  31. Benjamin EJ, Larson MG, Keyes MJ, Mitchell GF, Vasan RS, Keaney JF Jr, Lehman BT, Fan S, Osypiuk E, Vita JA (2004) Clinical correlates and heritability of flow-mediated dilation in the community: the Framingham Heart Study. Circulation 109:613–619

    Article  PubMed  Google Scholar 

  32. Ras RT, Streppel MT, Draijer R, Zock PL (2013) Flow-mediated dilation and cardiovascular risk prediction: a systematic review with meta-analysis. Int J Cardiol 168:344–351

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported by the Japan Society for the Promotion of Science (JSPS) through the Funding Program for World-Leading Innovative R&D on Science and Technology (FIRST) program.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku Tokyo, 113-8655, Tokyo, Japan

    Munenori Takata, Eisuke Amiya, Masafumi Watanabe, Atsuko Ozeki, Aya Watanabe, Shuichi Kawarasaki, Tomoko Nakao, Yumiko Hosoya & Issei Komuro

  2. Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo, Tokyo, Japan

    Kansei Uno

  3. Department of Cardiothoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Aya Saito & Minoru Ono

  4. Department of Medical Engineering, The University of Tokyo, Tokyo, Japan

    Takahide Murasawa

  5. Jichi Medical School, Shimotsuke, Japan

    Ryozo Nagai

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  1. Munenori Takata
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  2. Eisuke Amiya
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Correspondence to Eisuke Amiya.

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Takata, M., Amiya, E., Watanabe, M. et al. Brachial artery diameter has a predictive value in the improvement of flow-mediated dilation after aortic valve replacement for aortic stenosis. Heart Vessels 30, 218–226 (2015). https://doi.org/10.1007/s00380-014-0475-x

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