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Prognostic value of brachial–ankle pulse wave velocity changes post-transcatheter aortic valve replacement

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Abstract

Transcatheter aortic valve replacement (TAVR) offers a solution, especially for high-risk aortic stenosis (AS) patients. However, patient outcomes post-TAVR show variability, highlighting the need for reliable prognostic indicators. Brachial–ankle pulse wave velocity (baPWV), a measure of arterial stiffness, may predict outcomes post-TAVR. This study aims to explore baPWV’s prognostic value in relation to all-cause mortality post-TAVR. This study prospectively enrolled 212 severe AS patients undergoing TAVR between September 2015 and December 2021, focusing on pre- and post-TAVR baPWV measurements to explore associations with all-cause mortality. Of the 212 patients (119 females, 93 males, mean age 85 years), post-TAVR baPWV increased significantly from 1589 ± 376 to 2010 ± 521 cm/s (p < 0.001). Aortic valve (AV) peak velocity and mean pressure gradient decreased, while AV area increased, indicating procedural success. Despite this, 88% of patients experienced an increase in baPWV, with higher pre-procedure AV peak velocity and mean pressure gradient identified as predictors of increased baPWV post-TAVR. Over 23 months, 29 patients (14%) reached the primary endpoint of all-cause mortality. Notably, changes in baPWV, rather than baseline values, were significantly associated with event-free survival (HR: 0.64 per 1SD increase, p = 0.009). The study highlights the prognostic value of baPWV changes post-TAVR in predicting patient outcomes. Elevated baPWV post-TAVR may reflect a beneficial adaptation to altered hemodynamics, suggesting the need for individualized patient evaluation and the integration of baPWV measurements into clinical practice for improved post-TAVR management.

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Data availability

Data are available on reasonable request.

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Funding

This work was partially supported by JSPS Kakenhi Grants (23K07509 to K. Kusunose) and AMED grant (JP22uk1024007 to K. Kusunose). The funding source had no role in the design and conduction of the study, the collection, management, analysis, or interpretation of the data, the preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Nephrology, and Neurology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara Town, Okinawa, Japan

    Yuichiro Toma, Hidekazu Ikemiyagi, Shinya Shiohira, Haruno Nagata, Masashi Iwabuchi & Kenya Kusunose

  2. Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan

    Takaaki Nagano & Kojiro Furukawa

Authors
  1. Yuichiro Toma
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  2. Hidekazu Ikemiyagi
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  3. Shinya Shiohira
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  8. Kenya Kusunose
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Contributions

YT and KK conceived the idea for this study. YT conducted the data analyses. The initial draft of the manuscript was produced by YT and KK. All the authors were involved in interpreting the results and writing the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kenya Kusunose.

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The authors declare that they have no conflict of interest.

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The study was approved by the local ethics committee and Institutional Review Board of University of the Ryukyus (protocol: 23-2255-00-00-00).

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Kaplan–Meier curves (TIF 475 KB)

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Toma, Y., Ikemiyagi, H., Shiohira, S. et al. Prognostic value of brachial–ankle pulse wave velocity changes post-transcatheter aortic valve replacement. Heart Vessels (2024). https://doi.org/10.1007/s00380-024-02437-y

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