Transcatheter Aortic Valve Replacement (Tavr) Leads To An Increase In The Subendocardial Viability Ratio Assessed By Pulse Wave Analysis

BackgroundPulse wave analysis (PWA) is a useful tool for non-invasive assessment of central cardiac measures as subendocardial perfusion (Subendocardial Viability Ratio, SEVR) or contractility (dP/dt(max)). The immediate influence of transcatheter aortic valve replacement (TAVR) on these indices has not been investigated yet.MethodsWe prospectively enrolled 40 patients presenting with severe aortic stenosis receiving TAVR. Central pressure curves were derived from radial and carotid sites using PWA up to 2 days before and 7 days after TAVR. Parameters were compared between peripheral measurement sites. Changes in SEVR, dP/dt(max) and in indices of vascular stiffness were assessed. Additionally, association of these variables with clinical outcome was evaluated during a 12-month follow-up.ResultsCentral waveform parameters were comparable between measurement sites. SEVR, but not dP/dt(max), augmentation Index (AIx) or augmentation pressure height (AGPH) correlated significantly with disease severity reflected by peak transvalvular velocity and mean transvalvular pressure gradient over the aortic valve (V-max, Delta Pm) [r = -0.372,p = 0.029 for V-max and r = -0.371,p = 0.021 for Delta Pm]. V-max decreased from 4.5m/s (IQR:4.1-5.0) to 2.2m/s (IQR:1.9-2.7), (p<0.001). This resulted in a significant increase in SEVR [135.3%(IQR: 115.5-150.8) vs. 140.3%(IQR:123.0-172.5),p= 0.039] and dP/dt(max) [666mmHg(IQR:489-891) vs. 927mmHg(IQR:693-1092),p<0.001], and a reduction in AIx [154.8%(IQR:138.3-171.0) vs. 133.5%(IQR:128.3-151.8),p<0.001] and AGPH [34.1%(IQR:26.8-39.0) vs. 25.0%(IQR 21.8-33.7),p = 0.002], confirming the beneficial effects of replacing the stenotic valve. No association of these parameters could be revealed with outcome.ConclusionsPWA is suitable for assessing coronary microcirculation and contractility mirrored by SEVR and (max)dP/dt in the setting of aortic stenosis. PWA parameters attributed to vascular properties should be interpreted with caution.