title: Depressed Systemic Arterial Compliance is Associated with the Severity of Heart Failure Symptoms in Moderate-to-Severe Aortic Stenosis: a Cross-Sectional Retrospective Study.
abstract: BACKGROUND
  Patients with aortic stenosis (AS) may develop heart failure even in the absence of severe valve stenosis. Our aim was to assess the contribution of systemic arterial properties and the global left ventricular afterload to graded heart failure symptoms in AS.
  
  
  METHODS
  We retrospectively reviewed medical records of 157 consecutive subjects (mean age, 71±10 years; 79 women and 78 men) hospitalized owing to moderate-to-severe degenerative AS. Exclusion criteria included more than mild aortic insufficiency or disease of another valve, atrial fibrillation, coronary artery disease, severe respiratory disease or anemia. Heart failure symptoms were graded by NYHA class at admission. Systemic arterial compliance (SAC) and valvulo-arterial impedance (Zva) were derived from routine echocardiography and blood pressure.
  
  
  RESULTS
  Sixty-one patients were asymptomatic, 49 presented mild (NYHA II) and 47 moderate-to-severe (NYHA III-IV) heart failure symptoms. Mild symptoms were associated with lower SAC and transvalvular gradients, while more severe exercise intolerance coincided with older age, lower systolic blood pressure, smaller aortic valve area and depressed ejection fraction. By multiple ordinal logistic regression, the severity of heart failure symptoms was related to older age, depressed ejection fraction and lower SAC. Each decrease in SAC by 0.1 ml/m² per mmHg was associated with an increased adjusted odds ratio (OR) of a patient being in one higher category of heart failure symptoms graded as no symptoms, mild exercise intolerance and advanced exercise intolerance (OR: 1.16 [95% CI, 1.01-1.35], P=0.045).
  
  
  CONCLUSIONS
  Depressed SAC may enhance exercise intolerance irrespective of stenosis severity or left ventricular systolic function in moderate-to-severe AS. This finding supports the importance of non-valvular factors for symptomatic status in AS.
authors.affiliation: 1. Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College and John Paul II Hospital, Cracow, Poland.
authors.forename: Olga
authors.initials: O
authors.lastname: Kruszelnicka
authors.affiliation: 2. School of Medicine in English, Jagiellonian University Medical College, Cracow, Poland.
authors.forename: Mark
authors.initials: M
authors.lastname: Chmiela
authors.affiliation: 3. Second Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Medical College and University Hospital, Cracow, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Bobrowska
authors.affiliation: 3. Second Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Medical College and University Hospital, Cracow, Poland.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Świerszcz
authors.affiliation: 2. School of Medicine in English, Jagiellonian University Medical College, Cracow, Poland.
authors.forename: Seetha
authors.initials: S
authors.lastname: Bhagavatula
authors.affiliation: 4. Department of Electrocardiology, Jagiellonian University Medical College and John Paul II Hospital, Cracow, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Bednarek
authors.affiliation: 3. Second Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Medical College and University Hospital, Cracow, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Surdacki
authors.affiliation: 1. Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College and John Paul II Hospital, Cracow, Poland.
authors.forename: Jadwiga
authors.initials: J
authors.lastname: Nessler
authors.affiliation: 5. Department of Valvular Heart Defects, Institute of Cardiology, Warsaw, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Hryniewiecki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000503:physiopathology*; D001794:Blood Pressure; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D059289:Vascular Stiffness / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology
keywords: aortic valve stenosis; heart failure; vascular stiffness