[en] BACKGROUND: In aortic stenosis (AS), the combination of risk factors can progressively lead to an increased arterial rigidity, which can be evaluated by the carotid artery and aortic stiffness (beta index). The aim of this study was to investigate the relationship between carotid and aortic beta index, left ventricular (LV) function, plasma brain natriuretic peptide (BNP) level, and symptoms in patients with AS. METHODS: Comprehensive echocardiography including Doppler tissue imaging of the mitral annulus was performed in 53 patients with AS (aortic valve area < 1.2 cm(2)) and preserved LV ejection fractions (>/=50%). Carotid beta index was automatically derived from ultrasound wall tracking of the right carotid artery. The mitral E/e' ratio was used to estimate LV filling pressures. RESULTS: Carotid beta index was higher in women than in men and was significantly correlated with age (P < .0001), diastolic arterial pressure (P = .046), pulse pressure (P = .006), and systemic arterial compliance (P = .001). Interestingly, carotid beta index was significantly correlated with E/e' ratio (P < .0001) and plasma BNP level (P = .011). In multivariate regression analysis, carotid beta index was an independent predictor of E/e' ratio (P < .0001) and of BNP level (P = .02). Moreover, carotid beta index was significantly higher in symptomatic patients (P = .009). Aortic beta index was significantly correlated with carotid beta index (P < .0001), E/e' ratio (P = .004), and BNP (P < .001) and was significantly higher in symptomatic patients (P = .037). CONCLUSIONS: In patients with moderate to severe AS and preserved LV ejection fractions, the presence of increased carotid artery and aortic stiffness, assessed using carotid and aortic beta index, is independently associated with elevated LV filling pressures, BNP level, and symptoms.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Weisz, Sara Hana
Magne, Julien ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
H. Baumgartner, J. Hung, J. Bermejo, J.B. Chambers, A. Evangelista, B.P. Griffin American Society of Echocardiography; European Association of Echocardiography Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice Eur J Echocardiogr 10 2009 1 25
R.V. Freeman, and C.M. Otto Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies Circulation 111 2005 3316 3326
Z. Hachicha, J.G. Dumesnil, and P. Pibarot Usefulness of the valvuloarterial impedance to predict adverse outcome in asymptomatic aortic stenosis J Am Coll Cardiol 54 2009 1003 1011
P. Lancellotti, E. Donal, J. Magne, M. Moonen, K. O'Connor, and J.C. Daubert et al. Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay Heart 96 2010 1364 1371
M. Briand, J.G. Dumesnil, L. Kadem, A.G. Tongue, R. Rieu, and D. Garcia et al. 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 2005 291 298
J.J. Van der Heijden-Spek, J.A. Staessen, R.H. Fagard, A.P. Hoeks, H.A. Boudier, and L.M. van Bortel Effect of age on brachial artery wall properties differs from the aorta and is gender dependent: a population study Hypertension 35 2000 637 642
P. Boutouyrie, S. Laurent, A. Benetos, X.J. Girerd, A.P. Hoeks, and M.E. Safar Opposing effects of ageing on distal and proximal large arteries in hypertensives J Hypertens Suppl 10 1992 S87 S91
M. Roşca, J. Magne, A. Cǎlin, B.A. Popescu, L.A. Piérard, and P. Lancellotti Impact of aortic stiffness on left ventricular function and B-type natriuretic peptide release in severe aortic stenosis Eur J Echocardiogr 12 2011 850 856
S. Laurent, J. Cockcroft, L. Van Bortel, P. Boutouyrie, C. Giannattasio, D. Hayoz European Network for Non-Invasive Investigation of Large Arteries Expert consensus document on arterial stiffness: methodological issues and clinical applications Eur Heart J 27 2006 2588 2605
R.W. Stadler, W.C. Karl, and R.S. Lees The application of echo-tracking methods to endothelium-dependent vasoreactivity and arterial compliance measurements Ultrasound Med Biol 22 1996 35 42
R.M. Lang, M. Bierig, R.B. Devereux, F.A. Flachskampf, E. Foster, P.A. Pellikka American Society of Echocardiography's Nomenclature and Standards Committee Task Force on Chamber Quantification American College of Cardiology Echocardiography Committee American Heart Association European Association of Echocardiography European Society of Cardiology Recommendations for chamber quantification Eur J Echocardiogr 7 2006 79 108
P. Lancellotti, M. Moonen, J. Magne, K. O'Connor, B. Cosyns, and E. Attena et al. Prognostic effect of long-axis left ventricular dysfunction and B-type natriuretic peptide levels in asymptomatic aortic stenosis Am J Cardiol 105 2010 383 388
J.L. Monin, P. Lancellotti, M. Monchi, P. Lim, E. Weiss, and L. Piérard et al. Risk score for predicting outcome in patients with asymptomatic aortic stenosis Circulation 120 2009 69 75
O. Vriz, E. Bossone, M. Bettio, D. Pavan, S. Carerj, and F. Antonini-Canterin Carotid artery stiffness and diastolic function in subjects without known cardiovascular disease J Am Soc Echocardiogr 24 2011 915 921
M.A. Allison, P. Cheung, M.H. Criqui, R.D. Langer, and C.M. Wright Mitral and aortic annular calcification are highly associated with systemic calcified atherosclerosis Circulation 113 2006 861 866
A. Paini, P. Boutouyrie, D. Calvet, A.I. Tropeano, B. Laloux, and S. Laurent Carotid and aortic stiffness: determinants of discrepancies Hypertension 47 2006 371 376
F. Hansen, P. Mangell, B. Sonesson, and T. Länne Diameter and compliance in the human common carotid artery-variations with age and sex Ultrasound Med Biol 21 1995 1 9
F. Antonini-Canterin, M. Roşca, C.C. Beladan, B.A. Popescu, R. Piazza, and E. Leiballi et al. Echo-tracking assessment of carotid artery stiffness in patients with aortic valve stenosis Echocardiography 26 2009 823 831
J.R. Tobin Jr., S.H. Rahimtoola, P.E. Blundell, and H.J. Swan Percentage of left ventricular stroke work loss. A simple hemodynamic concept for estimation of severity in valvular aortic stenosis Circulation 35 1967 868 879
P. Lancellotti, E. Donal, J. Magne, K. O'Connor, M.L. Moonen, and B. Cosyns et al. Impact of global left ventricular afterload on left ventricular function in asymptomatic severe aortic stenosis: a two-dimensional speckle-tracking study Eur J Echocardiogr 11 2010 537 543
P. Boutouyrie, A.I. Tropeano, R. Asmar, I. Gautier, A. Benetos, and P. Lacolley et al. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study Hypertension 39 2002 10 15
P. Lim, J.L. Monin, M. Monchi, J. Garot, A. Pasquet, and L. Hittinger et al. Predictors of outcome in patients with severe aortic stenosis and normal left ventricular function: role of B-type natriuretic peptide Eur Heart J 25 2004 2048 2053
D. Levy, S.J. Hwang, A. Kayalar, E.J. Benjamin, R.S. Vasan, and H. Parise et al. Associations of plasma natriuretic peptide, adrenomedullin, and homocysteine levels with alterations in arterial stiffness: the Framingham Heart Study Circulation 115 2007 3079 3085
D.K. Arnett, L.E. Chambless, H. Kim, G.W. Evans, and W. Riley Variability in ultrasonic measurements of arterial stiffness in the Atherosclerosis Risk in Communities study Ultrasound Med Biol 25 1999 175 180
D. Liao, D.K. Arnett, H.A. Tyroler, W.A. Riley, L.E. Chambless, and M. Szklo et al. Arterial stiffness and the development of hypertension. The ARIC Study Hypertension 34 1999 201 206