Determinants and clinical significance of aortic stiffness in patients with moderate or severe aortic stenosis

Background: Patients with degenerative aortic stenosis (AS) are often older and have systemic hypertension and atherosclerosis, which all lead to increased aortic stiffness. We aimed to assess the determinants of carotid-femoral pulse wave velocity (cf-PWV), a direct measure of aortic stiffness, and its association with revealed symptoms and clinical outcome in patients with AS. Methods: We included 103 asymptomatic patients aged 66.6 +/- 13.2 years (range 27-85 years, 69% males) with moderate (n = 50) and severe (n = 53) AS. All underwent a comprehensive echocardiography, exercise treadmill test (ETT) and assessment of aortic stiffness derived from cf-PWV by applanation tonometry. Results: The mean cf-PWV was 10.6 +/- 3.1 m/s and resting brachial blood pressure (BP) 139 +/- 20/79 +/- 11mmHg. Increased cf-PWV (>= 10 m/s) was found in 44% (n = 45) patients. Patients with moderate and severe AS had a similar degree of aortic stiffness (cf-PWV 10.7 +/- 3.3 vs. 10.5 +/- 3.0 m/s, p = 0.698). In a univariate logistic regression analysis, higher cf-PWVwas not associatedwith revealed symptoms (odds ratio [OR] for 1SD higher cf-PWV 1.12; 95% CI 0.62-2.04, p = 0.706). In a multivariable linear regression analysis, age, resting brachial systolic BP and diabeteswere associatedwith higher cf-PWVindependent of antihypertensive treatment and left ventricular ejection fraction. The event-free survival was significantly lower in patients with cf-PWV >= 10 m/s compared to those with cf-PWV <10 m/s (p = 0.015). Conclusion: Increased cf-PWV was common in patients with moderate or severe AS, and was associated with higher cardiovascular disease burden and impaired prognosis. cf-PWV did not correlate with the severity of AS or the frequencies of revealed symptoms by ETT. (C) 2020 The Authors. Published by Elsevier B.V.