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Pulse wave velocity can be accurately measured during transcatheter aortic valve implantation and used for post-procedure risk stratification

Broyd, Christopher J.a; Patel, Kusha; Pugliese, Francescaa,b; Chehab, Omara; Mathur, Anthonya; Baumbach, Andreasa; Ozkor, Micka; Kennon, Simona; Mullen, Michaela

doi: 10.1097/HJH.0000000000002141
ORIGINAL PAPERS: Organ damage
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Objectives: Mortality following TAVI remains notable and optimizing other features of cardiovascular health following this intervention can be overlooked. Aortic pulse wave velocity (PWV) is the gold-standard for measuring arterial stiffness and is a powerful predictor of mortality. We identified the potential to calculate PWV during TAVI and aimed to use this tool to assess long-term outcome.

Methods: Data from 186 patients who underwent TAVI between April 2016 and June 2017 was assessed. Invasive pressure data was simultaneously recorded from the femoral head and aortic root prior to TAVI and wave-time calculated using an automated foot-to-foot methodology. Distance was measured from the pre-TAVI CT. PWV was calculated from these values.

Results: Median PWV was 9.92 (95% CI 9.6–10.2) m/s. Multivariate analysis revealed a relationship with PWV and age (β = 0.13, 95% CI 0.08–0.17, P < 0.01) and mean arterial pressure (β = 0.04, 95% CI 0.02–0.06, P < 0.01). An optimum cut-off of 11.01m/s was calculated using a series of ROC curves against 1-year mortality (sensitivity = 0.64, specificity = 0.70, AUC = 0.67). Using this value, PWV was the only predictor of 1-year mortality on multivariate analysis (OR 3.57, 95% CI 1.36–9.42, P = 0.01) and stratified survival (log-rank P = 0.04).

Conclusion: We have demonstrated that aortic PWV can be conveniently and accurately measured during TAVI. It is a strong predictor of post-procedure mortality and could be used to guide further therapy. This has particular relevance as TAVI moves into younger patients.

aBarts Heart Centre, St Bartholomew's Hospital, West Smithfield

bCentre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Queen Mary University of London and Cardiovascular Biomedical Research Centre at Barts, London, UK

Correspondence to Christopher J. Broyd, Bart's Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK. Tel: +44 2037658627; e-mail: christopher.broyd@nhs.net

Abbreviations: AUC, area under the curve; CCS, Canadian Cardiovascular Society; MAP, mean arterial pressure; NYHA, New York Heart Association; PWV, pulse wave velocity; ROC, receiver operator characteristics; TAVI, transcatheter aortic valve implantation

Received 24 January, 2019

Revised 17 February, 2019

Accepted 5 April, 2019

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