Hypertension and transcatheter aortic valve replacement: Parallel or series?

Nidhish Tiwari, Nidhi Madan

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

Aortic stenosis (AS) is the most common valvular heart disease in the elderly and it causes significant morbidity and mortality. Hypertension is also highly prevalent in elderly patients with AS, and AS patients with hypertension have worse outcomes. Accurate assessment of AS severity and understanding its relationship with arterial compliance has become increasingly important as the options for valve management, particularly transcatheter interventions, have grown. The parameters used for quantifying stenosis severity have traditionally mainly focused on the valve itself. However, AS is now recognized as a systemic disease involving aging ventricles and stiff arteries rather than one limited solely to the valve. Over the last decade, valvuloarterial impedance, a measure of global ventricular load, has contributed to our understanding of the pathophysiology and course of AS in heterogeneous patients, even when segregated by symptoms and severity. This review summarizes our growing understanding of the interplay between ventricle, valve, and vessel, with a particular emphasis on downstream vascular changes after transcatheter aortic valve replacement and the role of valvuloarterial impedance in predicting left ventricular changes and prognosis in patients with various trans-valvular flow patterns.

Original languageEnglish (US)
Pages (from-to)81-91
Number of pages11
JournalIntegrated Blood Pressure Control
Volume11
DOIs
StatePublished - 2018
Externally publishedYes

Keywords

  • Aortic stenosis
  • Arterial compliance
  • Global ventricular load
  • Transcatheter aortic valve replacement
  • Valvuloarterial impedance
  • Ventriculoarterial coupling

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

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