Abstract 12311: Impairment of Peripheral Endothelial Function in Patients With Aortic Valve Stenosis in the Aging Population
Background: In the progressive aging society, heart failure (HF) patients with aortic valve stenosis (AS) are increasing. We need to understand the clinical features and pathophysiological conditions in patients with AS. AS has been shown to be associated with atherosclerotic risk factors and the risk factors caused endothelial dysfunction involved in coronary artery disease (CAD) and HF. However, the correlation between AS and peripheral endothelial function remains unclear.
Methods: 41 consecutive older patients (age>65 years) with AS [aortic valve area (AVA) ≤2.0cm2 or maximal jet velocity>2.5m/s] were enrolled and age-, gender-, and classical coronary risk factors-matched normal subjects without AS were included as the control (n=42). AS patients were further divided into mild AS-group (n=18) and moderate-severe AS-group (n=23) by the cutoff values of AVA; 1.0cm2. We non-invasively assessed peripheral endothelial function as reactive hyperemia index (RHI) by peripheral arterial tonometry.
Results: RHI was significantly impaired in AS patients compared to the control (0.50±0.22 vs. 0.65±0.19, p=0.001). The moderate-severe AS-group and the mild AS-group had similar clinical characteristics but RHI was significantly lower in the moderate-severe AS-group compared to the mild AS-group (0.43±0.20 vs. 0.58±0.22, p=0.03). AS patients complicated with CAD (>75% organic coronary stenosis) (n=24) exhibited significant endothelial dysfunction compared to the AS patients without CAD (n=15) (0.44±0.19 vs. 0.59±0.23, p=0.03). RHI was significantly lower in the AS patients without CAD compared to the control (0.53±0.19 vs. 0.65±0.19, p=0.04). Multivariable logistic regression analysis including various clinical factors indicated RHI was independently associated with the presence of the moderate-severe AS (odds ratio [OR]: 0.63, 95% confidence interval [CI]: 0.40-0.98, p=0.04), and also independently associated with the presence of AS complicated with CAD (OR: 0.68, 95%-CI 0.33-0.97, p=0.03) in AS patients.
Conclusion: RHI was significantly associated with the presence of AS, its severity, and AS with CAD. We need to recognize the peripheral endothelial dysfunction is the important pathogenic vascular factor in the older patients with AS.
- © 2013 by American Heart Association, Inc.