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Augmentation index predicts mortality in patients with aortic stenosis: an echo-tracking study

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Abstract

Aortic valve stenosis (AS) shares similarities with the atherosclerotic process but little is known about the effect of the mechanical properties of large arteries on outcome in patients with AS. The aims of this study were (1) to determine the relationship between indexes of carotid stiffness/compliance and the severity of AS and (2) to identify whether local arterial stiffness is independently associated with mortality. 133 patients with moderate to severe isolated AS and preserved LV ejection fraction (LVEF) were included. All underwent transthoracic echocardiography and local carotid stiffness evaluation by means of high-definition echo-tracking ultrasound with the calculation of stiffness/compliance parameters included augmentation index (AIx). None of the carotid stiffness parameters were significantly associated with AS severity parameters. During a mean follow-up of 51.6 ± 39.4 months, 70 patients received aortic valve replacement, 45 died and 18 were alive with no surgery. Who died were older (79.2 ± 6.9 vs. 73 ± 8.8 years, p < 0.0001), had higher carotid AIx (21.3 ± 14 vs. 16 ± 12%, p = 0.028). In multivariate Cox regression analysis AIx was independently associated with mortality (HR 1.048, 95% CI 1.01–1.07, p = 0.001), also after inclusion of age and creatinine. There was a significant association between the level of AIx and mortality in those patients who did not have surgery (p = 0.016). In severe AS and a normal LVEF, carotid AIx measured by echo-tracking system was independently associated with death. No relationship between AS severity and local carotid stiffness was found. These data emphasize the importance of arterial stiffness has a hallmark of long-term atherosclerotic burden and impaired prognosis.

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Acknowledgements

The authors are grateful to Gloria Grillini for her excellent work with the patients, Cristina Degano, MD and Gloria Plett, MD for technical support.

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Authors and Affiliations

  1. Cardiac Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

    Olga Vriz & Hani AlSergani

  2. College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

    Olga Vriz

  3. Department of Medicine, University of Padova, Padova, Italy

    Paolo Palatini

  4. Department of Emergency Medicine, Cardiology, San Antonio Hospital, San Daniele del Friuli, Udine, Italy

    Lucio Mos

  5. Cardiac Surgery Department, University of Udine, Udine, Italy

    Igor Vendramin & Ugolino Livi

  6. Cardiologia Riabilitativa, Ospedale Riabilitativo di Alta Specializzazione, Motta di Livenza, Italy

    Francesco Antonini-Canterin

  7. Department of Cardiology, Dupuytren University Hospital, Limoges, France

    Julien Magne

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  1. Olga Vriz
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  2. Paolo Palatini
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  3. Lucio Mos
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  4. Hani AlSergani
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  8. Julien Magne
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Contributions

Olga Vriz: Conceptualization, methodology, data curation, writing—original draft preparation. Igor Ventramin, Ugolini Livi: Data curation. Hani Alsergani: Visualization, investigation. Paolo Palatini, Francesco Antonini-Canterin, Julien Magne: Supervision, writing—reviewing and editing.

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Correspondence to Olga Vriz.

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Vriz, O., Palatini, P., Mos, L. et al. Augmentation index predicts mortality in patients with aortic stenosis: an echo-tracking study. Int J Cardiovasc Imaging 37, 1659–1668 (2021). https://doi.org/10.1007/s10554-020-02151-6

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  • DOI: https://doi.org/10.1007/s10554-020-02151-6

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