Exercise-induced brachial-ankle pulse wave velocity changes before and after transcatheter aortic valve replacement.

Abstract

Elevated arterial stiffness is associated with cardiovascular risk. Brachial-ankle pulse wave velocity (baPWV), a measure of arterial stiffness, is decreased by exercise stress, which is associated with good vascular endothelial function. Moreover, baPWV may predict outcomes following transcatheter aortic valve replacement (TAVR) and has been reported to change before and after TAVR. However, studies on baPWV changes in patients with TAVR undergoing exercise stress have not been conducted. This study aimed to assess the changes in baPWV before and after TAVR using a simple exercise stress method. We enrolled 40 patients (mean age, 84.6 ± 4.4 years; 45% males) with severe symptomatic aortic stenosis undergoing TAVR. baPWV was assessed at rest and immediately following the exercise protocol. Exercise stress was performed using a simple method wherein patients actively plantar flexed and dorsiflexed their legs in a resting supine position. Measurements were conducted at baseline and after TAVR. Resting baPWV significantly increased from 1673 ± 322 to 2073 ± 426 cm/s (p < 0.001), and exercise stress baPWV also significantly increased from 1662 ± 339 to 1972 ± 335 cm/s (p < 0.001) after TAVR. Compared with resting baPWV, post-exercise baPWV did not change before TAVR (from 1673 ± 322 to 1662 ± 339 cm/s, p = 0.68), but significantly decreased after TAVR (from 2073 ± 426 to 1972 ± 335 cm/s, p = 0.012). The arterial system demonstrated increased baPWV in response to the acute relief of the obstruction following TAVR. Exercise stress decreased baPWV following TAVR, suggesting that endothelial function was maintained, which was masked before TAVR.