eprintid: 10126490
rev_number: 19
eprint_status: archive
userid: 608
dir: disk0/10/12/64/90
datestamp: 2021-04-23 10:24:55
lastmod: 2022-05-30 13:45:25
status_changed: 2021-04-23 10:24:55
type: article
metadata_visibility: show
creators_name: Comella, A
creators_name: Michail, M
creators_name: Chan, J
creators_name: Cameron, JD
creators_name: Gooley, R
creators_name: Mathur, A
creators_name: Hughes, AD
creators_name: Brown, AJ
title: Patients with aortic stenosis exhibit early improved endothelial function following transcatheter aortic valve replacement: The eFAST study
ispublished: pub
divisions: UCL
divisions: B02
divisions: D14
divisions: GA3
keywords: Aortic stenosis, Endothelial dysfunction, Flow mediated dilatation, Transcatheter aortic valve replacement
note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
abstract: BACKGROUND: Patients with severe aortic stenosis (AS) exhibit systemic endothelial dysfunction, which can be associated with myocardial ischaemia in absence of obstructive coronary disease. Transcatheter aortic valve replacement (TAVR) is used to treat severe AS in patients with high or prohibitive surgical risk. However, it remains unknown whether endothelial function recovers post-TAVR. We therefore sought to assess the early and late changes in flow-mediated dilation (FMD), a measure of endothelial function, following TAVR. METHODS: Patients undergoing TAVR for severe AS had ultrasound assessment of brachial endothelial-independent and -dependent FMD. Measurements were performed pre-TAVR, at early follow-up (<48 h post-TAVR) and late follow-up (4-6 weeks post-TAVR). RESULTS: 27 patients (mean age 82.0 ± 7.0; 33.3% female) were recruited; 37.0% had diabetes mellitus and 59.3% had hypertension. Brachial artery FMD increased from 4.2 ± 1.6% (pre-TAVR) to 9.7 ± 3.5% at early follow-up (p < 0.0001). At late follow-up, improvement compared with early follow-up was sustained (8.7 ± 1.9%, p = 0.27). Resting brachial arterial flow velocities decreased significantly at late follow-up (11.24 ± 5.16 vs. 7.73 ± 2.79 cm/s, p = 0.003). Concordantly, at late follow-up, there was decrease in resting wall shear stress (WSS; 14.8 ± 7.8 vs. 10.6 ± 4.8dyne/cm2, p = 0.01), peak WSS (73.1 ± 34.1 vs. 58.8 ± 27.8dyne/cm2, p = 0.03) and cumulative WSS (3543 ± 1852 vs. 2504 ± 1089dyne·s/cm2, p = 0.002). Additionally, a favourable inverse correlation between cumulative WSS and FMD was restored at late follow-up (r = -0.21 vs. r = 0.49). CONCLUSION: Endothelial function in patients with AS improves early post-TAVR and this improvement is sustained. This likely occurs as a result of improved arterial haemodynamics, leading to lower localised WSS and release of vasoactive mediators that may also alleviate myocardial ischaemia.
date: 2021-06-01
date_type: published
official_url: http://dx.doi.org/10.1016/j.ijcard.2021.03.062
oa_status: green
full_text_type: other
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1857745
doi: 10.1016/j.ijcard.2021.03.062
pii: S0167-5273(21)00566-0
lyricists_name: Hughes, Alun
lyricists_id: ADHUG42
actors_name: Hughes, Alun
actors_id: ADHUG42
actors_role: owner
full_text_status: public
publication: International Journal of Cardiology
volume: 332
pagerange: 143-147
event_location: Netherlands
citation:        Comella, A;    Michail, M;    Chan, J;    Cameron, JD;    Gooley, R;    Mathur, A;    Hughes, AD;           Comella, A;  Michail, M;  Chan, J;  Cameron, JD;  Gooley, R;  Mathur, A;  Hughes, AD;  Brown, AJ;   - view fewer <#>    (2021)    Patients with aortic stenosis exhibit early improved endothelial function following transcatheter aortic valve replacement: The eFAST study.                   International Journal of Cardiology , 332    pp. 143-147.    10.1016/j.ijcard.2021.03.062 <https://doi.org/10.1016/j.ijcard.2021.03.062>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10126490/1/IJCJOURNAL-D-20-02505_R1.pdf