Impact of aortic stiffness on left ventricular function and B-type natriuretic peptide release in severe aortic stenosis

Aims In aortic stenosis (AS), both reduced systemic arterial compliance and increased valvular load have been shown to contribute to impaired left ventricular (LV) function. However, the relationship between LV function and aortic stiffness has not yet been investigated. We aimed to assess the relationship between aortic stiffness and LV global longitudinal strain (GLS), LV filling pressures (E/E') and B-type natriuretic peptide (BNP) in AS. Methods and results A comprehensive echocardiogram was performed in 48 consecutive patients with severe AS (< 0.6 cm(2)/m(2)) and preserved LV ejection fraction (>= 50%). Aortic stiffness index (beta) was calculated based on aortic diameters measured by echocardiography and blood pressure. Systemic arterial compliance (SAC) and valvulo-arterial impedance (Z(va)) were also determined. Aortic beta index was significantly correlated with Z(va) (r = 0.30, P = 0.03) and SAC (r = -0.29, P = 0.04). GLS (r = 0.45, P = 0.001), E/E' (r = 0.48, P = 0.001) and BNP levels (r = 0.45, P = 0.001) were significantly related to aortic beta index. No significant correlation was found between GLS or E/E' and SAC or Z(va). In multivariate regression analysis, aortic beta index remained correlated with GLS, E/E', and BNP levels. Conclusions In patients with severe AS and preserved LV ejection fraction, independently of the valvular load, an increase in aortic rigidity, as assessed by aortic beta index, is independently correlated with reduced LV longitudinal function, increased LV filling pressures, and BNP levels.