Arterial wave reflection and aortic valve calcification in an elderly community-based cohort

Fusako Sera; Cesare Russo; Shinichi Iwata; Zhezhen Jin; Tatjana Rundek; Mitchell S V Elkind; Shunichi Homma; Ralph L Sacco; Marco R Di Tullio

doi:10.1016/j.echo.2014.12.011

Arterial wave reflection and aortic valve calcification in an elderly community-based cohort

J Am Soc Echocardiogr. 2015 Apr;28(4):430-6. doi: 10.1016/j.echo.2014.12.011. Epub 2015 Jan 15.

Authors

Fusako Sera¹, Cesare Russo¹, Shinichi Iwata¹, Zhezhen Jin², Tatjana Rundek³, Mitchell S V Elkind⁴, Shunichi Homma¹, Ralph L Sacco⁵, Marco R Di Tullio⁶

Affiliations

¹ Department of Medicine, Columbia University, New York, New York.
² Department of Biostatistics, Columbia University, New York, New York.
³ Departments of Neurology and Public Health Sciences, University of Miami, Miami, Florida.
⁴ Departments of Neurology and Epidemiology, Columbia University, New York, New York.
⁵ Departments of Neurology and Public Health Sciences, University of Miami, Miami, Florida; Department of Human Genetics, University of Miami, Miami, Florida.
⁶ Department of Medicine, Columbia University, New York, New York. Electronic address: md42@cumc.columbia.edu.

Abstract

Background: Aortic valve calcification (AVC) without stenosis is common in the elderly, is associated with cardiovascular morbidity and mortality, and may progress to aortic valve stenosis. Arterial stiffness and pulse-wave reflection are important components of proximal aortic hemodynamics, but their relationship with AVC is not established.

Methods: To investigate the relationship of arterial wave reflection and stiffness with AVC, pulse wave analysis and AVC evaluation by echocardiography were performed in 867 participants from the Cardiovascular Abnormalities and Brain Lesions study. Participants were divided into four categories on the basis of the severity and extent of AVC: (1) none or mild focal AVC, (2) mild diffuse AVC, (3) moderate to severe focal AVC, and (4) moderate to severe diffuse AVC. Central blood pressures and pulse pressure, total arterial compliance, augmentation index, and time to wave reflection were assessed using applanation tonometry.

Results: Indicators of arterial stiffness and wave reflection were significantly associated with AVC severity, except for central systolic and diastolic pressures and time to reflection. After adjustment for pertinent covariates (age, sex, race/ethnicity, and estimated glomerular filtration rate), only augmentation pressure (P = .02) and augmentation index (P = .002) were associated with the severity of AVC. Multivariate logistic regression analysis revealed that augmentation pressure (odds ratio per mm Hg, 1.14; 95% confidence interval, 1.02-1.27; P = .02) and augmentation index (odds ratio per percentage point, 1.07; 95% confidence interval, 1.01-1.13; P = .02) were associated with an increased risk for moderate to severe diffuse AVC, even when central blood pressure value was included in the same model.

Conclusions: Arterial wave reflection is associated with AVC severity, independent of blood pressure values. Increased contribution of wave reflection to central blood pressure could be involved in the process leading to AVC.

Keywords: Aortic valve calcification; Arterial stiffness; Blood pressure; Wave reflection.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Aged
Aortic Valve Stenosis / diagnostic imaging*
Aortic Valve Stenosis / etiology
Blood Flow Velocity*
Blood Pressure*
Calcinosis / complications
Calcinosis / diagnostic imaging*
Cohort Studies
Female
Humans
Image Interpretation, Computer-Assisted / methods*
Male
Pulse Wave Analysis / methods*
Reproducibility of Results
Sensitivity and Specificity
Ultrasonography
Vascular Stiffness

Abstract

Publication types

MeSH terms

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