Patients with aortic stenosis exhibit early improved endothelial function following transcatheter aortic valve replacement: The eFAST study

Background Patients with severe aortic stenosis (AS) exhibit systemic endothelial dysfunction, which can be associated myocardial ischaemia in absence of obstructive coronary disease. Transcatheter valve replacement (TAVR) is used to treat AS patients high or prohibitive surgical risk. However, it remains unknown whether function recovers post-TAVR. We therefore sought assess the early and late changes flow-mediated dilation (FMD), a measure function, following TAVR. Methods undergoing TAVR for had ultrasound assessment brachial endothelial-independent -dependent FMD. Measurements were performed pre-TAVR, at follow-up (<48 h post-TAVR) (4–6 weeks post-TAVR). Results 27 (mean age 82.0 ± 7.0; 33.3% female) recruited; 37.0% diabetes mellitus 59.3% hypertension. Brachial artery FMD increased from 4.2 1.6% (pre-TAVR) 9.7 3.5% (p < 0.0001). At follow-up, improvement compared was sustained (8.7 1.9%, p = 0.27). Resting arterial flow velocities decreased significantly (11.24 5.16 vs. 7.73 2.79 cm/s, 0.003). Concordantly, there decrease resting wall shear stress (WSS; 14.8 7.8 10.6 4.8dyne/cm2, 0.01), peak WSS (73.1 34.1 58.8 27.8dyne/cm2, 0.03) cumulative (3543 1852 2504 1089dyne·s/cm2, 0.002). Additionally, favourable inverse correlation between restored (r −0.21 r 0.49). Conclusion Endothelial improves post-TAVR this sustained. This likely occurs as result improved haemodynamics, leading lower localised release vasoactive mediators that may also alleviate ischaemia.