Ventricular-Arterial Coupling in Severe Aortic Stenosis: Relationship with Symptoms and Heart Failure

Left ventricular function is determined by ventricular-arterial coupling via effective arterial elastance (Ea) and leftventricular end-systolic elastance (Ees). In aortic stenosis, the characteristics of the vascular system may influence left ventricularfunction, particularly in patients with symptoms or heart failure.Objective: The aim of the present study was to evaluate ventricular-arterial coupling using the Ea/Ees ratio in patients with severeaortic stenosis and its relationship with symptoms and heart failure.Methods: The cohort consisted of 136 patients aged 69±11 years, with severe aortic stenosis (aortic valve area <1 cm2). Ea and Eeswere estimated noninvasively. Patients were divided into three groups: heart failure (n=48), symptomatic (n=45) and asymptomatic(n=43).Results: Ea was increased in patients with heart failure while Ees was significantly reduced in patients with symptoms and withheart failure compared with asymptomatic ones. The Ea/Ees ratio was significantly higher in symptomatic and heart failure patientscompared with asymptomatic patients (1.5±1.3 and 0.81±0.49 vs. 0.61±0.37; p<0.01). There were no significant differences inaortic valve area among groups.Conclusions: The Ea/Ees ratio was increased in patients with symptoms or heart failure due to increased Ea and reduced Ees. Thedevelopment of symptoms or heart failure in severe aortic stenosis seems to be related with the characteristics of the vascular system,irrespectively of aortic stenosis severity.Introducción: La función del ventrículo izquierdo (VI) está determinada por el acoplamiento entre la elastancia arterial efectiva (Ea) y la elastancia de fin de sístole del VI (Efs). En la estenosis aórtica (EAo) las características de la vasculatura pueden influir sobre la función del VI especialmente en pacientes con síntomas o insuficiencia cardíaca (IC). Objetivo: Evaluar la cupla ventrículo-arterial mediante la relación Ea /Efs en pacientes con estenosis aórtica grave y su relación con los síntoma e IC. Material y métodos: Se incluyeron 136 pacientes, edad promedio 69 ± 11 años, portadores de EAo grave (área valvular aórtica (AVA) < 1 cm2). Ea y Efs fueron estimadas en forma no invasiva. Los pacientes fueron divididos en tres grupos: IC (n = 48), sintomáticos (n = 45) y asintomáticos (n = 43). Resultados: La Ea se observó incrementada en los pacientes con IC mientras que la Efs estuvo significativamente disminuida en los pacientes sintomáticos y con IC con respecto a los asintomáticos. Ea /Efs fue significativamente mayor en los pacientes sintomáticos y con IC comparados con los pacientes asintomáticos (1.5 ± 1.3 y 0.81 ± 0.49 vs 0.61 ± 0.37,