Pulse Wave Morphology Changes in Aortic Valve Stenosis Detected with Cardio-Ankle Vascular Index

Oscar Plunde,1,2 Anders Franco-Cereceda,3,4 Magnus Bäck1,4 1Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; 2Novo Nordisk A/S, Medical & Science, Copenhagen, Denmark; 3Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 4Heart and Vascular Center, Karolinska University Hospital, Stockholm, SwedenCorrespondence: Oscar Plunde, Department of Medicine, Solna, Karolinska Institutet, 17164 Stockholm, Sweden, Tel +46 8-524 800 00, Email oscar.persson@ki.seBackground: Cardio-ankle vascular index (CAV) is a measure of systemic arterial stiffness and has been shown to increase after aortic valve surgery. However, change in CAVI-derived pulse wave morphology has not previously been addressed.Case Study: A 72-year-old female was transferred to a large center for heart valve interventions for evaluation of her aortic stenosis. Few co-morbidities were detected on medical history, other than previous radiation treatment for breast cancer, and no signs of other concomitant cardiovascular disease. The patient was accepted for surgical aortic valve replacement due to severe aortic valve stenosis and arterial stiffness was assessed with CAVI, as part of an ongoing clinical study. The pre-operative CAVI was 4.7 which after surgery increased almost 100% to 9.35. In tandem, the slope of systolic upstroke pulse morphology captured from brachial cuffs was changed from a prolonged flattened pattern to a steeper.Conclusion: After aortic valve replacement surgery due to aortic valve stenosis, in addition to increased CAVI-derived measures of arterial stiffness, the slope of the CAVI-derived upstroke pulse wave morphology changes to a steeper slope. This finding could have implications in the future of aortic valve stenosis screening and utilization of CAVI.Keywords: arterial stiffness, cardio-ankle vascular index, pulse wave morphology, aortic valve stenosis