Osawa Ayano, Ikenaga Hiroki, Kuraishi Atsushi, Togi Kiyotaka, Shigehara Mikio, Hamada Ayano, Takeuchi Makoto, Hyodo Yohei, Mogami Atsuo, Tsuchiya Akane, Takeda Atsushi, Nakano Takayuki, Ueda Yusuke, Takahari Kosuke, Morita Yuichi, Higashihara Tasuku, Watanabe Noriaki, Sada Yoshiharu, Utsunomiya Hiroto, Takasaki Taiichi, Takahashi Shinya, Nakano Yukiko
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Hiroshima, Minami-ku, 734-8551, Japan.
Department of Cardiovascular Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
Heart Vessels. 2025 Aug 18. doi: 10.1007/s00380-025-02593-9.
Elevated arterial stiffness is associated with cardiovascular risk. Brachial-ankle pulse wave velocity (baPWV), a measure of arterial stiffness, is decreased by exercise stress, which is associated with good vascular endothelial function. Moreover, baPWV may predict outcomes following transcatheter aortic valve replacement (TAVR) and has been reported to change before and after TAVR. However, studies on baPWV changes in patients with TAVR undergoing exercise stress have not been conducted. This study aimed to assess the changes in baPWV before and after TAVR using a simple exercise stress method. We enrolled 40 patients (mean age, 84.6 ± 4.4 years; 45% males) with severe symptomatic aortic stenosis undergoing TAVR. baPWV was assessed at rest and immediately following the exercise protocol. Exercise stress was performed using a simple method wherein patients actively plantar flexed and dorsiflexed their legs in a resting supine position. Measurements were conducted at baseline and after TAVR. Resting baPWV significantly increased from 1673 ± 322 to 2073 ± 426 cm/s (p < 0.001), and exercise stress baPWV also significantly increased from 1662 ± 339 to 1972 ± 335 cm/s (p < 0.001) after TAVR. Compared with resting baPWV, post-exercise baPWV did not change before TAVR (from 1673 ± 322 to 1662 ± 339 cm/s, p = 0.68), but significantly decreased after TAVR (from 2073 ± 426 to 1972 ± 335 cm/s, p = 0.012). The arterial system demonstrated increased baPWV in response to the acute relief of the obstruction following TAVR. Exercise stress decreased baPWV following TAVR, suggesting that endothelial function was maintained, which was masked before TAVR.
动脉僵硬度升高与心血管风险相关。肱踝脉搏波速度（baPWV）是一种衡量动脉僵硬度的指标，运动应激可使其降低，而运动应激与良好的血管内皮功能相关。此外，baPWV可预测经导管主动脉瓣置换术（TAVR）后的预后，并且有报道称TAVR前后baPWV会发生变化。然而，尚未开展关于接受运动应激的TAVR患者baPWV变化的研究。本研究旨在使用一种简单的运动应激方法评估TAVR前后baPWV的变化。我们纳入了40例接受TAVR的有严重症状性主动脉瓣狭窄患者（平均年龄84.6±4.4岁；45%为男性）。在静息状态和运动方案结束后立即评估baPWV。运动应激采用一种简单的方法进行，即患者在静息仰卧位时主动进行腿部的跖屈和背屈。在基线和TAVR后进行测量。静息baPWV从1673±322显著增加至2073±426 cm/s（p<0.001），TAVR后运动应激时的baPWV也从1662±339显著增加至1972±335 cm/s（p<0.001）。与静息baPWV相比，运动后baPWV在TAVR前未发生变化（从1673±322至1662±339 cm/s，p = 0.68），但在TAVR后显著降低（从2073±426至1972±335 cm/s，p = 0.012）。TAVR后梗阻急性解除，动脉系统显示baPWV增加。TAVR后运动应激使baPWV降低，提示内皮功能得以维持，而在TAVR前这种功能被掩盖。
