Aortic Stiffness and Cardiac Modification After Open or Endovascular Aortic Treatment: Preliminary Results of a Single-Center Prospective Cohort Study

Abstract

Increased aortic stiffness (AoS), is considered an independent marker of cardiovascular mortality and morbidity. Aortic endovascular treatment correlates to a worsening of AoS, indirectly evaluated with pulse wave velocity (PWV). This could lead to changes in cardiac geometry and efficiency over time. The aim of this study is to evaluate possible changes in AoS with consequent alterations in cardiac function after endovascular (ER) or open (OR) repair, also analyzing different endograft fabric. Patients who were candidate for elective ER or OR for different abdominal aortic disease were enrolled. PWV was measured during the preoperative period and after 1 year. Doppler echocardiography was performed before surgery and after 1 year evaluating arterial (Ea) and ventricular (Ees) elastance and their coupling (Ea/Ees), left ventricular left atrial volume index and left atrial volume index, ejection fraction, and ratio of early ventricular filling to atrial systole (E/A). Furthermore, systolic and diastolic blood pressure and exercise tolerance by the Specific Activity Scale score were assessed preoperatively and after one-year. All data were compared between ER and OR groups and between endo-PTFE and endo-Polyester group. Sixty patients have been enrolled in the 2-year period from 2019 to 2021 (19 OR and 41 ER). Both groups were homogeneous considering cardiovascular risk factors, except for age, which was lower for the OS group (67.2 ± 7.2 vs 75.4 ± 6.4 years; P < .001). Fifty-one patients completed the follow-up (13 OR, 38 ER). PWV increased in both groups, significantly in ER (+2.9 m/second; P = .016). Systolic blood pressure grew in both ER (+20.2 mm Hg; P < .001) and OR groups (+18.4 mm Hg; P = .005). Diastolic blood pressure grew in ER group (+5.2 mm Hg; P = .009) Ea increased +0.3 mm Hg/mL/m2 in both ER and OR groups (P = .026; P = .020), without significant changes in Ea/Ees coupling. E/A ratio decreased (−0.1; P < .001) in the ER group. No significant changes in left ventricular left atrial volume index, left atrial volume index and ejection fraction were recorded (Table I). In ER group, the Specific Activity Scale score got worse (+0.3; P = .004) and three cardiac events were recorded. Considering the subanalysis endo-PTFE vs endo-Polyester, PWV (+3.8 m/second; P = .023) and Ea (+0.4 mm Hg/mL/m2; P = .008) increased significantly in endo-Polyester group only (Table II). AoS increases after ER, mostly in patients with a polyester-covered device. Furthermore, the reversal of E/A ratio means an initial alteration in ventricular diastole, not related to significant mid-term changes in cardiac geometry. These changes could lead to diastolic disfunction with an increased risk of cardiovascular events over time. Further investigation is needed to validate our results.Table IPulse wave velocity (PWV), pressures and echocardiographic data after 1 year of follow-up in the open repair (OR) and endovascular repair (ER) groupsCharacteristicsOR (n = 13)P < .05ER (n = 38)P < .05Preoperative1 YearPreoperative1 YearPWV (m/second)11.6 ± 5.215.5 ± 8.1.05712.7 ± 3.615.6 ± 6.3.016SBP (mm Hg)132.9 ± 22.8151.3 ± 15.9.005134.7 ± 15.6154.9 ± 16.9<.001DBP (mm Hg)78.2 ± 8.481.9 ± 8.5.41573.9 ± 9.979.1 ± 8.4.009LVVi (mL/m2)50.3 ± 1257 ± 15.2.35948.1 ± 17.350.9 ± 16.2.093LAVi (mL/m2)31.5 ± 8.334.5 ± 13.6.89831.9 ± 6.634.9 ± 11.6.378EF (%)60 ± 5.758 ± 6.8.21559.4 ± 6.358.8 ± 6.1.604E/A ratio0.8 ± 0.31 ± 0.5.2500.8 ± 0.20.7 ± 0.2<.001Ea (mm Hg/mL/m2)1.4 ± 0.31.7 ± 0.4.0201.5 ± 0.51.8 ± 0.5.026Ees (mm Hg/mL/m2)1.6 ± 0.81.9 ± 0.5.1481.6 ± 0.61.7 ± 0.6.188Ea/Ees1 ± 0.30.9 ± 0.2.5781 ± 0.31.1 ± 0.3.740DBP, Diastolic blood pressure; Ea, arterial elastance; E/A, early ventricular filling to atrial systole ratio; Ees, ventricular end-systolic elastance; EF, ejection fraction; LAVi, left atrial volume index; LVVi, left ventricular volume index; SBP, systolic blood pressure.All data are reported as mean ± standard deviation. Open table in a new tab Table IIPulse wave velocity (PWV), pressures and echocardiographic data after 1 year of follow-up in endo-PTFE and endo-Polyester group.CharacteristicsEndo-PTFE (n = 15)P < .05Endo-Polyester (n = 23)P < .05Preoperative1 YearPreoperative1 YearPWV (m/second)11.7 ± 3.114 ± 4.6.09112.9 ± 3.116.7 ± 7.1.023SBP (mm Hg)128.7 ± 16.7157.3 ± 19.5<.001138.7 ± 13.9153.3 ± 15.1<.001DBP (mm Hg)68.7 ± 8.179 ± 7.1.00277.3 ± 9.479.1 ± 9.3.356LVVi (mL/m2)44.9 ± 9.647.7 ± 9.2.18450.2 ± 20.753 ± 19.4.330LAVi (mL/m2)32.8 ± 6.736.5 ± 13.2.31331.3 ± 6.833.9 ± 10.7.685EF (%)59.2 ± 4.158.9 ± 3.7159.5 ± 7.558.8 ± 7.2.557E/A ratio0.9 ± 0.30.7 ± 0.2.0160.8 ± 0.20.7 ± 0.2.001Ea (mm Hg/mL/m2)1.7 ± 0.71.7 ± 0.5.6071.4 ± 0.31.8 ± 0.5.008Ees (mm Hg/mL/m2)1.6 ± 0.71.8 ± 0.7.1761.6 ± 0.71.7 ± 0.6.637Ea/Ees1.1 ± 0.31 ± 0.3.5701 ± 0.31.1 ± 0.3.391DBP, Diastolic blood pressure; Ea, arterial elastance; E/A, early ventricular filling to atrial systole ratio; Ees, ventricular end-systolic elastance; EF, ejection fraction; LAVi, left atrial volume index; LVVi, left ventricular volume index; SBP, systolic blood pressure.All data are reported as mean ± standard deviation. 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