Changes in Arterial Stiffness and N-terminal pro-brain natriuretic peptide Levels after Endovascular Repair of Descending Thoracic Aorta

Abstract

Limited data exist concerning the biomechanical and central hemodynamic changes induced by endograft implantation in the descending thoracic aorta. The aim of this prospective ongoing study was to evaluate changes in arterial stiffness, assessed by pulse wave velocity (PWV; m/sec), and N-terminal pro-brain natriuretic peptide (NT-proBNP; pg/mL) levels in patients undergoing endovascular repair of descending thoracic aorta (thoracic endovascular aortic repair [TEVAR]). Twenty-seven patients with thoracic aorta pathology who underwent elective TEVAR were included in the study. Blood samples were obtained preoperatively, 24hr, 48hr, and 6months postoperatively, and serum levels of NT-proBNP were measured. PWV was determined before and 6months after TEVAR. One-way analysis of variance by ranks was used to test the alterations in PWV (from baseline to 6months) and NT-proBNP (along the 4 phases of evaluation). Post hoc analyses were appropriately performed. We recorded an increase in values of NT-proBNP from baseline (median=96.1, interquartile range [IQR]=82.7-117.9) to 24 hr postoperative (median=201.6, IQR=82.8-425.9), 48 hr postoperative (median=317.0, IQR=102.5-1,479.5), and 6months postoperative (median=144, IQR=82.8-276.4). The Kruskal-Wallis H test showed a statistically significant increase (x2(3)=11.17, P=0.01) in NT-proBNP from baseline (rank mean=22.19) toward the postoperative time points of evaluation (24 hr postoperative: 35.17 [change: +12.9, P=0.02]; 48 hr postoperative: 42.64 [change: +20.5, P<0.001]; 6month postoperative: 34.91 [change: +12.7, P=0.03]). An increase in PWV values was recorded from baseline (median=11.9, IQR=10.0-13.5) to 6months postoperatively (median=13.9, IQR=11.9-16.4). That change achieved statistically significant level [x2(1)=4.86, P=0.03], with an increase in mean rank PWV (+7.5). Implementation of thoracic stent grafts may be associated with considerable increase of both arterial stiffness and NT-proBNP serum levels along time. Those results may indicate an adverse cardiac impact of TEVAR. However, the early and long-term effects of TEVAR on cardiovascular outcomes require further investigation.