Kidher Emaddin, Harling Leanne, Ashrafian Hutan, Naase Hatam, Francis Darrel P, Evans Paul, Athanasiou Thanos
The Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, 10th Floor, QEQM Wing, St Mary's Campus, London W2 1NY, UK.
J Cardiothorac Surg. 2014 Jun 17;9:102. doi: 10.1186/1749-8090-9-102.
Cardiac function and myocardial strain are affected by cardiac afterload, which is in part due to the stiffness of the aortic wall. In this study, we hypothesize that aortic pulse wave velocity (PWV) as a marker of aortic stiffness correlates with conventional clinical and biochemical markers of cardiac function and perioperative myocardial strain in aortic valve replacement (AVR).
Patients undergoing AVR for aortic stenosis between June 2010 and August 2012 were recruited for inclusion in this study. PWV, NYHA class and left ventricular (LV) function were assessed pre-operatively. PWV was analysed both as a continuous and dichotomous variable according to age-standardized reference values. B-type natriuretic peptide (BNP) was measured pre-operatively, and at 3 h and 18-24 h after cardiopulmonary bypass (CPB). NYHA class, leg edema, and LV function were recorded at follow-up (409 ± 159 days).
Fifty-six patients (16 females) with a mean age of 71 ± 8.4 years were included, with 50 (89%) patients completing follow-up. The NYHA class of PWV-norm patients was significantly lower than PWV-high patients both pre- and post-operatively. Multiple logistic regression also highlighted PWV-cut off as an independent predictor of NYHA class pre- and post-operatively (OR 8.3, 95% CI [2.27,33.33] and OR 14.44, 95% CI [1.49,139.31] respectively). No significant relationship was observed between PWV and either LV function or plasma BNP.
In patients undergoing AVR for aortic stenosis, PWV is independently related to pre- and post-operative NYHA class but not to LV function or BNP. These findings provisionally support the use of perioperative PWV as a non-invasive marker of clinical functional status, which when used in conjunction with biomarkers of myocardial strain such as BNP, may provide a holistic functional assessment of patients undergoing aortic valve surgery. However, in order for PWV assessment to be translated into clinical practice and utilised as more than simply a research tool, further validation is required in the form of larger prospective studies specifically designed to assess the relationship between PWV and these functional clinical outcomes.
心脏功能和心肌应变受心脏后负荷影响，部分原因是主动脉壁的僵硬度。在本研究中，我们假设主动脉脉搏波速度（PWV）作为主动脉僵硬度的标志物，与主动脉瓣置换术（AVR）中传统的心脏功能临床和生化标志物以及围手术期心肌应变相关。
招募2010年6月至2012年8月期间因主动脉瓣狭窄接受AVR的患者纳入本研究。术前评估PWV、纽约心脏协会（NYHA）心功能分级和左心室（LV）功能。根据年龄标准化参考值，将PWV作为连续变量和二分变量进行分析。术前、体外循环（CPB）后3小时和18 - 24小时测量B型利钠肽（BNP）。随访（409±159天）时记录NYHA心功能分级、腿部水肿和LV功能。
纳入56例患者（16例女性），平均年龄71±8.4岁，50例（89%）患者完成随访。PWV正常患者的NYHA心功能分级在术前和术后均显著低于PWV高的患者。多因素逻辑回归还强调PWV临界值是术前和术后NYHA心功能分级的独立预测因素（分别为OR 8.3，95%CI[2.27,33.33]和OR 14.44，95%CI[1.49,139.31]）。未观察到PWV与LV功能或血浆BNP之间存在显著关系。
在因主动脉瓣狭窄接受AVR的患者中，PWV与术前和术后NYHA心功能分级独立相关，但与LV功能或BNP无关。这些发现初步支持围手术期PWV作为临床功能状态的非侵入性标志物的应用，当与心肌应变生物标志物如BNP联合使用时，可能为接受主动脉瓣手术的患者提供全面的功能评估。然而，为了使PWV评估转化为临床实践并不仅仅作为一种研究工具使用，需要通过专门设计用于评估PWV与这些功能性临床结局之间关系的更大规模前瞻性研究进行进一步验证。
