Department of Cardiovascular Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
Department of Epidemiology, Fukushima Medical University, Fukushima, Japan.
Sci Rep. 2021 Feb 15;11(1):3830. doi: 10.1038/s41598-020-80920-y.
Reflected wave increases after endovascular aortic repair (EVAR) in patients with aortic aneurysm. This affects the left ventricular (LV) diastolic function and leads to a poor prognosis. This study aimed to evaluate the relationship between increased reflected wave amplitude and aortic diameter after EVAR. EVAR was performed in seven healthy goats. We assessed wave intensity (WI), aortic diameter, and stiffness parameter β. Moreover, we evaluated the relationship between negative reflected wave (NW, reflected waves toward the heart from the periphery by WI) and other parameters after EVAR. Results showed an increase in stiffness parameter β (3.5 ± 0.3 vs 15.9 ± 4.7, p = 0.018) and a decrease in the change of aortic diameter (6.9 ± 0.7 vs 2.7 ± 0.4%, p = 0.018) after EVAR. The NW was significantly amplified after EVAR from baseline (-589.8 ± 143.4 to - 1192.3 ± 303.7 mmHg-m/sec, p = 0.043). The NW showed a significant correlation with maximum aortic diameter (R = 0.707, p = 0.038) and minimum aortic diameter (R = 0.724, p = 0.033). The reflected wave was enhanced after EVAR and was correlated to the aortic diameter at the stent-graft site. It is important to consider that patients with smaller aortic diameters in landing zone who undergo EVAR may develop LV dysfunction.
血管内主动脉修复（EVAR）后，主动脉瘤患者的反射波增加。这会影响左心室（LV）舒张功能，并导致预后不良。本研究旨在评估 EVAR 后反射波幅度增加与主动脉直径之间的关系。在 7 只健康山羊中进行了 EVAR。我们评估了波强（WI）、主动脉直径和僵硬参数β。此外，我们还评估了 EVAR 后负反射波（NW，通过 WI 从外周向心脏反射的反射波）与其他参数之间的关系。结果显示，僵硬参数β增加（3.5±0.3 比 15.9±4.7，p=0.018），EVAR 后主动脉直径变化减小（6.9±0.7 比 2.7±0.4%，p=0.018）。EVAR 后，NW 从基线显著放大（-589.8±143.4 至-1192.3±303.7mmHg-m/sec，p=0.043）。NW 与最大主动脉直径（R=0.707，p=0.038）和最小主动脉直径（R=0.724，p=0.033）呈显著相关性。EVAR 后反射波增强，并与支架移植物部位的主动脉直径相关。重要的是要考虑到在着陆区进行 EVAR 的主动脉直径较小的患者可能会出现 LV 功能障碍。
