主动脉瓣狭窄患者经经导管主动脉瓣置换术后早期内皮功能改善：eFAST 研究。
Patients with aortic stenosis exhibit early improved endothelial function following transcatheter aortic valve replacement: The eFAST study.
机构信息
Monash Cardiovascular Research Centre, MonashHeart, Monash University and Monash Health, Melbourne, Australia.
Monash Cardiovascular Research Centre, MonashHeart, Monash University and Monash Health, Melbourne, Australia; Institute of Cardiovascular Science, University College London, London, United Kingdom.
出版信息
Int J Cardiol. 2021 Jun 1;332:143-147. doi: 10.1016/j.ijcard.2021.03.062. Epub 2021 Mar 26.
BACKGROUND
Patients with severe aortic stenosis (AS) exhibit systemic endothelial dysfunction, which can be associated with myocardial ischaemia in absence of obstructive coronary disease. Transcatheter aortic valve replacement (TAVR) is used to treat severe AS in patients with high or prohibitive surgical risk. However, it remains unknown whether endothelial function recovers post-TAVR. We therefore sought to assess the early and late changes in flow-mediated dilation (FMD), a measure of endothelial function, following TAVR.
METHODS
Patients undergoing TAVR for severe AS had ultrasound assessment of brachial endothelial-independent and -dependent FMD. Measurements were performed pre-TAVR, at early follow-up (<48 h post-TAVR) and late follow-up (4-6 weeks post-TAVR).
RESULTS
27 patients (mean age 82.0 ± 7.0; 33.3% female) were recruited; 37.0% had diabetes mellitus and 59.3% had hypertension. Brachial artery FMD increased from 4.2 ± 1.6% (pre-TAVR) to 9.7 ± 3.5% at early follow-up (p < 0.0001). At late follow-up, improvement compared with early follow-up was sustained (8.7 ± 1.9%, p = 0.27). Resting brachial arterial flow velocities decreased significantly at late follow-up (11.24 ± 5.16 vs. 7.73 ± 2.79 cm/s, p = 0.003). Concordantly, at late follow-up, there was decrease in resting wall shear stress (WSS; 14.8 ± 7.8 vs. 10.6 ± 4.8dyne/cm2, p = 0.01), peak WSS (73.1 ± 34.1 vs. 58.8 ± 27.8dyne/cm2, p = 0.03) and cumulative WSS (3543 ± 1852 vs. 2504 ± 1089dyne·s/cm, p = 0.002). Additionally, a favourable inverse correlation between cumulative WSS and FMD was restored at late follow-up (r = -0.21 vs. r = 0.49).
CONCLUSION
Endothelial function in patients with AS improves early post-TAVR and this improvement is sustained. This likely occurs as a result of improved arterial haemodynamics, leading to lower localised WSS and release of vasoactive mediators that may also alleviate myocardial ischaemia.
背景
严重主动脉瓣狭窄（AS）患者表现出全身内皮功能障碍，在没有阻塞性冠状动脉疾病的情况下，可能与心肌缺血有关。经导管主动脉瓣置换术（TAVR）用于治疗高危或禁忌手术的严重 AS 患者。然而，尚不清楚 TAVR 后内皮功能是否恢复。因此，我们试图评估 TAVR 后血流介导的扩张（FMD），一种内皮功能的测量，早期和晚期的变化。
方法
接受 TAVR 治疗严重 AS 的患者进行肱动脉内皮非依赖性和依赖性 FMD 的超声评估。测量在 TAVR 前、早期（TAVR 后<48 小时）和晚期（TAVR 后 4-6 周）进行。
结果
共招募 27 例患者（平均年龄 82.0±7.0 岁；33.3%为女性）；37.0%患有糖尿病，59.3%患有高血压。肱动脉 FMD 从 4.2±1.6%（TAVR 前）增加到早期随访时的 9.7±3.5%（p<0.0001）。在晚期随访时，与早期随访相比，改善持续存在（8.7±1.9%，p=0.27）。晚期随访时，静息肱动脉血流速度明显下降（11.24±5.16 与 7.73±2.79cm/s，p=0.003）。相应地，在晚期随访时，静息壁切应力（WSS）下降（14.8±7.8 与 10.6±4.8dyne/cm2，p=0.01），峰值 WSS（73.1±34.1 与 58.8±27.8dyne/cm2，p=0.03）和累积 WSS（3543±1852 与 2504±1089dyne·s/cm，p=0.002）。此外，晚期随访时，累积 WSS 与 FMD 之间恢复了有利的负相关（r=-0.21 与 r=0.49）。
结论
AS 患者的内皮功能在 TAVR 后早期改善，并且这种改善持续存在。这可能是由于动脉血流动力学改善，导致局部 WSS 降低，释放血管活性介质，也可能缓解心肌缺血。
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