Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan.
Fujikoshi Hospital, Toyama 930-0964, Japan.
Medicina (Kaunas). 2021 Sep 24;57(10):1008. doi: 10.3390/medicina57101008.
: Endothelial dysfunction is associated with exercise intolerance and adverse cardiovascular events. Transcatheter aortic valve implantation (TAVI) is applied to treat elderly patients with severe aortic stenosis, but less is known about the impact of TAVI on endothelial dysfunction, which can be assessed by measuring flow-mediated vasodilation (FMD). In this parameter, a low value indicates impaired endothelial function. Vascular endothelial function was evaluated by FMD of the brachial artery just before and one week after TAVI. Factors associated with the normalization of FMD and their prognostic impact were investigated. : Fifty-one patients who underwent TAVI procedure (median 86 years old, 12 men) were included. FMD improved significantly from baseline to one week following TAVI (from 5.3% [3.7%, 6.7%] to 6.3% [4.7%, 8.1%], < 0.001). Among 33 patients with baseline low FMD (≤6.0%), FMD normalized up to >6.0% following TAVI in 15 patients. Baseline higher cardiac index was independently associated with normalization of FMD following TAVI (odds ratio 11.8, 95% confidence interval 1.12-124; < 0.04). : Endothelial dysfunction improved following TAVI in many patients with severe aortic stenosis. The implication of this finding is the next concern.
内皮功能障碍与运动耐量下降和不良心血管事件有关。经导管主动脉瓣植入术（TAVI）用于治疗老年严重主动脉瓣狭窄患者，但对于 TAVI 对内皮功能障碍的影响知之甚少，内皮功能障碍可以通过测量血流介导的血管扩张（FMD）来评估。在此参数中，低值表示内皮功能受损。 在 TAVI 之前和之后一周，通过肱动脉 FMD 评估血管内皮功能。研究了与 FMD 正常化相关的因素及其预后影响。 ：共纳入 51 例行 TAVI 手术的患者（中位年龄 86 岁，12 名男性）。FMD 从基线到 TAVI 后一周显著改善（从 5.3%[3.7%，6.7%]到 6.3%[4.7%，8.1%]，<0.001）。在 33 名基线 FMD 较低（≤6.0%）的患者中，有 15 名患者的 FMD 在 TAVI 后恢复到>6.0%。基线较高的心输出量与 TAVI 后 FMD 正常化独立相关（比值比 11.8，95%置信区间 1.12-124；<0.04）。 ：在许多严重主动脉瓣狭窄患者中，TAVI 后内皮功能障碍得到改善。这一发现的意义是下一个关注点。
