Sobajima Mitsuo, Imamura Teruhiko, Ueno Yohei, Onoda Hiroshi, Tanaka Shuhei, Ushijima Ryuichi, Fukuda Nobuyuki, Ueno Hiroshi, Kinugawa Koichiro
Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama Toyama Japan.
Circ Rep. 2022 Jan 29;4(2):92-98. doi: 10.1253/circrep.CR-22-0004. eCollection 2022 Feb 10.
The cardio-ankle vascular index (CAVI) is associated with the severity of vascular stiffness and heart failure (HF). However, little is known about CAVI in aortic stenosis (AS) patients, probably because of the difficulty of accurately measuring CAVI in these patients owing to their slow-rising pulse. In this study, we investigated the prevalence and prognostic impact of abnormally elevated CAVI measured after transcatheter aortic valve implantation (TAVI). Among patients with AS who underwent TAVI, those with bilateral peripheral artery disease, atrial fibrillation, and systolic HF were excluded. The effect of post-TAVI elevated CAVI (defined as ≥9.0) on HF readmission after the index discharge was investigated. In all, 149 patients (mean [±SD] age 84.8±5.6 years, 24.2% men, mean [±SD] post-TAVI CAVI 9.6±1.4) were included in the study. There was no significant difference in baseline characteristics between groups with and without elevated CAVI, except for lower high-density lipoprotein cholesterol (HDL-C) and a higher prevalence of HF history in the group with elevated CAVI (P<0.05 for both). Post-TAVI elevated CAVI (n=102) was associated with lower freedom from HF recurrence during the observational period (89.1% vs. 100%; median 726 days [interquartile range 329-1,104 days]; P<0.05). Moreover, CAVI was an independent predictor of HF occurrence (hazard ratio 1.62; 95% confidence interval 1.07-2.46; P=0.022). Elevated CAVI was associated with HF occurrence before and after TAVI.
心踝血管指数（CAVI）与血管僵硬度和心力衰竭（HF）的严重程度相关。然而，对于主动脉瓣狭窄（AS）患者的CAVI情况知之甚少，这可能是因为这些患者脉搏上升缓慢，难以准确测量CAVI。在本研究中，我们调查了经导管主动脉瓣植入术（TAVI）后测量的CAVI异常升高的患病率及其对预后的影响。在接受TAVI的AS患者中，排除了患有双侧外周动脉疾病、心房颤动和收缩性HF的患者。研究了TAVI后CAVI升高（定义为≥9.0）对出院后HF再入院的影响。共有149例患者（平均[±标准差]年龄84.8±5.6岁，男性占24.2%，TAVI后平均[±标准差]CAVI为9.6±1.4）纳入本研究。CAVI升高组和未升高组的基线特征无显著差异，但CAVI升高组的高密度脂蛋白胆固醇（HDL-C）较低，HF病史患病率较高（两者P<0.05）。TAVI后CAVI升高（n = 102）与观察期内较低的HF复发率相关（89.1%对100%；中位数726天[四分位间距329 - 1,104天]；P<0.05）。此外，CAVI是HF发生的独立预测因素（风险比1.62；95%置信区间1.07 - 2.46；P = 0.022）。CAVI升高与TAVI前后的HF发生均相关。
