Miki Yusuke, Tanaka Akihito, Tokuda Yoshiyuki, Tobe Akihiro, Shirai Yoshinori, Yuhara Satoshi, Akita Sho, Furusawa Kenji, Ishii Hideki, Mutsuga Masato, Murohara Toyoaki
Department of Cardiology.
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya.
J Cardiovasc Med (Hagerstown). 2023 May 1;24(5):302-307. doi: 10.2459/JCM.0000000000001456. Epub 2023 Mar 17.
Arterial stiffness indices are used to assess the material properties of the arterial wall and are associated with cardiovascular events. Aortic stenosis (AS) is commonly caused by degenerative calcification and can be associated with increased arterial stiffness. However, the clinical implications of arterial stiffness indices in AS patients before and after treatment are unknown.
This single-center observational study enrolled 150 consecutive patients who underwent transcatheter aortic valve implantation (TAVI) for severe AS. The cardio-ankle vascular index (CAVI) was measured before and after TAVI. The patients were divided into two groups according to the CAVI values before and after TAVI: high CAVI group and low CAVI group. Patient and echocardiographic data and clinical outcomes, including cardiac death and hospitalization for heart failure (HF), were compared.
The pre- and postprocedural CAVI was 7.90 (6.75-9.30) and 9.65 (8.90-10.65), respectively. In the analyses with preprocedural CAVI, preprocedural echocardiographic aortic valve peak flow velocity was significantly lower in the high CAVI group. No significant differences between the two groups were observed in the occurrence of cardiac death or hospitalization for HF. In the analyses with postprocedural CAVI, B-type natriuretic peptide levels and E / e ' ratio after TAVI were significantly higher in the high CAVI group. The composite of cardiac death and hospitalization occurrence for HF was significantly higher in the high CAVI group.
CAVI before TAVI is mainly affected by the AS severity, while CAVI after TAVI is associated with left ventricular diastolic dysfunction and late cardiac events, which may reflect arterial stiffness.
动脉僵硬度指数用于评估动脉壁的材料特性，并与心血管事件相关。主动脉瓣狭窄（AS）通常由退行性钙化引起，且可能与动脉僵硬度增加有关。然而，AS患者治疗前后动脉僵硬度指数的临床意义尚不清楚。
本单中心观察性研究纳入了150例连续接受经导管主动脉瓣植入术（TAVI）治疗重度AS的患者。在TAVI术前和术后测量心踝血管指数（CAVI）。根据TAVI术前和术后的CAVI值将患者分为两组：高CAVI组和低CAVI组。比较患者和超声心动图数据以及临床结局，包括心源性死亡和因心力衰竭（HF）住院。
术前和术后的CAVI分别为7.90（6.75 - 9.30）和9.65（8.90 - 10.65）。在术前CAVI的分析中，高CAVI组术前超声心动图主动脉瓣峰值流速显著较低。两组在心源性死亡或因HF住院的发生率方面未观察到显著差异。在术后CAVI的分析中，高CAVI组TAVI术后B型利钠肽水平和E/e'比值显著更高。高CAVI组心源性死亡和因HF住院的复合发生率显著更高。
TAVI术前的CAVI主要受AS严重程度影响，而TAVI术后的CAVI与左心室舒张功能障碍和晚期心脏事件相关，这可能反映了动脉僵硬度。
