O-014 - "AORTIC STIFFNESS AND CARDIAC MODIFICATION AFTER OPEN OR ENDOVASCULAR AORTIC TREATMENT: PRELIMINARY RESULTS OF A SINGLE-CENTRE PROSPECTIVE COHORT STUDY"

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Mariani E. (Vascular Surgery, Department of Medicine and Surgery, University of Parma ~ Parma ~ Italy) , Bramucci A. (Vascular Surgery, Department of Medicine and Surgery, University of Parma ~ Parma ~ Italy) , Suma S. (Cardiology and Cardiac Imaging Department, University of Parma ~ Parma ~ Italy) , Fornasari A. (Vascular Surgery, Department of Medicine and Surgery, University of Parma ~ Parma ~ Italy) , Catasta A. (Vascular Surgery, Department of Medicine and Surgery, University of Parma ~ Parma ~ Italy) , Gaibazzi N. (Cardiology and Cardiac Imaging Department, University of Parma ~ Parma ~ Italy) , Perini P. (Vascular Surgery, Department of Medicine and Surgery, University of Parma ~ Parma ~ Italy) , Freyrie A. (Vascular Surgery, Department of Medicine and Surgery, University of Parma ~ Parma ~ Italy)
Introduction:
Increased arterial stiffness, particularly Aortic Stiffness (AoS), is considered an independent marker of cardiovascular mortality and morbidity. According to the literature, aortic endovascular treatment correlates to a worsening of AoS in the medium term, indirectly evaluated as an increase in Pulse Wave Velocity (PWV). This appears to lead to changes in cardiac geometry and efficiency. The arterial elastance (Ea) represents the total workload opposite to the left ventricle; it is a poorly researched parameter in this field but it could estimate the total arterial compliance. The aim of this study is to evaluate possible changes in AoS with consequent alterations in cardiac function after endovascular repair (ER) or open surgery (OS), also by comparing these two different techniques.
Methods:
Patients who were candidates for elective ER or OS for abdominal aortic disease (aneurysm, intramural haematoma, penetrating aortic ulcers) were enrolled in the study, excluding those with a history of previous aortic or cardiac surgery or severe peripheral arterial disease. Carotid-femoral PWV (cf-PWV) was measured with a doppler ultrasound (DUS)-ECG coupling system during the pre-operative and post-operative period and after one-year of follow-up. An experienced cardiologist performed doppler echocardiography before surgery and after one year evaluating: Ea and ventricular end-systolic elastance (Ees) and their coupling (Ea/Ees), inter-ventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular (LVVi) and left atrial volume index (LAVi), ejection fraction (EF), ratio of early ventricular filling to atrial systole (E/A) and ratio of trans-mitral early peak velocity to early diastolic mitral anulus velocity (E/E'). Furthermore, systolic (SBP) and diastolic blood pressure (DBP) and exercise tolerance by the Specific Activity Scale score (SASs) were assessed preoperatively and after one year. B-type natriuretic peptide (BNP) was measured before and after surgery. A descriptive statistical analysis was first performed. Continuous variables were compared by Mann-Whitney U test or Student's T test, and presented as mean ± standard deviation. Categorical variables were compared using the χ2 - test or the Fisher exact test.
Results:
Fifty-five patients have been enrolled, from December 2019 to June 2021, fourteen undergoing OS and forty-one undergoing ER. Pre-operative characteristics and risk factors are described in Table 1. Both groups were homogeneous, except for age which was lower for the OS group (67.4±6.9 vs 75.5±6.4 years, p<.001). During the post-operative period it was observed a not significant increase in cf-PWV in both groups (mean increase: +1.9 m/sec for OS, p=.568, and +2.5 m/sec for ER, p=.123) and a statistically significant rise of BNP for both OS (47±28.2 vs 183±128.8 pg/ml; p=.006) and ER (88.8±104.8 vs 184.4±217.5 pg/ml; p=.007). BNP was not evaluated at follow-up. Twenty-three patients completed the one-year follow-up (seventeen from the ER group, six from OS): an increase in cf-PWV was observed in patients undergoing ER (13.7±3.5 vs 16.3±7.6 m/sec, p=.151) and a decrease in patients from OS group (11.3±5.8 vs 10.5±3.1 m/sec, p=783) compared to pre-operative data. Both results are not statistically significant. SBP and DBP grew in both ER (SBP: +19.7 mmHg, p<.001; DBP: +5.3 mmHg, p=.026) and OS groups (SBP: +27.5 mmHg, p=.002; DBP: +7.9 mmHg, p=.037). Considering the main echocardiographic data, after one year the following was recorded: a significant increase in Ea (1.5±0.3 vs 1.8±0.4 mmHg/ml/m2, p=.049) and a significant decrease in E/A ratio (0.8±0.2 vs 0.6±0.1; p=.001) in the ER group only, without a significant change in Ea/Ees coupling. Follow-up data are shown in Table 2. No cardiovascular events and no significant changes in SAS score were observed during follow-up in either groups.
Conclusion:
This preliminary study shows an increase of aortic wall stiffness after ER described as a worsening of arterial elastance rather than PWV. Furthermore, the reversal of E/A ratio means an initial alteration in ventricular diastole, not related to significant mid-term changes in cardiac geometry. Both groups patients' developed hypertension after one-year of follow-up. These changes could lead to diastolic disfunction with an increased risk of cardiovascular events over time. It may be useful to improve the cardiological follow-up of these patients. A larger sample is needed to confirm these data and assess any significant increase in PWV and therefore in aortic stiffness.
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