Impact of Aortic Diameter on Left Ventricular Diastolic Dysfunction Following Endovascular Aortic Repair in Patients with Abdominal Aortic Aneurysm

OBJECTIVES Endovascular aortic repair (EVAR) is a less invasive treatment for abdominal aortic aneurysm (AAA). It has been reported the relationship between aortic diameter and the cardiovascular dysfunction caused by hemodynamic changes after EVAR in animal model. This study explored the relationship between abdominal aortic diameter and cardiovascular dysfunction post-EVAR in AAA patients. METHODS Eighty-five patients who underwent EVAR (76.0±7.4 years) received contrast-enhanced computed tomography to assess abdominal aortic diameter, echocardiography and vascular function tests (CAVI) before and one year after EVAR. The patients were categorized as the Small (<21.7 mm, N=42) and Large (≥21.7 mm, N=43) groups based on the median abdominal aortic diameter. We investigated the correlation between abdominal aortic diameters and changes in cardiovascular function. RESULTS In all patients, pulse pressure and CAVI significantly increased, while E/A decreased post-EVAR (P<0.05 for each). The left ventricular mass index (LVMI) tended to rise post-EVAR in the small group (87.7±19.2 to 93.5±20.7 g/m2, p=0.059), but not in the large group. When quartiles categorized abdominal aortic diameters, the percentage change of LVMI tended to increase with smaller aortic diameters, and there was a notable difference between quartiles 1 and 4. CONCLUSION EVAR exacerbates arterial stiffness and LV diastolic dysfunction in patients with AAAs. Additionally, a smaller aortic diameter in these patients may be associated with more significant LV hypertrophy post-EVAR. This highlights the significance of monitoring for LV diastolic dysfunction when performing EVAR in patients with smaller aortic diameters.