Key result
Thoracic endovascular aortic repair was associated with a significantly smaller increase in end-systolic elastance during exercise stress compared to controls (P=0.002).
Why the study?
Does TEVAR alter ventricle-aorta coupling and cardiac afterload during exercise in patients with thoracic aortic diseases?
Cohort (n=47)
Does TEVAR alter ventricle-aorta coupling and cardiac afterload during exercise in patients with thoracic aortic diseases?
p-value: p=0.002
TEVAR may suppress left ventricular contractile capacity and increase cardiac afterload during exercise, likely due to increased aortic stiffness from the stent graft.
May limit LV contractile reserve during exercise post-TEVAR; hypothesis-generating and should not yet change practice.
OBJECTIVES: The aim of this study was to explore, with exercise echocardiography, the potential impact of thoracic endovascular aortic repair (TEVAR) on the ventricle-aorta coupling, based on the hypothesis that the interaction between the ventricle and aorta may be influenced by an increase in aortic stiffness due to the stent graft. METHODS: Of the patients who underwent isolated TEVAR for thoracic aortic diseases between April 2016 and December 2016, changes found in haemodynamic and echocardiographic parameters between the control (n = 17) and TEVAR (n = 30) groups were analysed by a stress echocardiogram. RESULTS: The end-systolic elastance significantly increased with stress in both groups [from 3.0 (2.5-4.5) mmHg/ml to 4.8 (3.7-6.5) mmHg/ml, P < 0.001, in the control group and from 2.9 (2.0-3.5) mmHg/ml to 3.4 (2.6-4.2) mmHg/ml, P < 0.001, in the TEVAR group]. The arterial elastance significantly elevated only in the TEVAR group [from 1.6 (1.3-1.8) mmHg/ml to 1.7 (1.5-2.0) mmHg/ml, P = 0.007] and arterial elastance/end-systolic elastance (ventricular-arterial coupling) significantly decreased only in the control group [from 0.5 (0.4-0.7) to 0.4 (0.3-0.5), P = 0.002, in the control group and from 0.6 (0.4-0.8) to 0.5 (0.4-0.6), P = 0.10, in the TEVAR group]. In the control group, the change in end-systolic elastance and ventricular-arterial coupling tended to be greater (P = 0.002 and 0.07). CONCLUSIONS: An exercise echocardiogram showed the underlying influences of TEVAR on the interaction between the heart and aorta. TEVAR may have the potential to suppress left ventricular contractile capacity and increase cardiac afterload during exercise. CLINICAL TRIAL REGISTRATION NUMBER: A201770-01.
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Hiraoka et al. (2018) conducted a cohort in Thoracic aortic diseases (n=47). Thoracic endovascular aortic repair (TEVAR) vs. Control group was evaluated on Change in end-systolic elastance with stress (p=0.002). Thoracic endovascular aortic repair was associated with a significantly smaller increase in end-systolic elastance during exercise stress compared to controls (P=0.002).
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