Assessment of Arterial Stiffness by Cardio-Ankle Vascular Index for Prediction of Five-Year Cardiovascular Events After Coronary Artery Bypass Surgery

Abstract

The study aim was to investigate the possibility of cardiovascular complications development predicting during a five-year follow-up of patients after coronary artery bypass grafting (CABG) using the cardio-ankle vascular index (CAVI) assessment. Methods: Three hundred and fifty–six patients after elective CABG were enrolled in the study. Prior to surgery, arterial stiffness was assessed in all patients using CAVI. The follow-up was performed five years after the surgery, information was obtained on 238 patients, who were divided into two groups: patients with pathological (≥9.0, n = 88), and normal (<9.0, n = 150) CAVI. Results: Pathological CAVI (≥9.0) was detected in 33% patients before CABG, in stepwise analyses only age and left atrium dimensions statistically significantly predicted CAVI. In patients with pathological CAVI the combined endpoint (major adverse cardiovascular events and hospitalization) and cardiovascular death developed more often in a five-year follow-up after CABG compared with normal CAVI (48.86% versus 34.9%, p = 0.034 and 4.55% versus 0.67%, p = 0.049, respectively). Pathological CAVI (p = 0.021) and the number of coronary bypass grafts (p = 0.023) were independent factors associated with the combined endpoint. Conclusions: Patients with pathological CAVI before CABG surgery are more likely to develop cardiovascular complications and cardiovascular death within a subsequent five-year follow-up. Evaluation of CAVI after CABG in dynamics deserves further study, it is important for monitoring the effects of secondary prevention and the possibility of influencing the prognosis.

Long-Term Prognosis after Coronary Artery Bypass Grafting: The Impact of Arterial Stiffness and Multifocal Atherosclerosis

“…We studied CAD patients who underwent CABG in the cardio-vascular surgery department of the Research Institute for Complex Issues of Cardiovascular Diseases between March 2011 and March 2012. A detailed characterization of the studied cohort of patients is presented in our previous article [ 22 ]. We did not include in the analysis patients with diseases that could affect the values of CAVI.…”

“…We assessed arterial stiffness by determining the cardio-ankle vascular index (CAVI) using the VaSera VS-1000 device (Fukuda Denshi, Tokyo, Japan) according to the previously described method [ 22 ]. This index is calculated automatically by the device on both lower extremities, it does not depend on the qualification of the operator, on the level of blood pressure, and is highly reproducible.…”

“…The study was carried out by experienced sonographers on an expert class ultrasound device ‘Vivid 7 Dimension’ (General Electric, Boston, MA, USA), and a 7.5 MHz linear-array transducer following a standard protocol [ 22 ]. We measured the thickness of the intima-media complex and assessed the state of the vessel: patency, and the structure of the plaque (in Doppler and B-mode).…”

“…Left ventricular ejection fraction (LVEF) was calculated using the Simpson method. In the right parts of the heart, the dimensions of the right atrium (RA) and the dimensions of the right ventricle (RV) were assessed [ 22 ].…”

“…Of course, there is evidence in the literature that acute renal failure after CABG adversely affects long-term prognosis [ 21 ], but a direct assessment of the effect of increased arterial stiffness on long-term prognosis has not been performed. Only in our group’s study has it been shown that increased arterial stiffness is associated with a poor prognosis at mid-term follow-up [ 22 ], but whether this effect persists at longer follow-up remains an open question.…”