title: Changes in Arterial Stiffness and N-terminal pro-brain natriuretic peptide Levels after Endovascular Repair of Descending Thoracic Aorta.
abstract: BACKGROUND
  Limited data exist concerning the biomechanical and central hemodynamic changes induced by endograft implantation in the descending thoracic aorta. The aim of this prospective ongoing study was to evaluate changes in arterial stiffness, assessed by pulse wave velocity (PWV; m/sec), and N-terminal pro-brain natriuretic peptide (NT-proBNP; pg/mL) levels in patients undergoing endovascular repair of descending thoracic aorta (thoracic endovascular aortic repair [TEVAR]).
  
  
  METHODS
  Twenty-seven patients with thoracic aorta pathology who underwent elective TEVAR were included in the study. Blood samples were obtained preoperatively, 24 hr, 48 hr, and 6 months postoperatively, and serum levels of NT-proBNP were measured. PWV was determined before and 6 months after TEVAR. One-way analysis of variance by ranks was used to test the alterations in PWV (from baseline to 6 months) and NT-proBNP (along the 4 phases of evaluation). Post hoc analyses were appropriately performed.
  
  
  RESULTS
  We recorded an increase in values of NT-proBNP from baseline (median = 96.1, interquartile range [IQR] = 82.7-117.9) to 24 hr postoperative (median = 201.6, IQR = 82.8-425.9), 48 hr postoperative (median = 317.0, IQR = 102.5-1,479.5), and 6 months postoperative (median = 144, IQR = 82.8-276.4). The Kruskal-Wallis H test showed a statistically significant increase (x2(3) = 11.17, P = 0.01) in NT-proBNP from baseline (rank mean = 22.19) toward the postoperative time points of evaluation (24 hr postoperative: 35.17 [change: +12.9, P = 0.02]; 48 hr postoperative: 42.64 [change: +20.5, P < 0.001]; 6 month postoperative: 34.91 [change: +12.7, P = 0.03]). An increase in PWV values was recorded from baseline (median = 11.9, IQR = 10.0-13.5) to 6 months postoperatively (median = 13.9, IQR = 11.9-16.4). That change achieved statistically significant level [x2(1) = 4.86, P = 0.03], with an increase in mean rank PWV (+7.5).
  
  
  CONCLUSIONS
  Implementation of thoracic stent grafts may be associated with considerable increase of both arterial stiffness and NT-proBNP serum levels along time. Those results may indicate an adverse cardiac impact of TEVAR. However, the early and long-term effects of TEVAR on cardiovascular outcomes require further investigation.
authors: Department of Vascular Surgery, "Attikon" University Hospital, Athens, Greece. Electronic address: konmoulakakis@yahoo.gr.
authors: Konstantinos G
authors: KG
authors: Moulakakis
authors: 2nd Department of Cardiology, "Attikon" University Hospital, Athens, Greece.
authors: Nikolaos P E
authors: NPE
authors: Kadoglou
authors: Department of Vascular Surgery, "Attikon" University Hospital, Athens, Greece.
authors: Constantine N
authors: CN
authors: Antonopoulos
authors: Department of Vascular Surgery, "Attikon" University Hospital, Athens, Greece.
authors: Spyridon N
authors: SN
authors: Mylonas
authors: Department of Vascular Surgery, "Attikon" University Hospital, Athens, Greece.
authors: John
authors: J
authors: Kakisis
authors: 2nd Department of Cardiology, "Attikon" University Hospital, Athens, Greece.
authors: Ioannis
authors: I
authors: Papadakis
authors: Department of Cytopathology, University of Athens, Attikon Hospital, Greece.
authors: Petros
authors: P
authors: Karakitsos
authors: Department of Vascular Surgery, "Attikon" University Hospital, Athens, Greece.
authors: Christos D
authors: CD
authors: Liapis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001018:Aortic Diseases / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D015415:Biomarkers / Q000097:blood; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D059289:Vascular Stiffness
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain