Combined impact of elevated arterial stiffness and left ventricular filling pressure on outcomes after off-pump coronary artery bypass grafting

Abstract

Abstract Background Brachial-ankle pulse wave velocity (baPWV) and early diastolic transmitral flow velocity to mitral annular tissue velocity (E/e′)—which are markers of arterial stiffness and left ventricular (LV) filling pressure, respectively—have been associated with morbidity and mortality. We investigated their combined impact on postoperative complications and long-term survival of patients undergoing off-pump coronary artery bypass grafting (OPCAB). Methods A cohort of 164 patients were divided into four groups: baPWV ≤ 19 m/s and E/e′ ≤ 15 (reference), baPWV > 19 m/s and E/e′ ≤ 15 (high-PWV-only), baPWV ≤ 19 m/s and E/e′ > 15 (high-E/e′-only), and baPWV > 19 m/s and E/e′ > 15 (high-PWV-and-E/e′). After inverse probability treatment weighting adjustment, each group was compared with the reference group to analyze the odds ratios of postoperative complications and the Kaplan–Meier survival curves, and to identify the group representing an independent prognostic predictor. Results The median age and follow-up duration were 69 years and 57.2 months, respectively. Both postoperative acute kidney injury (POAKI) and atrial fibrillation (POAF) were higher in the high-PWV-and-E/e′ group (adjusted odds ratio (OR) = 89.5; 95% confidence interval (CI), 8.5–942.3; p < 0.001 and OR = 12.5; CI, 2.5–63.8; p = 0.002, respectively). Compared to the reference group, only the high-PWV-and-E/e′ group showed significantly lower survival rate (91.0%; CI, 82.8–100% vs. 44.8%; CI, 21.2–94.6%) and a higher hazard for all-cause mortality after adjustment for covariates (hazard ratio = 6.1; p = 0.002). Conclusion Concurrent elevation in PWV and E/e′ may independently affect not only the rates of POAKI and POAF but also long-term survival after OPCAB.

Keywords

• Pulse wave velocity
• Arterial stiffness
• Ventricular filling pressure
• Diastolic dysfunction
• Survival