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Preoperative endothelial function and long-term cardiovascular events in patients undergoing cardiovascular surgery

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Abstract

We recently reported that preoperative endothelial dysfunction [i.e., reactive hyperemia index (RHI) ≤ 1.64] predicted short-term postoperative adverse events in patients undergoing cardiovascular surgery. However, the relationship between preoperative RHI and long-term cardiovascular risk in these patients is unclear. A total of 195 patients with at least 1-year follow-up who underwent cardiovascular surgery were included. Preoperative endothelial function was assessed by RHI. The primary outcome was a composite of cardiac death, stroke, myocardial infarction, rehospitalization due to heart failure, and any coronary revascularization. Nineteen patients (9.7%) met the primary outcome, including cardiac death (n = 7), stroke (n = 5), heart failure (n = 9), and coronary revascularization (n = 2) during a median follow-up of 20 months. There was no significant difference in the baseline characteristics between patients with RHI ≤ 1.64 (n = 86) and those with RHI > 1.64 (n = 109). The primary outcome occurred in 13 patients with RHI ≤ 1.64 (15.1%) and in 6 patients with RHI > 1.64 (5.5%). Kaplan–Meier analysis demonstrated a significantly higher incidence of the primary outcome in patients with RHI ≤ 1.64 compared to their counterpart (hazard ratio 2.94; 95% confidence interval 1.12–7.75; p = 0.02). Multivariate analysis showed diabetes and RHI ≤ 1.64 as independent predictors for the primary outcome. In conclusion, preoperative endothelial dysfunction assessed by RHI was associated with long-term cardiovascular events in patients undergoing cardiovascular surgery.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan

    Yuichi Saito, Hideki Kitahara & Yoshio Kobayashi

  2. Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan

    Goro Matsumiya

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  1. Yuichi Saito
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  2. Hideki Kitahara
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  3. Goro Matsumiya
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  4. Yoshio Kobayashi
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Correspondence to Yuichi Saito.

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Saito, Y., Kitahara, H., Matsumiya, G. et al. Preoperative endothelial function and long-term cardiovascular events in patients undergoing cardiovascular surgery. Heart Vessels 34, 318–323 (2019). https://doi.org/10.1007/s00380-018-1248-8

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