Disfuncţia endotelială şi prognosticul postoperator pe termen lung la pacienţii cu arteriopatie obliterantă.

Objective - To establish the impact of endothelial dysfunction (assessed by flow mediated vasodilatation - FMD and plasma level of von Willebrand factor - vWF) on long term (15 month) cardiovascular risk at patients with peripheral arterial disease undergoing nonemergent vascular surgery. Methods - We studied the relation between endothelial dysfunction asessed by FMD and vWF value and cardiovascular events at 90 consecutive patients with peripheral arterial disease proposed for nonemergent vascular surgery. Cardiovascular events (cardiac death, cardiac arrest, acute myocardial infarction, unstable angina, stroke) were followed 15 months (± 3 months) after surgical intervention. Results - Sixteen patients (17.8%) had cardiovascular events (cardiac death - 4 patients; cardiac arrest - 2 patients; myocardial infarction - 4 patients; unstable angina - 3 patients; stroke - 3 patients). Preoperative endothelium dependent FMD was between 4.87 % and 15%, with a mean value of 8.82 ± 2.13%; at the patients with a postoperative cardiovascular event FMD was significantly lower (5.96 ± 1.37%) than in those without an event (9.43 ± 1.73%; p = 0.0001), whereas nonendothelium-dependent vasodilation to nitroglycerin was similar in both groups (13.68 ± 1.77% versus 14.92 ± 2.76%, p = 0,088). Preoperative vWF levels were between 70 - 296 U/dl, with a mean value of 176.6 ± 55.28 U/dl, significantly higher at the patients with cardiovascular events (214.43 ± 54.78 U/dl versus 168.41 ± 52.22 U/dl, p= 0,002). Relative risk of cardiovascular events was higher at the patients with FMD below 7.2% (lower tertile) associated with vWF above 216 U/dl (higher tertile) - 3.51 (CI: 1.05 - 11.69) relative to patients with only FMD below 7.2% (lower tertile) - 2.51 (CI: 1.45 - 4.34) and only vWF above 216 U/dl (higher tertile)- 1.49 (CI: 1.04 - 2.23). Also, independent predictors for cardiovascular events were: ejection fraction (p=0.0003), ankle-brachial index (p=0.0001), type of surgical intervention (p=0.004), PDW (p=0.001), but PAI-1 was not significantly different at patients with cardiovascular events. Conclusions - Impaired endothelial function assessed by flow mediated dilatation and plasma von Willebrand levels predicts long-term cardiovascular events in patients with peripheral arterial disease undergoing a nonemergent vascular surgical intervention. [ABSTRACT FROM AUTHOR]