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Published on: October 19, 2016
How arterial stiffness may affect coronary blood flow: a challenging pathophysiological link
Maurizio Cusmà-Piccione1, Concetta Zito, Bijoy K Khandheria
1aClinical and Experimental Department of Medicine, University of Messina, Messina, Italy bAurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA cCardiology Unit, ARC, S. Maria degli Angeli Hospital, Pordenone dCardiology Unit, O.C. San Antonio, San Daniele del Friuli, Udine eCardiac Thoracic and Vascular Department, University of Pisa, Pisa fInternal Medicine, Villa Sofia Hospital, Palermo, Italy.
Insights
Increased arterial stiffness is linked to reduced diastolic coronary blood flow. Carotid artery stiffness measurements using echo-tracking may improve cardiovascular risk assessment.
Area of Science:
- Cardiovascular Physiology
- Medical Imaging
- Vascular Biology
Background:
- Arterial stiffening is a known cardiovascular risk factor.
- The precise relationship between arterial stiffness and coronary flow abnormalities requires further elucidation.
- Carotid stiffness and coronary blood flow are potential indicators of cardiovascular health.
Purpose of the Study:
- To investigate the relationship between carotid stiffness, measured by echo-tracking, and Doppler parameters of coronary blood flow in the left anterior descending (LAD) artery.
- To assess the association between carotid stiffness and coronary flow indices in patients with cardiovascular risk factors.
Main Methods:
- Eighty-eight patients with cardiovascular risk factors underwent carotid ultrasound for stiffness parameters (β index, elastic modulus) and echocardiography for coronary flow indices (diastolic velocity time integral, DVTICI).
- Carotid intima-media thickness (IMT) was also measured.
- Patients without prior cardiovascular disease were included.
Main Results:
- A significant inverse relationship was observed between DVTICI and carotid stiffness parameters (β index, elastic modulus), age, left ventricular mass index, E/E', pulse pressure, and IMT.
- Increased arterial stiffness was independently associated with reduced DVTICI.
- Men exhibited a significantly greater DVTICI than women.
Conclusions:
- Elevated arterial stiffness is associated with diminished diastolic coronary blood flow.
- Echo-tracking assessment of carotid artery stiffness offers a feasible method for cardiovascular risk stratification.
- These findings highlight the importance of arterial stiffness in assessing coronary perfusion.
Aims:
A relationship between arterial stiffening and coronary flow abnormalities, although not fully elucidated, has been observed. The purpose of this study was to investigate the relationship among carotid stiffness, measured using echo-tracking, and Doppler parameters of coronary blood flow, sampled at the left anterior descending (LAD) artery.
Methods:
We studied 88 consecutive patients (49 men, mean age 51.2 ± 16.2 years) with cardiovascular risk factors but without history of cardiovascular diseases. Each patient underwent echocardiographic evaluation for measurement of the diastolic velocity time integral (DVTI) and calculation of the diastolic velocity time integral coronary index (DVTICI), the ratio between DVTI and total velocity time integral of LAD artery flow × 100, and carotid ultrasound for measurement of carotid intima media thickness (IMT) and stiffness parameters such as β index and elastic modulus (Ep).
Results:
DVTICI was significantly greater in men than in women (median 82, interquartile range 78-86 vs. median 80, interquartile range 73-83, respectively; P < 0.016). After correlating DVTICI with other variables, a significant inverse relation was obtained with β index (Rho = -0.449, P < 0.001), Ep (Rho = -0.478, P < 0.001), age (Rho = -0.52, P < 0.001), left ventricular mass index (Rho = -0.543, P < 0.001), E/E' (Rho = -0.411, P < 0.001), pulse pressure (Rho = -0.417, P < 0.001) and IMT (Rho = -0.480, P < 0.001). With linear multiple regression analysis, only β index (P < 0.001), Ep (P < 0.001), male sex (P < 0.001) and left ventricular mass index (P = 0.008) were independently associated with reduction of DVTICI.
Conclusion:
Increased arterial stiffness, directly affecting coronary perfusion, is associated with reduced diastolic coronary flow. Echo-tracking for feasible measurement of carotid artery stiffness parameters may be valuable in more accurate cardiovascular risk stratification.
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