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Aortic velocity propagation: A novel echocardiographic method in predicting atherosclerotic coronary artery disease
Pakala Vasudeva Chetty1, Durgaprasad Rajasekhar1, Velam Vanajakshamma1
1Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, IndiaaIndia.
Insights
Aortic velocity propagation (AVP) and carotid intima-media thickness (CIMT) effectively predict coronary artery disease (CAD) burden. AVP shows promise as a noninvasive bedside tool for assessing atherosclerotic disease and guiding preventive cardiovascular therapy.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- Atherosclerosis is a leading cause of global cardiovascular disease mortality.
- Early detection and noninvasive assessment of atherosclerosis are crucial for disease management.
- Aortic velocity propagation (AVP) quantifies aortic stiffness, reflecting atherosclerotic changes.
Purpose of the Study:
- To evaluate the utility of AVP in predicting coronary artery disease (CAD) burden.
- To compare AVP's predictive capability with carotid intima-media thickness (CIMT), a known atherosclerosis marker.
- To assess the correlation between AVP, CIMT, and the SYNTAX score in patients undergoing coronary angiography.
Main Methods:
- A cross-sectional study involving 100 patients who underwent coronary angiography.
- AVP measured using color M-mode echocardiography.
- CIMT measured using Philips QLAB-IMT software.
- Coronary artery disease significance defined by >50% diameter stenosis.
Main Results:
- Significant CAD was present in 69% of patients.
- Patients with significant CAD exhibited significantly lower AVP and higher CIMT compared to those without.
- AVP strongly and negatively correlated with CIMT (r=-0.836) and SYNTAX score (r=-0.803).
- CIMT showed a significant positive correlation with the SYNTAX score (r=0.828).
Conclusions:
- Both AVP and CIMT are robust predictors of CAD burden.
- AVP demonstrates potential as a valuable, noninvasive bedside tool for assessing atherosclerotic burden.
- AVP can aid in guiding preventive strategies for cardiovascular disease.
Background:
The major burden of cardiovascular disease mortality around the globe is due to atherosclerosis and its complications. Hence its early detection and management with easily accessible and noninvasive methods are valuable. Aortic velocity propagation (AVP) through color M-mode of the proximal descending aorta determines aortic stiffness, reflecting atherosclerosis. The aim of this study was to find the utility of AVP in predicting coronary artery disease (CAD) burden assessed through SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score and compared with carotid intima-media thickness (CIMT), which is an established surrogate marker of atherosclerosis.
Methods:
In this cross-sectional comparative study, we measured AVP by color M-mode and CIMT by using Philips QLAB-IMT software in 100 patients, who underwent conventional coronary angiogram (CAG) between May 2013 and November 2014. Coronary artery disease is considered significant if >50% diameter stenosis is present in any epicardial coronary artery and insignificant if otherwise.
Results:
Initially, to know the normal range we measured AVP and CIMT in 50 patients without any major risk factors for CAD but CAG was not done. Aortic velocity propagation ranged from 46 cm/s to 76 cm/s (mean = 58.62 ± 6.46 cm/s), CIMT ranged from 0.50 mm to 0.64 mm (mean = 0.55 ± 0.03 mm). Among 100 patients who underwent CAG we found 69% had significant CAD, 13% had insignificant CAD, and 18% had normal coronaries. Those with significant CAD had significantly lower AVP (41.65 ± 4.94 cm/s) [F (2,97) = 44.05, p < 0.0001] and significantly higher CIMT (0.86 ± 0.11 mm) [F (2,97) =35.78, p < 0.0001]. AVP had significant strong negative correlation with CIMT (r = -0.836, p < 0.0001, n = 100) and SYNTAX score (r = -0.803, p < 0.0001, n = 69), while CIMT was positively correlated with SYNTAX score significantly (r = 0.828, p < 0.0001, n = 69).
Conclusions:
AVP and CIMT can predict CAD burden in a robust way. AVP may emerge as an exquisite bedside tool to predict atherosclerotic burden and guide in implementing preventive therapy for cardiovascular disease.
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