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Aortic distensibility in post-stenotic aortic dilatation: the effect of co-existing coronary artery disease
C Stefanadis1, C F Wooley, C A Bush
1Division of Cardiology, Ohio State University, Columbus.
Insights
Aortic distensibility is reduced in patients with aortic stenosis and post-stenotic dilatation. Co-existing coronary artery disease further decreases aortic distensibility, potentially due to impaired arterial wall nutrition.
Area of Science:
- Cardiovascular Medicine
- Vascular Physiology
Background:
- Aortic distensibility is known to decrease in patients with coronary artery disease (CAD) even with a normal-appearing aorta.
- Post-stenotic dilatation is a common finding in aortic stenosis.
Purpose of the Study:
- To investigate aortic distensibility in patients with aortic stenosis and post-stenotic dilatation.
- To compare distensibility between patients with and without concurrent coronary artery disease.
Main Methods:
- Studied three groups: post-stenotic dilatation with normal coronaries (Group A, n=15), post-stenotic dilatation with CAD (Group B, n=14), and normal subjects (n=18).
- Measured aortic area and calculated mean diameters from aortography of the proximal aorta.
- Calculated aortic distensibility using a standard formula.
Main Results:
- Aortic distensibility was significantly lower in Group A (2.5 ± 0.4 cm²/dyne) and Group B (1.0 ± 8 cm²/dyne) compared to normal subjects (3.4 ± 0.4 cm²/dyne).
- Group B demonstrated significantly lower distensibility than Group A (p < 0.001).
- These findings indicate reduced aortic distensibility in post-stenotic dilatation, with a further reduction in the presence of CAD.
Conclusions:
- Patients with post-stenotic aortic dilatation exhibit decreased aortic distensibility.
- The presence of coronary artery disease exacerbates this reduction, possibly linked to compromised vasa vasorum supply to the ascending aorta.
Abstract:
Aortic distensibility is decreased in patients with coronary artery disease (CAD) and the angiographically normal aorta. To determine if the same is true in patients with aortic stenosis and post-stenotic dilatation, two groups were studied. Group A consisted of 15 patients with post-stenotic aortic dilatation and normal coronary arteries, and group B, 14 patients with post-stenotic aortic dilatation and CAD. The patients were compared to 18 normal subjects. The area of the first 6 cm of the aorta above the valve obtained by aortography was planimetered and the mean diameters were calculated. Distensibility was calculated using the formula: (formula; see text) Distensibility was greater in group A (2.5 +- .4 cm2.dynes-1) compared to group B (1.0 +- 8 cm2.dynes-1, p less than 0.001). Distensibility in normal subjects reported recently from this laboratory (3.4 +- .4 cm2.dynes-1) was greater compared to both groups A and B (p less than 0.001). Thus, distensibility was decreased in patients with post-stenotic aortic dilatation. The further decrease in distensibility in patients with co-existing coronary artery disease may be partially related to abnormal nutrition of the arterial wall since the vasa vasorum of the ascending aorta are derived from the coronary arteries.