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Association of changes of pulse wave velocity and augmentation index after isometric handgrip exercise with coronary
Seong Taeg Kim1, Yeekyoung Ko1, Jong-Wook Beom1
1Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju City, Jeju Province, 63241, Republic of Korea.
Insights
Increased pulse wave velocity (PWV) after handgrip exercise indicates more severe coronary artery disease (CAD) and need for revascularization. Augmentation index (AIx) changes did not show this association.
Area of Science:
- Cardiovascular physiology
- Vascular biomechanics
- Clinical cardiology
Background:
- Arterial stiffness is linked to coronary artery disease (CAD) and myocardial ischemia.
- Arterial stiffness indexes can increase after isometric handgrip exercise, potentially revealing underlying CAD severity.
- This study explores the relationship between changes in arterial stiffness post-exercise and CAD characteristics.
Purpose of the Study:
- To investigate the association between changes in arterial stiffness indexes after isometric handgrip exercise and the extent of coronary artery disease (CAD).
- To determine if these changes predict the need for coronary revascularization.
- To compare the utility of pulse wave velocity (PWV) and augmentation index (AIx) in this context.
Main Methods:
- Patients undergoing coronary angiography had arterial waveforms measured at the aortic root and iliac artery.
- Measurements were taken at baseline and 3 minutes post-isometric handgrip exercise.
- Pulse wave velocity (PWV) and augmentation index (AIx) were calculated from pressure waveforms.
Main Results:
- Both PWV and AIx increased post-exercise, with a significant correlation between the changes (ΔPWV and ΔAIx).
- Higher ΔPWV was associated with more extensive CAD (2- or 3-vessel disease) and increased likelihood of percutaneous coronary intervention (PCI).
- Higher ΔAIx did not correlate with lesion extent or PCI, though ΔPWV showed a trend towards association with PCI (AUC=0.70, P=0.056) and was a significant predictor in logistic regression (OR=7.78, P=0.027).
Conclusions:
- The change in pulse wave velocity (ΔPWV) after isometric handgrip exercise is a valuable indicator of coronary artery disease severity.
- Elevated ΔPWV is associated with more extensive CAD and predicts the need for coronary revascularization.
- Augmentation index (AIx) changes after handgrip exercise are not similarly associated with CAD extent or revascularization necessity.
Background:
Arterial stiffness is associated with myocardial ischemia and incident coronary artery disease (CAD), and indexes of arterial stiffness are usually increased in patients with CAD. However, these indexes are often increased in elderly without CAD. Arterial stiffness in patients with CAD may become more evident after isometric handgrip exercise which increases systolic pressure and ventricular afterload. We investigated the association of the change of stiffness indexes after isometric handgrip exercise with the lesion extent of CAD and the necessity for coronary revascularization.
Methods:
Patients who were scheduled a routine coronary angiography via a femoral artery were enrolled. Arterial waveforms were traced at aortic root and external iliac artery using coronary catheters at baseline and 3 min after handgrip exercise. Augmentation index (AIx) was measured on the recorded aortic pressure waveform, and pulse wave velocity (PWV) was calculated using the ECG-gated time difference of the upstroke of arterial waveforms and distance between aortic root and external iliac artery.
Results:
Total 37 patients were evaluated. Both PWV and AIx increased after handgrip exercise. ΔPWV was significantly correlated with ΔAIx (r = 0.344, P = 0.037). Patients were divided into higher and lower ΔPWV or ΔAIx groups based on the median values of 0.4 m/sec and 3.3%, respectively. Patients with higher PWV had more 2- or 3-vessel CAD (69% vs. 27%, P = 0.034), and underwent percutaneous coronary intervention (PCI) more frequently (84% vs. 50%, P = 0.038), but higher ΔAIx was not associated with either the lesion extent or PCI. Area under curve (AUC) of ΔPWV in association with PCI by C-statistics was 0.70 (95% confidence interval [CI] 0.51-0.88; P = 0.056). In multiple logistic regression analysis, ΔPWV was significantly associated with PCI (odds ratio 7.78; 95% CI 1.26-48.02; P = 0.027).
Conclusions:
Higher ΔPWV after isometric handgrip exercise was associated with the lesion extent of CAD and the necessity for coronary revascularization, but higher ΔAIx was not.
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