Clinical study: large artery stiffness in CAD
Large artery stiffness predicts ischemic threshold in patients with coronary artery disease

https://doi.org/10.1016/S0735-1097(02)02009-0Get rights and content
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Abstract

Objectives

The goal of this study was to determine whether large artery stiffness contributes to exercise-induced myocardial ischemia in patients with coronary artery disease (CAD).

Background

Large artery stiffness is an independent predictor of cardiovascular mortality and a major determinant of pulse pressure and, thus, cardiac afterload and coronary perfusion. Clinical relevance of the hemodynamic consequences of large artery stiffening has not previously been demonstrated in relation to myocardial ischemia.

Methods

We hypothesized that stiffer large arteries would reduce myocardial ischemic threshold as assessed by time to ST-segment depression of 0.15 mV during a treadmill exercise test in patients with CAD. Ninety-six patients with CAD (78 men) age 62 ± 9 years (mean ± SD) were classified as having single (52 patients), double (31 patients), or triple (13 patients) coronary vessel disease, based on angiographically confirmed stenoses >50%. Systemic arterial compliance, distensibility index, aortic pulse wave velocity, and carotid augmentation index were measured using carotid applanation tonometry and Doppler velocimetry of the ascending aorta, at rest.

Results

In univariate analysis, all large artery stiffness/compliance indexes correlated with time to ischemia (p = 0.01 to 0.009). Both carotid (p = 0.007) and brachial (p = 0.001) pulse pressure also correlated inversely with time to ischemia. In multivariate analysis including other major risk factors plus severity of coronary stenosis, indexes of arterial stiffness were significant independent predictors of ischemic threshold.

Conclusions

Within a patient group with moderate CAD, large artery stiffness was a major determinant of myocardial ischemic threshold.

Abbreviations

AI
augmentation index
CAD
coronary artery disease
DI
distensibility index
PP
pulse pressure
PWV
pulse wave velocity
RPP
rate pressure product
SAC
systemic arterial compliance
SBP
systolic blood pressure

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Supported by research grants from VicHealth, Australia; the National Heart Foundation of Australia; and the National Health and Medical Research Council of Australia.