Correlation between Impaired Aortic Distensibility and the Severity of Coronary Artery Disease and Calcium Scoring Measured by Cardiac CT

Background: Multi-Slice cardiac CT has evolved as a noninvasive imaging technique for evaluation of stenosis in the coronary arteries by what is called Coronary Computed Tomographic Angiography (CCTA), but it is also widely used in quantitative plaque assessments through Coronary Artery Calcium (CAC) scoring and plaque type identification ( soft or Mixed VS calcific) . Evaluation of aortic distensibility and aortic stiffness can also be performed through Multi-Slice Computed Tomography (MSCT) by calculating Aortic Distensibility Index (ADI) and Pulse Wave Velocity (PWV). Aim: To evaluate whether impaired Aortic Distensibility Index (ADI) and Aortic Stiffness measured by Cardiac CT is correlating with the severity of coronary artery disease and coronary calcium scoring in at-risk individuals (assessed by CCTA). Patients and Methods: We included 180 patients. Patients were classified into four groups according to their CAC score and according to the degree of stenosis based on CCTA. All patients in this study have underwent full history taking, short clinical examination including B.P. and H.R. measurements, standard ECG, routine laboratory investigations, and Multi-Slice CT Coronary Angiography (MSCT-CA). All patients underwent coronary artery calcium (CAC) scanning and CCTA, and their ADI and Aortic Stiffness were measured. Maximum systolic and maximum diastolic cross sectional-area (CSA) of ascending-aorta (AAo) was measured 15-mm above the left main coronary ostium. ADI was defined as: [(Systolic CSA –Diastolic CSA)/ (Diastolic CSA in X systemic-pulse-pressure) X 103]. Aortic stiffness was measured as PWV using Bramwell-Hill equation [1] [(3.57/ ?distensibility)]. Results: There were strong correlation between Aortic distensibility and Aortic stiffness (PWV) with degree of stenosis and coronary artery calcium. In patients stratified based on the degree of calcium scoring (CAC score), there was a statistically significant negative correlation between calcium scoring and the ADI (Pearson's r= -0.771, p<?.001), and a statistically significant positive correlation between calcium scoring and PWV (Pearson's r=0.817, p<?.001). In patients stratified based on the degree of stenosis, there was a statistically significant negative correlation between ADI and the Degree of stenosis (Pearson's r=-0.707, p<?.001), and there was a statistically significant positive correlation between PWV and the Degree of stenosis (Pearson's r=0.697, p<?.001). Conclusion: Impaired aortic distensibility strongly correlates with the severity of coronary atherosclerosis, degree of stenosis and coronary artery calcium. Addition of ADI to CAC and traditional risk factors provides incremental value to predict at-risk individuals.

Evaluation of cardiovascular risk in patients with Parkinson disease under levodopa treatment / 老年心脏病学杂志（英文版）

BackgroundLevodopa is the indispensable choice of medial therapy in patients with Parkinson disease (PD). Since L-dopa treatment was shown to increase serum homocysteine levels, a well-known risk factor for cardiovascular disorders, the patients with PD under L-dopa treatment will be at increased risk for future cardiovascular events. The objective of this study is to evaluate cardiovascular risk in patients with PD under levodopa treatment.MethodsThe study population consisted of 65 patients with idiopathic PD under L-dopa treatment. The control group included 32 age and gender matched individuals who had no cognitive decline. Echocardiographic measurements, serum homocysteine levels and elastic parameters of the aorta were compared between the patients with PD and controls.ResultsAs an expected feature of L-dopa therapy, the Parkinson group had significantly higher homocystein levels (15.1 ± 3.9 μmol/Lvs. 11.5 ± 3.2 μmol/L,P = 0.02). Aortic distensibility was significantly lower in the patients with PD when compared to controls (4.8 ± 1.5 dyn/cm2vs. 6.2 ± 1.9 dyn/cm2,P = 0.016). Additionally, the patients with PD had higher aortic strain and aortic stiffness index (13.4% ± 6.4%vs. 7.4% ± 3.6%,P < 0.001 and 7.3 ± 1.5vs. 4.9 ± 1.9,P< 0.001 respectively). Furthermore, serum homocysteine levels were found to be positively correlated with aortic stiffness index and there was a negative correlation between aortic distensibility and levels of serum homocysteine (r = 0.674,P < 0.001;r=-0.602,P < 0.001, respectively).ConclusionsThe patients with PD under L-dopa treatment have increased aortic stiffness and impaired diastolic function compared to healthy individuals. Elevated serum homocysteine levels may be a possible pathophysiological me-chanism.

Hypertension and Increased Left Ventricular End-diastolic Pressure Influence Arterial Stiffness

OBJECTIVE: There have been few studies regarding the relationship between arterial stiffness and left ventricular end-diastolic pressure (LVEDP). In the current study, we evaluated the relationship between the LVEDP and arterial stiffness in patients with hypertension (HTN). METHODS: Group I (n=34) included patients with a normal E/E' (8) without HTN, group III (n=20) included patients with a normal E/E' (8) with HTN. Aortic distensibility (AD) and the right brachial-ankle pulse wave velocity (baPWV) were measured. RESULTS: The mean age was 46.0+/-11.3 years. The mean value of AD was significantly lower in the group III compared to the group I. The group IV showed significantly lower AD compared to the group II. The group III demonstrated higher baPWV compared to the group I (1422+/-182 cm/sec vs. 1186+/-178 cm/sec, p<0.01), and the group IV showed higher baPWV compared to the group II (1456+/-228 vs. 1259+/-238 cm/sec, p<0.01). However, AD and baPWV were not significantly different between the group I and II, and between the group III and IV. The E/E' ratio showed a weak negative correlation with AD and a weak positive correlation with baPWV. CONCLUSION: Patients with hypertension showed a lower AD and a higher baPWV compared to those with normal blood pressure independent of the LVEDP. But the correlation between E/E' ratio and arterial stiffness suggests that a high LVEDP might not significantly influence arterial stiffness.

Aortic Elasticity was not Related with Duration, Bath Ankylosing Spondylitis Disease Activity Index / 대한류마티스학회지

OBJECTIVE: Cardiac manifestations are well recognized complication of ankylosing spondylitis (AS). They include aortic incompetence, conduction defects, mitral valve disease, pericarditis and cardiomyopathy. There was one study to evaluate the change of aortic elasticity in AS patient and the association between the aortic strain and duration of AS, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). We designed this study to determine whether aortic elasticity changes in Korean AS patients and is associated with the duration of AS or BASDAI. METHODS: 18 AS patients without cardiovascular involvement and 18 sex and age- matched healthy subjects were enrolled in the study. Aortic strain and distensibility was calculated from aortic diameters measured by echocardiography and blood pressure measured by sphygmomanometry. RESULTS: The mean aortic strain and mean aortic distensibility in AS group indicated that there was not any correlation with those of control group, based on the statistical analysis. Moreover, there was no statistical correlation between the means of aortic strain, aortic distensibility and the duration or BASDAI of AS. CONCLUSION: In patients with AS without cardiac involvement, the aortic elasticity was not decreased than that of control group, and aortic strain and distensibility were not correlated with the duration or BASDAI of AS.

A research on the aortic distensibility in patients with coronary artery disease / 医学研究生学报

0.05].Sao and Eao was significantly different between CHD group and the control group,but Aao has not significant different.③Sao positively correlated with ascending aortic distensibility coefficient(D)(r=0.73,P=0.03),and negatively correlated with aortic stiffness(?)(r=-0.68,P=0.03).Conclusion:Elastic properties of the aorta can directly be assessed by measuring the movements in the upper wall of the aorta with DTI.Reduced aortic S-velocity is significantly correlated with Ascending aortic distensibility coefficient(D) and stiffness index beta(?),which are important factors in assessing the changes of the aortic distensibility.

Effects of habitual physical exercise and aortic distensibility on systolic blood pressure in males. A study using aortic pulse wave velocity / 体力科学

The authors hypothesized that habitual physical exercise and aortic distensibility would be the major factors which influence systolic blood pressure. This study was designed to analyze the relationships among systolic blood pressure (SBP) and parameters determined at medical checks, including age, diastolic blood pressure (DBP), aortic pulse wave velocity (APWV) index (APWVI : APWV standardized by the diastolic blood pressure), plasma lipid profiles (IC, TG), plasma glucose during an oral glucose tolerance test (2 h-OGTT), percentage body fat (%Fat), cigarette smoking habit (Cigarettes), alcohol consumption (Alcohol), and physical activity index (PAI) using a questionnaire, in 678 males aged 30 to 69 years, who visited a hospital for a thorough medical check-up. For analysis of factorial structure in the subjects, principal factor analysis was applied to the correlation matrix which was calculated with 12 variables. Correlational analysis and path analysis were applied to confirm the hypothetical model. The results demonstrated that DBP and APWVI were the major factors which significantly affected the SBP. The PAI was significantly and inversely correlated not only with the APWVI, but also with %Fat, which was significantly and positively correlated with the DBP. In conclusion, aortic wall stiffness may be an independent factor in the manifestation of systolic hypertension, and habitual physical exercise may decrease the SBP through direct reduction of aortic wall stiffness and indirectly decreasing the DBP.