Risk stratification in patients with coronary artery disease: the impact of aortic stiffness

ABSTRACT

Identification of individuals at high risk of coronary heart disease and future events is an important challenge for primary prevention of cardio-vascular disease. Intra-vascular ultrasound confirmed. the link between aortic stiffness and coronary atheromatous plaques, beside the proved relation between aortic elasticity and coronary endothelial function. The purpose of the present study was to assess the value of non-invasive assessment of aortic elastic properties by tissue Doppler versus conventional measures in predicting coronary artery disease and long-term risk of major coronary events. 48 pts with documented coronary artery disease [CAD] were compared to 12 pts with normal coronary angiogram. Ascending [A SC] aortic diameters and pulse pressure were used to calculateo aortic stiffness index. Pulsed wave velocity [PWV] measured as the time taken by the pulse wave to travel along the thoracic aorta. Systolic [SW] and diastolic [EW and A W] velocity waves of ASC and descending [DSC.] aortic wall were measured by tissue Doppler imaging. Patients with CAD had significantly higher Aortic stiffness index [14.77 +/- 5.31 vs. 8.94 +/- 1.76, p=0.0001], faster PWV [13.73 +/- 1.25 vs. 5.82 +/- 1.19 mlsec, p=0.0001], and slower ASC aortic wall velocities [SW [8.87 +/- 3.23 vs. 13.02 +/- 1, 3 cm/sec, p=0.003], EW [9.34 +/- 3.14 vs. By multivariate Cox model analysis, aortic stiffness [relative risk 95% Cl 6.4-10.6; P=0.001], SW velocity of ASC aorta [relative risk 95% CI 6.2-8.1; P=0.001], and PWV [relative risk 95% CI 12.5-15.92; P=0.01], were the strongest predictors of progression to any end-point. In patients with coronary artery disease, aortic stiffness properties are independent risk factors and predictors of major coronary events. Tissue Doppler recording of ascending aortic wall velocity is simple, non-invasive measurement of aortic elastic properties with good correlation and comparable prognostic value to conventional aortic stiffness parameters