Aortic Distensibility Can Predict Events in Patients With Premature Coronary Artery Disease: A Cardiac Magnetic Resonance Study

Abstract

Noninvasive assessment of aortic distensibility (AD) is feasible with cardiac magnetic resonance (CMR). We investigated the relationship between AD (assessed by CMR) and coronary artery disease (CAD) severity (assessed by the SYNTAX score) in patients with premature CAD. We recruited 125 patients with CAD confirmed by coronary angiography (males were <55 years old and females <65 years old). We excluded patients with significant aortic disease or contraindications to CMR. We also recruited 25 age- and sex-matched healthy patients as controls. One-year follow-up was also carried out. Aortic distensibility at the aortic root (AR) and descending aorta (DA) was significantly ( P < .001 for both) lower in the patient group. There was a significant negative correlation between SYNTAX score and AD at the AR (r = −0.56; P < .001) and DA (r = −0.34; P < .001), but insignificant correlation with distensibility at the ascending aorta (AA; r = −0.03; P = .81). AR, AA, and DA distensibility, as well as left ventricular ejection fraction were predictors of adverse events. The severity of CAD in young patients is associated with decreased AD, especially at the level of the AR. Aortic distensibility can predict adverse events in these patients.

From Arterial to Cardiac Dysfunction

“…This finding is in agreement with the concept that increased arterial stiffness is a CV risk factor. Moreover, a significant negative correlation between severity of CAD (calculated using the SYNTAX score) and distensibility of the aortic root and descending aorta was reported by Razik et al 1 In presence of increased aortic stiffness, the chronic decrease in coronary artery perfusion pressure and blood flow during diastole may lead to flow-mediated decreases in shear stress and inward arterial remodeling (narrowing of lumen diameter). 2 Arterial diameter is dependent on several dynamic factors, among which are the level of vascular tone in the short term and vascular remodeling in the long term.…”

“…A contribution of subclinical chronic inflammation 7 in these processes cannot be excluded. Unfortunately, no marker of inflammation was reported by Razik et al 1…”

“…Razik et al, 1 in this issue of Angiology , provide an interesting contribution with regard to the relationship between arterial and cardiac dysfunction in patients with premature coronary artery disease (CAD). Briefly, cross-sectional aortic distensibility, an index of local arterial stiffness, was lower at baseline in patients with CAD who developed cardiovascular (CV) events.…”

“…The article by Razik et al 1 is of interest for the technique and the site used for the determination of local distensibility. Pulse wave velocity (PWV) at the level of the aorta (carotid-femoral PWV, aortic stiffness) is a validated method for the measurement of regional arterial stiffness in clinical practice.…”

“…However, the viscoelastic properties change from the ascending to the descending aorta, as reported in the controls enrolled in the Razik et al study. 1 Moreover, arterial applanation tonometry does not allow to study the aortic arch, and this segment makes an important contribution to total arterial compliance. 9 To overcome these limits, the study of local arterial stiffness in different aortic sections can be helpful.…”