High Brachial Ankle Pulse Wave Velocity as a Marker for Predicting Coronary Artery Stenosis in Patients with Type 2 Diabetes

Abstract

BackgroundWe evaluated the ability of brachial ankle pulse wave velocity (baPWV) to predict coronary artery stenosis (CAS) in patients with type 2 diabetes, and compared the predictive power of baPWV to that of well-known cardiovascular disease (CVD) risk calculators.MethodsThe study group included 83 consecutive patients over 30 years old with type 2 diabetes who complained of vague chest discomfort. An automatic pulse waveform analyzer was used to measure baPWV. CAS was measured using multi-slice computed tomographic (MSCT) angiography.ResultsAge, maximal baPWV, duration of diabetes, current smoking, the UK Prospective Diabetes Study (UKPDS) Risk Engine score, American College of Cardiology/American Heart Association (ACC/AHA) risk estimator score, the Framingham risk calculator score, and coronary artery calcium score were greater in patients with CAS than in those without CAS. An area under the curve (AUC) indicative of a predictive value for CAS (≥20%) was found for several parameters. The AUC of maximal baPWV, the UKPDS Risk Engine, the ACC/AHA ASCVD risk estimator, and the Framingham risk calculator were 0.672 (95% confidence interval [CI], 0.554 to 0.785; P=0.010), 0.777 (95% CI, 0.675 to 0.878; P<0.001), 0.763 (95% CI, 0.660 to 0.866; P<0.001), and 0.736 (95% CI, 0.629 to 0.843; P<0.001), respectively. The optimal cutoff value of baPWV for the detection of CAS was 1,650 cm/sec (sensitivity, 68.9%; specificity, 63.2%).ConclusionMaximal baPWV was closely related with CAS detected by MSCT coronary angiography in patients with type 2 diabetes. baPWV has the potential to be a useful, noninvasive screening tool for the prediction of occult CAS in patients with type 2 diabetes.

Association of serum FAM19A5 with metabolic and vascular risk factors in human subjects with or without type 2 diabetes

“…Increased baPWV, which reflects arterial stiffness, has been established as a useful tool to predict occult coronary artery disease and the severity of coronary atherosclerosis in individuals with or without type 2 diabetes. [17][18][19] A trend of increasing baPWV with increasing serum FAM19A5 tertile, and a significant positive correlation between circulating FAM19A5 concentration and baPWV in our study suggest that FAM19A5 may be involved in vascular remodelling and atherosclerosis also in humans. In the present study, circulating FAM19A5 concentration had significant positive correlations with WC and WHR, but not with BMI.…”

“…[3][4][5] Upregulation of pro-inflammatory adipokines and dysfunction of protective anti-inflammatory adipokines have been postulated to promote obesity-associated metabolic and cardiovascular diseases. 4,5 The family with sequence similarity 19 [chemokine (C-C motif)-like] member A5 (FAM19A5), also named TAFA5, has recently been described as a novel secreted adipokine with protective properties. 5,6 Wang et al 5 reported that adipocyte-derived FAM19A5 inhibited vascular smooth muscle cell proliferation and migration, and obesity and obesity-related inflammation was associated with repression of adipose-derived FAM19A5 in rodent models.…”

Pulse Wave Velocity in Atherosclerosis

“…Chung et al reported the same finding of the positive correlation between baPWV and SYNTAX score in a study of 703 patients undergoing ICA (37). In asymptomatic diabetic population, both cfPWV and baPWV was associated with the presence and progression of coronary stenosis or plaque on computed tomography coronary angiography (CCTA) (33, 38). Our group investigated 470 patients with chest discomfort, and showed that baPWV has positive correlations with CAD extent and severity evaluated CCTA (39).…”

Association of impaired arterial wall properties with the presence of coronary artery disease in patients with abdominal aortic aneurysms

“…Proportional increases in PWV values with the severity of CAC score have also been reported . Furthermore, PWV was correlated with the presence and progression of stenosis or plaque development in the coronary arteries according to findings from CCTA in asymptomatic DM patients . Similarly, in asymptomatic individuals, PWV was identified as an independent prognostic factor for the presence of CAD diagnosed by CCTA .…”

“…33 Furthermore, PWV was correlated with the presence and progression of stenosis or plaque development in the coronary arteries according to findings from CCTA in asymptomatic DM patients. 14,34 Similarly, in asymptomatic individuals, PWV was identified as an independent prognostic factor for the presence of CAD diagnosed by CCTA. 15,35,36 In symptomatic patients, PWV levels were positively related to the presence and severity of CAD as assessed by invasive coronary angiography.…”