Impact of aortic stiffness on myocardial ischaemia in non-obstructive coronary artery disease

Abstract

ObjectiveHigh aortic stiffness may reduce myocardial perfusion pressure and contribute to development of myocardial ischaemia. Whether high aortic stiffness is associated with myocardial ischaemia in patients with stable angina and non-obstructive coronary artery disease (CAD) is less explored.MethodsAortic stiffness was assessed as carotid-femoral pulse wave velocity (PWV) by applanation tonometry in 125 patients (62±8 years, 58% women) with stable angina and non-obstructive CAD participating in the Myocardial Ischemia in Non-obstructive CAD project. PWV in the highest tertile (>8.7 m/s) was taken as higher aortic stiffness. Stress-induced myocardial ischaemia was detected as delayed myocardial contrast replenishment during stress echocardiography, and the number of left ventricular (LV) segments with delayed contrast replenishment as the extent of ischaemia.ResultsPatients with higher aortic stiffness were older with higher LV mass index and lower prevalence of obesity (all p<0.05), while angina symptoms, sex, prevalence of hypertension, diabetes, smoking or LV ejection fraction did not differ between groups. Stress-induced myocardial ischaemia was more common (73% vs 42%, p=0.001) and the extent of ischaemia was larger (4±3 vs 2±3 LV segments, p=0.005) in patients with higher aortic stiffness. In multivariable logistic regression analysis, higher aortic stiffness was associated with stress-induced myocardial ischaemia independent of other known covariables (OR 4.74 (95% CI 1.51 to 14.93), p=0.008).ConclusionsIn patients with stable angina and non-obstructive CAD, higher aortic stiffness was associated with stress-induced myocardial ischaemia. Consequently, assessment of aortic stiffness may add to the diagnostic evaluation in patients with non-obstructive CAD.Trial registration numberNCT01853527.

Miyokard perfüzyon sintigrafisinde kan basıncı değerleri kardiyak iskemiyi öngördürebilir

“…High aortic stiffness reduce myocardial perfusion pressure and may contribute to development of myocardial ischaemia. [15] LVH is independently associated with presence of myocardial ischemia in patients with non-obstructive CAD. [16] In addition, because adenosine is not used in patients with SBP <90mmHg, the number of samples was low.…”

Preclinical cardiac organ damage during statin treatment in patients with inflammatory joint diseases: the RORA-AS statin intervention study

“…TNFα has been shown to promote LV hypertrophy in mouse models, and in TNFα knock-out mice LV hypertrophy development was attenuated [ 28 ]. TNFα inhibition has also been shown to reduce arterial stiffness and presence of atherosclerosis in IJD patients [ 29 ], factors that are both associated with unfavourable LV remodelling [ 30 , 31 ]. In patients with established CVD, inhibition of IL-1β with 150 mg canakinumab led to a 15% reduction in new CVD events in the Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS) trial [ 32 ].…”

Total coronary atherosclerotic plaque burden is associated with myocardial ischemia in non-obstructive coronary artery disease

“…The Myocardial Ischemia in Non-obstructive Coronary Artery Disease (MicroCAD) study is a cross-sectional study including participants with chronic coronary syndrome and non-obstructive CAD by CCTA. Inclusion and exclusion criteria have been previously described in detail [12] , [13] . In brief, the participants were prospectively included from patients with symptomatic chronic coronary syndrome clinically diagnosed with non-obstructive CAD by CCTA at the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway from May 2013 until November 2014.…”

“…Echocardiography was performed in all patients following a standardized protocol, as previously described [12] , [13] . Quantitative echocardiography was performed in line with the current joint guidelines of the American Society of Echocardiography and European Association of Cardiovascular Imaging [23] .…”