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CLINICAL STUDY: CORONARY ARTERY DISEASE

Determinants of coronary artery compliance in subjects with and without angiographic coronary artery disease

Manuscript received June 21, 2001; revised manuscript received February 20, 2002, accepted February 20, 2002.

^* Reprint requests and correspondence: Dr. Anthony M. Dart, Alfred and Baker Medical Unit, Baker Medical Research Institute, P.O. Box 6492, St. Kilda Road Central, Melbourne, 8008, Australia.
a.dart{at}alfred.org.au

OBJECTIVES: The goal of this study was to determine factors contributing to the biomechanical properties of coronary arteries in people with and without angiographic coronary artery disease (CAD).

BACKGROUND: The stiffness of the aorta is known to increase with increasing age and in the presence of CAD. However, little is known about the mechanics of coronary arteries, which may have important clinical consequences.

METHODS: Intravascular ultrasound was used to determine the mechanical properties of coronary arteries and plaque behavior in subjects with CAD (n = 38), those with chest pain but angiographically normal coronary arteries (N) (n = 9) and those early (<2 weeks) after cardiac transplant (T) (n = 14).

RESULTS: Coronary arteries dilated during systole in all groups, but cross-sectional compliance and distensibility were lowest in the proximal left anterior descending artery (LAD) in the subjects with CAD compared with the N and T groups (compliance: 1.2 ± 0.2 vs. 1.7 ± 0.5 and 2.7 ± 0.6 x 10^–2 mm² mm Hg^–1 [mean ± SEM] respectively, p < 0.02 CAD vs. T; distensibility: 0.8 ± 0.2 vs. 1.7 ± 0.5 and 1.7 ± 0.3 x 10^–3 mm Hg^–1, p < 0.05 CAD vs. T). There was extensive plaque in the CAD group, and plaque was also present in the N group, but minimal atheroma was present in the T group. Plaque cross-sectional area diminished significantly during systole in both the LAD and circumflex arteries. Absolute changes were: 0.50 ± 0.30, 0.33 ± 0.11 and 0.68 ± 0.13 mm² in the proximal LAD, distal LAD and proximal circumflex arteries, respectively. In subjects with atheroma, there was a significant correlation between cross-sectional compliance and plaque compression at all sites, and plaque compression was a significant determinant of cross-sectional compliance at both proximal sites in multiple regression analyses with age, mean arterial pressure and extent of plaque as the other independent variables.

CONCLUSIONS: A major determinant of the systolic increase in coronary luminal area in patients with atheroma is a reduction in plaque cross-sectional area during systole.

Abbreviations and Acronyms   C   compliance   CAD   coronary artery disease   Cx   circumflex artery   D   distensibility   GTN   glyceryl trinitrate   IM   intima-media   IVUS   intravascular ultrasound   LAD   left anterior descending artery   N   normal subjects investigated for chest pain but without angiographic disease   PP   pulse pressure   T   transplant

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