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J Am Coll Cardiol, 2002; 40:773-779 © 2002 by the American College of Cardiology Foundation |
* Alfred and Baker Medical Unit, Baker Medical Research Institute, Prahran, Victoria, Australia
Department of Electronic Engineering, Latrobe University, Bundoora, Victoria, Australia
Manuscript received September 6, 2001; revised manuscript received April 16, 2002, accepted May 20, 2002.
* Reprint requests and correspondence: Dr. Bronwyn Kingwell, Alfred and Baker Medical Unit, Baker Medical Research Institute, P.O. Box 6492, St. Kilda Road Central, Melbourne, Victoria, 8008, Australia.
b.kingwell{at}alfred.org.au
OBJECTIVES: The goal of this study was to determine whether large artery stiffness contributes to exercise-induced myocardial ischemia in patients with coronary artery disease (CAD).
BACKGROUND: Large artery stiffness is an independent predictor of cardiovascular mortality and a major determinant of pulse pressure and, thus, cardiac afterload and coronary perfusion. Clinical relevance of the hemodynamic consequences of large artery stiffening has not previously been demonstrated in relation to myocardial ischemia.
METHODS: We hypothesized that stiffer large arteries would reduce myocardial ischemic threshold as assessed by time to ST-segment depression of 0.15 mV during a treadmill exercise test in patients with CAD. Ninety-six patients with CAD (78 men) age 62 ± 9 years (mean ± SD) were classified as having single (52 patients), double (31 patients), or triple (13 patients) coronary vessel disease, based on angiographically confirmed stenoses >50%. Systemic arterial compliance, distensibility index, aortic pulse wave velocity, and carotid augmentation index were measured using carotid applanation tonometry and Doppler velocimetry of the ascending aorta, at rest.
RESULTS: In univariate analysis, all large artery stiffness/compliance indexes correlated with time to ischemia (p = 0.01 to 0.009). Both carotid (p = 0.007) and brachial (p = 0.001) pulse pressure also correlated inversely with time to ischemia. In multivariate analysis including other major risk factors plus severity of coronary stenosis, indexes of arterial stiffness were significant independent predictors of ischemic threshold.
CONCLUSIONS: Within a patient group with moderate CAD, large artery stiffness was a major determinant of myocardial ischemic threshold.
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