Aortic Pulse Pressure Is Associated With the Localization of Coronary Artery Disease Based on Coronary Flow Lateralization

Abstract

Hypertension has a major impact on cardiovascular and renal mortality and morbidity, with a 90% lifetime risk of developing hypertension. 1 Optimal blood pressure control reduces the risk of stroke by 38% and of myocardial infarction by 16%. 2 Compared to peripheral arterial pressure measurements, aortic pressures were shown to better predict coronary artery disease (CAD) 3,4 and cardiovascular risk. 5 Brachial arterial pressure does not correctly reflect aortic pressure, especially its systolic component, due to pulse pressure amplification. 6,7 It is also important to mention that central (aortic) pressures are the pressures directly affecting coronary and cerebral circulations, as well as the left ventricle, much more than pressures measured in the arm, and the latter is of paramount importance in end-organ damage related to hypertension. 8 Several ascending aortic blood pressure indices were studied, among which aortic pulse pressure (APP) correlated with increased cardiovascular complications. 9 Moreover, a higher APP was associated with more extensive CAD at time of coronary angiography. 10 A recent large prospective study has shown the superiority of central (aortic) over peripheral (brachial) pressures, as well as the superiority of APP and pulsatility over mean pressure in predicting adverse cardiovascular events. 11 Higher APP is related to arterial stiffness, a feature of aging and multiple cardiovascular conditions. 7 Although arterial stiffening is thought to represent by itself a form of cardiovascular end-organ damage, 7 and although APP is only an indirect indicator of arterial stiffness, higher APP may link arteriosclerosis (arterial stiffening) to other forms of end-organ damage such as atherosclerosis. The role of cyclical stretch due to pulsatile pressure in atherosclerosis is recognized. 12 BackgroundAortic pulse pressure (APP) is related to arterial stiffness and associated with the presence and extent of coronary artery disease (cAD). Besides, the left coronary artery (LcA) has a predominantly diastolic flow while the right coronary artery (RcA) receives systolic and diastolic flow. thus, we hypothesized that increased systolicdiastolic pressure difference had a greater atherogenic effect on the RcA than on the LcA.

Artificial controlled model of blood circulation system for adhesive evaluation

“…In addition, since the characteristics of animal tissue can vary with age, weight and so on, it is hard to standardize animal models for reliable and reproducible data. Moreover, it is challenging to aptly evaluate injury to the aorta, which is characterized by high blood pressure and active pulsation 16,17 , in models, which brings about issues of reliability and reproducibility of experiments.…”

Pulse Pressure, Blood Flow, and Atherosclerosis

“…Cyclic changes in the intramural tension have recently been recognized an important factor in the pathogenesis of atherosclerosis and acute coronary syndromes. 1 The study by Khoueiry et al 2 fits well into list of recent research investigating the relation between BP, arterial stiffness, and atherosclerosis. 3,4 Nowadays, there is no doubt about the presence of significant relation between the pulsatile BP component and atherosclerosis, but these links are in fact bidirectional.…”

“…1 A number of studies have shown the correlation between central PP and the extent of coronary atherosclerosis. 5 In the population studied by Khoueiry et al 2 aortic PP was higher in subjects with right coronary artery (RCA) stenosis compared to those with stenosis in the left coronary artery (LCA). This could be due to the difference in blood flow pattern between LCA and RCA (as suggested by Khoueiry et al 2 ) or earlier (at lower level of BP) atherosclerotic plaque development in LCA compared to RCA.…”

“…5 In the population studied by Khoueiry et al 2 aortic PP was higher in subjects with right coronary artery (RCA) stenosis compared to those with stenosis in the left coronary artery (LCA). This could be due to the difference in blood flow pattern between LCA and RCA (as suggested by Khoueiry et al 2 ) or earlier (at lower level of BP) atherosclerotic plaque development in LCA compared to RCA. Although the former explanation cannot be fully excluded due to crosssectional nature of the study it should be underscored that systolic, diastolic, and mean pressure were similar in the study groups as was the mean number of antihypertensive drugs used per one participant (unfortunately the doses of drugs are unknown).…”

Hormones and Arterial Stiffness in Patients with Chronic Kidney Disease

“…AS has been associated with numerous comorbidities and, most importantly, shown to independently predict all-cause and cardiovascular mortality, fatal and nonfatal coronary events and fatal strokes, both in the general and CKD populations [12][13][14][15][16] . Increased left ventricular stress and reduced coronary perfusion, both caused by AS, lead to cardiac hypertrophy and myopathy, thus resulting in congestive heart failure and sudden death in CKD patients.…”