Aortic Stiffness Measurement Improves the Prediction of Asymptomatic Coronary Artery Disease in Stroke/Transient Ischemic Attack Patients

Calvet, D.; Touzé, Emmanuel; Laurent, Stéphane; Varenne, Olivier; Sablayrolles, Jean‐Louis; Boutouyrie, Pierre; Mas, Jean‐Louis

doi:10.1111/ijs.12015

Cited by 16 publications

(16 citation statements)

References 37 publications

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“…We showed that increasing PWV was an independent predictor of the presence of angiographic CAD in our population similar to previous reports [19][20][21][22]43]. To our knowledge, only one previous study in patients with a history of stroke reported an improvement in the prediction of CAD presence with the use of PWV beyond FRS [43]. No association of other vascular indices with angiographic CAD was observed; conflicting results have been reported using AIx [21,25,44].…”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

Role of 9p21 and 2q36 variants and arterial stiffness in the prediction of coronary artery disease

Vakalis

Bechlioulis

Naka

et al. 2014

Eur J Clin Investigation

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Section: Discussionsupporting

confidence: 90%

“…We showed that increasing PWV was an independent predictor of the presence of angiographic CAD in our population similar to previous reports [19][20][21][22]43]. Initially, we investigated the role of vascular indices alone in the prediction of CAD.…”

Section: Discussionsupporting

confidence: 89%

Role of 9p21 and 2q36 variants and arterial stiffness in the prediction of coronary artery disease

Vakalis

Bechlioulis

Naka

et al. 2014

Eur J Clin Investigation

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“…In fact, the association between aortic stiffness and coronary heart disease, as well as stroke, remains after adjusting for age, sex, blood pressure, BMI and other known predictors of cardiovascular disease including the Framingham risk factors, thus suggesting that arterial stiffness (measured cfPWV) is a better predictor than each of these known risk factors for cardiovascular disease outcomes [5]. These observations have been corroborated in larger and more recent studies reporting that arterial stiffness is associated or predicts a) coronary heart disease, stroke and cardiovascular disease events independent of and better than conventional risk factors [6], b) coronary artery disease in patients with stroke/transient ischemic attacks (after adjustment for the Framingham Risk Score) [7], and c) all-cause mortality and cardiovascular events in chronic kidney disease [8].…”

Section: Introductionmentioning

confidence: 71%

Aortic and Carotid Arterial Stiffness and Epigenetic Regulator Gene Expression Changes Precede Blood Pressure Rise in Stroke-Prone Dahl Salt-Sensitive Hypertensive Rats

et al. 2014

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Multiple clinical studies show that arterial stiffness, measured as pulse wave velocity (PWV), precedes hypertension and is an independent predictor of hypertension end organ diseases including stroke, cardiovascular disease and chronic kidney disease. Risk factor studies for arterial stiffness implicate age, hypertension and sodium. However, causal mechanisms linking risk factor to arterial stiffness remain to be elucidated. Here, we studied the causal relationship of arterial stiffness and hypertension in the Na-induced, stroke-prone Dahl salt-sensitive (S) hypertensive rat model, and analyzed putative molecular mechanisms. Stroke-prone and non-stroke-prone male and female rats were studied at 3- and 6-weeks of age for arterial stiffness (PWV, strain), blood pressure, vessel wall histology, and gene expression changes. Studies showed that increased left carotid and aortic arterial stiffness preceded hypertension, pulse pressure widening, and structural wall changes at the 6-week time-point. Instead, differential gene induction was detected implicating molecular-functional changes in extracellular matrix (ECM) structural constituents, modifiers, cell adhesion, and matricellular proteins, as well as in endothelial function, apoptosis balance, and epigenetic regulators. Immunostaining testing histone modifiers Ep300, HDAC3, and PRMT5 levels confirmed carotid artery-upregulation in all three layers: endothelial, smooth muscle and adventitial cells. Our study recapitulates observations in humans that given salt-sensitivity, increased Na-intake induced arterial stiffness before hypertension, increased pulse pressure, and structural vessel wall changes. Differential gene expression changes associated with arterial stiffness suggest a molecular mechanism linking sodium to full-vessel wall response affecting gene-networks involved in vascular ECM structure-function, apoptosis balance, and epigenetic regulation.

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“…The identification of severe occult coronary artery stenosis may help to improve prevention of cardiac events in stroke/TIA patients. The prevalence of severe (≥50% reduction in diameter) occult coronary artery stenosis has been reported to be significantly high, between 18% and 38% in patients with stroke or TIA and no previous history of coronary heart disease and predictable …”

Section: Introductionmentioning

confidence: 99%

Coronary Artery Calcium Score Improves the Prediction of Occult Coronary Artery Stenosis in Ischemic Stroke Patients

Beigneux

Sablayrolles

Varenne

et al. 2016

JAHA

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BackgroundCoronary heart disease is a significant cause of morbidity and mortality in stroke patients. The coronary artery calcium score (CACS) has emerged as a robust and noninvasive predictor of coronary events. We assessed the predictive ability of CACS to identify stroke patients with severe (≥50%) occult coronary artery stenosis in a stroke/transient ischemic attack population, in addition to the PRECORIS score, based on Framingham Risk Score and presence of cervicocephalic artery stenosis, which was derived and validated for that purpose.Methods and ResultsWe enrolled consecutive patients aged 45 to 75 years referred to our stroke unit with noncardioembolic ischemic stroke or transient ischemic attack, and no prior history of coronary disease. The presence of coronary stenosis was assessed with 64‐section computed tomography coronary angiography, and all patients had a detailed etiological work‐up. CACS was determined from computed tomography measurement using the Agatson score. The predictive value of CACS was assessed by logistic regression and reclassification method. Among 300 patients included in the study, 274 had computed tomography coronary angiography. Fifty patients (18%) had at least 1 coronary artery stenosis ≥50%. In multivariable analysis, after adjustment for the PRECORIS score, CACS was strongly associated with the presence of occult coronary artery stenosis (odds ratio=14.8 [1.8–120.3] for CACS [1–100] and 70.9 [8.9–562.0] for CACS >100). When CACS was added to the standard model, model fit was improved (P<0.001), Net Reclassification Improvement was 28.2% (P<0.001), and Integrated Discrimination Index was 18.2% (P<0.001).ConclusionsIn stroke/transient ischemic attack patients, CACS improves the prediction of occult coronary stenosis beyond classical risk factors.

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Aortic Stiffness Measurement Improves the Prediction of Asymptomatic Coronary Artery Disease in Stroke/Transient Ischemic Attack Patients

Abstract: In stroke/transient ischemic attack patients, aortic pulse wave velocity improves the prediction of ≥50% asymptomatic coronary artery disease beyond classical risk factors.

Cited by 16 publications

References 37 publications

Role of 9p21 and 2q36 variants and arterial stiffness in the prediction of coronary artery disease

Role of 9p21 and 2q36 variants and arterial stiffness in the prediction of coronary artery disease

Aortic and Carotid Arterial Stiffness and Epigenetic Regulator Gene Expression Changes Precede Blood Pressure Rise in Stroke-Prone Dahl Salt-Sensitive Hypertensive Rats

Coronary Artery Calcium Score Improves the Prediction of Occult Coronary Artery Stenosis in Ischemic Stroke Patients

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