Assessment of cardio-ankle vascular index in patients with cardiac syndrome-X: an observational study

Abstract

Objective: Arterial stiffness is associated with major adverse cardiovascular events. Cardio-ankle vascular index (CAVI), a novel marker of arterial stiffness, which is weakly influenced by systolic blood pressure, is a sensitive marker the atherosclerosis and arteriolosclerosis. The aim of this study is to investigate arterial stiffness by CAVI in patients with cardiac syndrome X (CSX). Methods: The present study was observational and cross sectional, and involved 49 patients (26 male) with CSX (angina-like chest pain, positive electrocardiographic ischemic changes at treadmill exercise test, angiographically normal coronary arteries) and 54 healthy subjects (21 male). CAVI was measured by VaSera-1000 CAVI instrument. Statistical analysis was performed using the Chi-square, Student t-test, correlation analysis and logistic regression analysis. Results: The CAVI and pulse pressure were significantly increased in patients with CSX compared to control group (7.50±1.50, 6.49±0.77, p<0.001; 53.00±10.06, 47.39±8.17, p=0.002, consecutively). In contrast, there were no significant differences in the age, weight, height, body mass index, waist circumference, hip circumference, systolic blood pressure, diastolic blood pressure, mean blood pressure, glucose, low density lipoprotein level, high density lipoprotein level (HDL), triglyceride, estimated creatinine clearance, hemoglobin, left atrium diameter, left ventricular mass (LVM), LVM index and ejection fraction. CAVI was the only independent predictor of CSX in logistic regression analysis (OR=1.780, 95% CI: 1.157-2.737, p=0.009). Conclusion: CAVI is increased in syndrome X patients and is an independent predictor of this syndrome. (Anadolu Kardiyol Derg 2013; 13: 766-71) Key words: CAVI, arterial stiffness, cardiac syndrome X, coronary, angiography, regression analysis Original Investigation Özgün Araşt›rma 766ÖZET Amaç: Damar sertliği önemli kardiyovasküler kötü hadiselerle ilişkilidir. Kalp-ayak bileği vasküler indeks ölçümü (KAVI), sistolik kan basıncından çok az etkilenir ve damar sertliği değerlendirilmesinde yeni ve hassas bir yöntem olup ateroskleroz ve arteriolosklerozun hassas bir gösterge-sidir. Bu çalışmanın amacı kardiyak sendrom-X'li hastalarda (KSX) KAVI yöntemi ile damar sertliğinin değerlendirilmesidir. Yöntemler: Çalışmamız gözlemsel ve kesitsel nitelikte olup, bu çalışmada 49 KSX (tipik göğüs ağrısı olan, egzersiz elektrokardiyografi testinde pozitif iskemik değişiklikleri bulunan ve yapılan koroner anjiyografide normal koroner arterler tespit edilen hastalar) (29 erkek) ve 54 sağlıklı hasta (21 erkek) değerlendirildi. KAVI VaSera-1000 KAVI aletiyle ölçüldü. İstatistiksel analizde Ki-kare, t-testi, korelasyon analizi ve mantıksal regresyon analizi kullanıldı. Bulgular: KSX hastalarında KAVI ve nabız basıncı kontrol grubuna göre anlamlı olarak daha yüksekti

Cardio‐ankle vascular index and cardiovascular disease: Systematic review and meta‐analysis of prospective and cross‐sectional studies

“…When we explored the 13 studies comparing CAVI values in individuals with and without CVD, the pooled mean difference in CAVI values was significantly positive at 1.28 (0.86‐1.70) (Figure ). This pattern was generally consistent for coronary heart disease and stroke (Table ). The funnel plot for the mean difference in CAVI values against their standard errors did not indicate publication bias (Figure ).…”

“…Despite varying definitions of CVD across studies (Table ), all 17 studies reported significant associations between CAVI and CVD (Table ) . When we explored the 13 studies comparing CAVI values in individuals with and without CVD, the pooled mean difference in CAVI values was significantly positive at 1.28 (0.86‐1.70) (Figure ).…”

“…Of 17 cross‐sectional studies (n = 7,309) investigating CAVI values in patients with and without CVD (Table ), 11 were from Japan, two were from South Korea, and the remaining studies were from China, Thailand, Turkey, and Czech Republic . Most studies were small, and only one study had a sample size of more than 1,000 participants.…”

Assessment of arterial stiffness in patients with venous thromboembolism: Separate or continuous circuits?

“…CAVI is associated with epicardial fat thickness, atherosclerosis, chronic obstructive lung disease, coronary syndrome-x, dipping status, silent neuronal injury, diabetes, aging, chronic renal failure, dyslipidemia, smoking, hypertension, and obstructive sleep apnea. [14][15][16][17][18][19] Additionally, vasoactive medications including alpha-blockers, betablockers, angiotensin-converting enzyme inhibitors also alter CAVI. 19 None of our patient used antihypertensive medications in this study.…”

Computed Tomography Angiography Approach in Low-Intermediate Test Probability with Positive Exercise Electrocardiography Test in Young Women

“…However, its limited sensitivity and specifi city lead to suboptimal performance in many cases which can raise indirect costs: inconclusive tests generally necessitate additional exams, which increases the overall cost of the diagnostic strategy; false negative results can delay or prevent correct diagnosis, while false positive results frequently require more complex and costly non-invasive exams or result in unnecessary diagnostic catheterization, which entails risks and potentially avoidable cost (4) . Evaluation of epicardial fat thickness, ankle brachial index, carotid intima media thickness, aortic stiffness, coronary calcium score and oxidative stress may confer further risk stratifi cation (5)(6)(7)(8)(9)(10)(11) It is recommended to continue further imaging stress test to patients with intermediate results and low-intermediate pretest probability (1) . CCTA is a promising non-invasive anatomical test for the evaluation of stable coronary artery disease.…”