Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries

Lembo, Maria; Sicari, Rosa; Esposito, Roberta; Rigo, Fausto; Cortigiani, Lauro; Iudice, Francesco Lo; Trimarco, Bruno; Galderisi, Maurizio

doi:10.1161/jaha.117.005710

Cited by 19 publications

(18 citation statements)

References 62 publications

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“…This study examined transthoracic-derived CFR in a study population of 398 patients. However, the resting coronary flow velocity, and not the CFR, was significantly associated with PP and only on multiple linear regression analysis, at that 9. Other echo-based studies have also demonstrated that arterial stiffness is inversely related to CFR or hyperaemic coronary flow velocity in patients with non-obstructive CAD 7–9.…”

Section: Discussionmentioning

confidence: 86%

“…9 Other echo-based studies have also demonstrated that arterial stiffness is inversely related to CFR or hyperaemic coronary flow velocity in patients with nonobstructive CAD. [7][8][9] Previous studies used transthoracic echocardiography to measure coronary flow and velocity, and recruited a relatively small number of participants. These studies did not measure invasive aortic BP.…”

Section: Discussionmentioning

confidence: 96%

“…Furthermore, the number of study participants was relatively small, and coronary endothelial function was not examined separately for coronary microvascular endothelial dysfunction (CMED) and coronary microvascular endothelium-independent dysfunction (CMEID). [7][8][9] Therefore, this study aimed to evaluate the relationship between invasively measured arterial stiffness indices measured directly from invasive aortic PP and coronary vasoreactivity, including CMED and CMEID, in patients with non-obstructive CAD.…”

Section: Key Questionsmentioning

confidence: 99%

“…Although previous studies have reported that PP was inversely related to CMD in patients with non-obstructive CAD, these studies used transthoracic echocardiography to measure coronary flow and velocity and measured non-invasive BP. Furthermore, the number of study participants was relatively small, and coronary endothelial function was not examined separately for coronary microvascular endothelial dysfunction (CMED) and coronary microvascular endothelium-independent dysfunction (CMEID) 7–9…”

Section: Introductionmentioning

confidence: 99%

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Impact of invasive aortic pulse pressure on coronary microvascular endothelial-independent dysfunction and on mortality in non-obstructive coronary artery disease

et al. 2022

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BackgroundPulse pressure (PP), a raw index of arterial stiffness, is inversely related to coronary microvascular function, even among patients with non-obstructive coronary artery disease (CAD), as per non-invasive studies. We aimed to determine whether invasive aortic PP is associated with coronary microvascular endothelial dysfunction (CMED) and/or coronary microvascular endothelial independent dysfunction (CMEID) in patients with non-obstructed CAD.MethodsWe retrospectively analysed a cohort of 1894 patients (mean age, 51.2 years; 1261 (66.6%) women) who presented with chest pain and non-obstructive CAD (angiographic stenosis <50%); coronary vasoreactivity was assessed in the mid-left anterior descending artery. The patients were classified based on whether aortic PP was high (≥50 mm Hg). CMEID was defined as abnormal coronary flow reserve (<2.5) or hyperaemic myocardial resistance (>2.0 mm Hg/cm/s), CMED was defined as abnormal acetylcholine-induced per cent change of coronary blood flow (≤50%).ResultsPatients with high aortic PP had a higher rate of CMEID than those with low aortic PP (40.9 vs 25.2%, p<0.001). Conversely, aortic PP was not associated with CMED. On multivariate analysis, high aortic PP was associated with CMEID occurrence (OR 1.42, 95% CI 1.13 to 1.78; p=0.003). On follow-up (median, 150 months), all-cause death was more frequent among patients with vs without high aortic PP (20.1% vs 7.3%, log-rank p<0.001) and HR was 2.08 (95% CI 1.34 to 3.32, p=0.002) on multivariate cox regression analysis. Furthermore, among patients with low aortic PP, CMEID was an independent risk factor for all-cause mortality (HR 2.04, 95% CI 1.01 to 4.16, p=0.048).ConclusionIn patients with non-obstructive CAD, invasive aortic PP was significantly associated with CMEID, but not with CMED. High aortic PP was an independent predictor of all-cause mortality, but CMEID was an independent risk factor in patients with low aortic PP.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 96%

Section: Key Questionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of invasive aortic pulse pressure on coronary microvascular endothelial-independent dysfunction and on mortality in non-obstructive coronary artery disease

et al. 2022

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“…[76] ESC/ESH guidelines propose the carotid-femoral pulse wave velocity (PWV) as the gold standard to assess arterial stiffness [6,77]: the stiffer the arteries, the higher the PWV. Therefore, correctly diagnosing and treating patients at the beginning of the disease could prevent this further complication by limiting the aortic damage [78][79]. However, this tool is not currently used in the clinical practice.…”

Section: Aortamentioning

confidence: 99%

Identification of cardiac organ damage in arterial hypertension: insights by echocardiography for a comprehensive assessment

Cameli

Lembo

Sciaccaluga

et al. 2020

Journal of Hypertension

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Arterial hypertension (AH), a widespread disease, whose prevalence increases with age, represents a major risk factor for cardiovascular events, causing damage in several organs, including the heart. In this context, echocardiography has a clear and pivotal role, being able to assess cardiac morphology and detect hemodynamic changes induced by this disease. 2018 ESC/ESH guidelines on arterial hypertension identified main echo parameters such as left ventricular mass, relative wall thickness and left atrial volume, for detecting cardiac organ damage. The present review highlights the advantage of additional echocardiographic parameters such as diastolic

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Low mechano‐energetic efficiency is associated with future left ventricular systolic dysfunction in hypertensives

et al. 2022

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AimsIn a hypertensive population with optimal blood pressure control with a long-term follow-up, we aimed at analysing possible predictors of left ventricular (LV) ejection fraction (LVEF) reduction, including indexed mechano-energetic efficiency (MEEi), a well-recognized echo-derived parameter of LV performance. Methods and resultsThe study population included 5673 hypertensive patients from the Campania Salute Network with a long-term follow-up, normal baseline LVEF (≥50%), and no prevalent cardiovascular (CV) disease. Patients developing LVEF impairment (LVEF < 50% or a reduction of at least 10 percentage points compared with baseline) were compared with patients with persistently normal LVEF. Optimal blood pressure control was achieved in about 80% of patients. Patients who experienced LVEF reduction were 2.41% during a long-term follow-up (mean duration 5.6 ± 3.9 years). At baseline, they were older (59.46 ± 11.58 vs. 53.40 ± 11.41, P < 0.0001) and showed higher LV mass index (53.3 ± 12.83 vs. 47.56 ± 9.58, P < 0.0001), left atrial (LA) volume index (14.4 ± 4.2 vs. 13.1 ± 2.8, P < 0.0001) and carotid intima-media thickness (1.99 ± 0.86 vs. 1.61 ± 0.73, P < 0.0001), lower MEEi (0.32 ± 0.08 vs. 0.34 ± 0.07, P = 0.037), and higher prevalence of CV events during follow-up (13.9% vs. 3%, P < 0.0001) compared with patients with persistently normal LVEF. A logistic regression analysis, performed after running univariate analyses and selecting parameters significantly associated with LVEF reduction, showed that having a CV event [odds ratio (OR) 7.57, P < 0.0001], being in the lowest MEEi quartile (OR 2.43, P = 0.003), and having a larger LA volume index (OR 1.08, P = 0.028) were all parameters independently associated with the development of LV systolic dysfunction. A further logistic regression model, performed by excluding patients experiencing CV events, demonstrated that the lowest MEEi quartile was independently associated with the evolution towards LVEF reduction (OR 2.35, P = 0.004), despite significant impact of LA volume index (OR 1.08, P = 0.023) and antiplatelet therapy (OR 1.89, P < 0.01). Receiver operating characteristic curves showed that the model including MEEi had higher accuracy than the model without MEEi in predicting LVEF reduction (areas under the curve 0.68 vs. 0.63, P = 0.046). Conclusions Lower values of MEEi at baseline identify hypertensive patients more liable to develop LVEF reduction. In hypertensive setting, MEEi evaluation improves risk stratification for development of LV systolic dysfunction during long-term follow-up.

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Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries

Cited by 19 publications

References 62 publications

Impact of invasive aortic pulse pressure on coronary microvascular endothelial-independent dysfunction and on mortality in non-obstructive coronary artery disease

Impact of invasive aortic pulse pressure on coronary microvascular endothelial-independent dysfunction and on mortality in non-obstructive coronary artery disease

Identification of cardiac organ damage in arterial hypertension: insights by echocardiography for a comprehensive assessment

Low mechano‐energetic efficiency is associated with future left ventricular systolic dysfunction in hypertensives

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