Chronically decreased aortic distensibility causes deterioration of coronary perfusion during increased left ventricular contraction

Ohtsuka, Sadanori; Kakihana, Masatoshi; Watanabe, Hideki; Sugishita, Yasuro

doi:10.1016/0735-1097(94)90127-9

Cited by 178 publications

(107 citation statements)

References 24 publications

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“…Another interpretation is that abnormalities in the microcirculation and, therefore, in peripheral vascular resistance, lead to the perturbations in aortic stiffness (41). The hypothesis that coronary flow may be influenced by aortic elastic properties was introduced by Bouvrain et al (42), and was confirmed by experimental studies (37,38). In previous studies, significant correlations between CFR and aortic stiffness assessed by pulse wave velocity have been demonstrated in patients with hypertension and coronary artery disease (43,44).…”

Section: Discussionmentioning

confidence: 82%

“…Several components of the MetS, including high blood pressure, hyperglycemia, and abdominal fat, have been related to increased aortic stiffness (12,15). Relations between microvascular function and aortic stiffness have been reported (37,38). In the Framingham Heart Study offspring cohort increased aortic stiffness was associated with higher forearm vascular resistance at baseline and during reactive hyperemia, and with blunted flow reserve during hyperemia (39).…”

Section: Discussionmentioning

confidence: 99%

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Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study

Tok¹,

Özcan²,

Kadife³

et al. 2013

AnadoluKardiyolDerg

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Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational studyMetabolik sendromlu hastalarda ekokardiyografik olarak gösterilen bozulmuş koroner akım rezervi artmış aort sertliği ile ilişkilidir: Gözlemsel bir çalışma ABSTRACTObjective: Metabolic syndrome (MetS) is a strong predictor of cardiovascular events and coronary flow reserve (CFR), an indicator of microvascular function, has been found to be impaired in MetS. Aortic stiffness (AS) is a simple and effective method for assessing arterial elasticity. The aim of this study was to evaluate whether there is an independent association of impaired coronary flow and aortic elasticity in patients with MetS. Methods: Forty-six patients (mean age 47.3±6.6 years) with the diagnosis of MetS according to the ATP III update criteria and 44 age and gender matched controls (mean age 46.0±6.1 years) were included into the cross-sectional observational study. Peak diastolic coronary flow velocities were measured in left anterior descending artery by pulsed wave Doppler at baseline and after adenosine infusion, and CFR was calculated as the ratio of hyperemic to baseline velocities. Aortic strain, distensibility and stiffness were calculated by M-mode echocardiography. Statistical analysis was performed by using Student t-test, Chi-square test, Pearson correlation and linear regression analyses. Results: CFR was significantly lower in patients with MetS than in controls (2.3±0.2 vs 2.7±0.2, p<0.001). In the MetS group, aortic distensibility (10.4±3.5 cm 2 .dyn -1 .10 -6 vs. 12.7±3.4 cm 2 .dyn -1 .10 -6 , p=0.002) was decreased and AS was significantly increased (6.5±2.0 vs. 3.2±0.8, p<0.001). In multivariate linear regression analysis, AS (β=-0.217, p=0.047), systolic blood pressure (β=-0.215, p=0.050) and waist circumference (β=-0.272, p=0.012) had an independent relationship with impaired CFR. Conclusion: This study demonstrated that coronary flow reserve is impaired in patients with MetS and there is an independent relationship between impaired CFR and increased aortic stiffness, systolic blood pressure or waist circumference. (Anadolu Kardiyol Derg 2013; 13: 227-34)

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study

Tok¹,

Özcan²,

Kadife³

et al. 2013

AnadoluKardiyolDerg

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“…15 -17 But increased aortic stiffness decreases coronary flow reserve and during increased myocardial contractility endocardial flow becomes impaired with subendocardial ischemia. 16 These undesirable alterations are enhanced with a high-grade coronary stenosis or during reductions in diastolic BP. 18 In stable angina patients there is an inverse relationship between central aortic stiffness and coronary flow.…”

Section: Clinical Cardiology Doi:101002/clcmentioning

confidence: 99%

The pathophysiology of chronic ischemic heart disease

Pepine¹,

Nichols²

2007

Clin Cardiol

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SummaryWith our success in management of acute coronary syndromes (ACS), aging population and epidemics of diabetes and obesity, the management of patients with chronic coronary artery disease is becoming an increasing important part of clinical practice. Although the rates of death and myocardial infarction (MI) in this group of patients are not high as a group, a subgroup has very high risk but many have poor quality of life related to limiting angina. The purpose of this article is to review the pathophysiology of the chronic angina syndrome to provide an improved understanding of the basis for the comprehensive management required to yield patient benefits. Where possible, targets for novel therapeutic approaches are highlighted.

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“…22 Thus, arterial stiffness causes a mismatch between myocardial oxygen demands and myocardial perfusion resulting in subendocardial ischemia, LV diastolic dysfunction and elevation of diastolic filling pressure, which further decreases myocardial perfusion. 22 Indeed, experimental studies have shown that arterial stiffness contributed to a decrease in CFR 26 and has an effect on subendocardial ischemia. 27 Furthermore, Kingwell et al 28 demonstrated that aortic stiffness is an important independent determinant of myocardial ischemic threshold in patients with CAD.…”

Section: Discussionmentioning

confidence: 99%

Incremental predictive value of carotid intima–media thickness to arterial stiffness for impaired coronary flow reserve in untreated hypertensives

et al. 2010

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Coronary microcirculation is disturbed in patients with arterial hypertension. Carotid intima-media thickness (IMT) and arterial stiffness are markers of subclinical atherosclerosis with prognostic significance. We investigated whether the combination of increased carotid IMT and arterial stiffness has a greater predictive value for the presence of impaired coronary flow reserve (CFR) than each index alone in never-treated hypertensives. We studied 110 untreated patients (age: 54.5±12 years) with newly diagnosed arterial hypertension. We measured (1) carotid-to-femoral artery pulse wave velocity (PWV), (2) carotid IMT and (3) CFR by means of color-guided Doppler echocardiography after adenosine infusion. Among other confounders, arterial stiffness and IMT were independent determinants of CFR (coefficient B¼À0.146 and B¼À0.006, Po0.05). Arterial stiffness and IMT had an incremental value for the determination of CFR when added to a model including other confounders (v 2 change¼4.423, P for change¼0.038 after addition of IMT; and v 2 change¼5.369, P for change¼0.020 after addition of PWV). Receiver operating curve analysis showed that PWV410.2 m s À1 and IMT41 mm were the optimal cutoff values to predict a CFRo2.5. Patients with IMT41 mm, PWV410.2 m s À1 or their combination had an odds ratio of 3.5, 5.0 and 11.2, Po0.05, for a CFRo2.5, respectively. The combination of increased carotid IMT and arterial stiffness has a greater predictive value for impaired CFR than each index alone in never-treated hypertensives.

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Chronically decreased aortic distensibility causes deterioration of coronary perfusion during increased left ventricular contraction

Cited by 178 publications

References 24 publications

Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study

Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study

The pathophysiology of chronic ischemic heart disease

Incremental predictive value of carotid intima–media thickness to arterial stiffness for impaired coronary flow reserve in untreated hypertensives

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