Incremental Value of Pulse Wave Velocity in the Determination of Coronary Microcirculatory Dysfunction in Never-treated Patients With Essential Hypertension

Ikonomidis, Ignatios; Lekakis, John; Papadopoulos, Costas; Triantafyllidi, Helen; Paraskevaidis, Ioannis; Georgoula, Georgia; Tzortzis, Stavros; Revela, Ioanna; Kremastinos, Dimitrios Th.

doi:10.1038/ajh.2008.172

Cited by 87 publications

(86 citation statements)

References 41 publications

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“…In particular, increased fractional PP was found to be associated with impaired CFR and diastolic dysfunction in hypertensive patients with normal coronary arteries 26, 27. Ikonomidis et al28 observed an independent association between pulse wave velocity, another good surrogate of arterial stiffness,44 and CFR in never‐treated hypertensive patients. Our results extend these findings since the impact of PP was primarily exerted on increased coronary flow velocity at rest, whereas the hyperemic coronary flow response did not differ significantly in comparison with patients having PP ≤60 mm Hg.…”

Section: Discussionmentioning

confidence: 97%

“…Several conditions can be associated with decreased CFR, such as a significant epicardial coronary artery stenosis, but also aging, aortic valve stenosis, left ventricular (LV) hypertrophy, hypertrophic and dilated cardiomyopathy, and even isolated coronary microvascular dysfunction 20, 21, 22, 23. Although previous studies have shown an inverse relationship between arterial stiffness and CFR,24, 25 limited information is available on the relationships between PP and CFR, in particular in patients who have cardiovascular risk factors but are free of obstructive coronary artery disease 26, 27, 28. Accordingly, the aim of our study was to evaluate the relationships of PP with noninvasively determined CFR and its components, ie, resting and hyperemic coronary flow velocities, in patients without angiographic evidence of epicardial coronary artery stenosis.…”

Section: Introductionmentioning

confidence: 99%

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

Lembo

Sicari

Esposito

et al. 2017

JAHA

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BackgroundThe aim of our study was to evaluate the relationship of pulse pressure (PP), a raw index of arterial stiffness, with noninvasively determined coronary flow reserve (CFR) and its components, in patients with angiographically normal epicardial coronary arteries.Methods and ResultsThe study population included 398 patients without angiographic evidence of coronary stenosis, who underwent high‐dose dipyridamole stress echocardiography with transthoracic‐derived CFR evaluation on the left anterior descending artery. CFR was calculated as the ratio between high‐dose dipyridamole and resting coronary diastolic peak velocities. Patients were divided into 2 groups: the first group included the first and second PP tertiles (n=298, PP ≤60 mm Hg) and the second group included the highest PP tertile (n=100, PP >60 mm Hg). Mean blood pressure, systolic blood pressure (both P<0.0001), age (P<0.002), and left ventricular mass index (P=0.013) were higher in the highest PP tertile, which also showed higher resting coronary flow velocity (31.6±9.6 cm/s versus 27.7±6.4 cm/s, P<0.0001) and marginally lower CFR (2.5±0.6 versus 2.6±0.6, P=0.044). Hyperemic coronary flow velocity did not differ between the 2 groups. By separate multiple linear regression analyses, after adjusting for sex, age, the highest systolic blood pressure tertile (≥140 mm Hg), left ventricular mass index, and cardiovascular risk factors, the highest PP tertile was associated with resting coronary flow velocity (P=0.003) and only marginally with hyperemic coronary flow velocity (P<0.02), whereas its association with CFR was not significant.ConclusionsIn patients without epicardial coronary artery stenosis, the highest PP tertile is associated with an increased coronary flow velocity at rest.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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

Lembo

Sicari

Esposito

et al. 2017

JAHA

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“…The ratio of the E wave of the mitral inflow measured by pulse-wave Doppler to Em was calculated as an index of LV diastolic filling pressures. 8,15 Inter-and intra-observer variability of E and Em were 1 and 3% and 0.5 and 1.7%, respectively.…”

Section: D Doppler and Color Tissue Doppler Echocardiographymentioning

confidence: 92%

“…6 In our previous studies, we have demonstrated that, in hypertensive patients, impaired CFR was related to increased PWV. 8 Other investigators have shown an association between IMT and CFR. 9 The assessment of CFR provides important clinical and prognostic information in hypertensive patients.…”

Section: Introductionmentioning

confidence: 94%

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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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The role of ventricular–arterial coupling in cardiac disease and heart failure: assessment, clinical implications and therapeutic interventions. A consensus document of the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases, European Association of Cardiovascular Imaging, and Heart Failure Association

Ikonomidis

Aboyans

Blacher³

et al. 2019

European J of Heart Fail

220

243

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Ventricular–arterial coupling (VAC) plays a major role in the physiology of cardiac and aortic mechanics, as well as in the pathophysiology of cardiac disease. VAC assessment possesses independent diagnostic and prognostic value and may be used to refine riskstratification and monitor therapeutic interventions. Traditionally, VAC is assessed by the non‐invasive measurement of the ratio of arterial (Ea) to ventricular end‐systolic elastance (Ees). With disease progression, both Ea and Ees may become abnormal and the Ea/Ees ratio may approximate its normal values. Therefore, the measurement of each component of this ratio or of novel more sensitive markers of myocardial (e.g. global longitudinal strain) and arterial function (e.g. pulse wave velocity) may better characterize VAC. In valvular heart disease, systemic arterial compliance and valvulo–arterial impedance have an established diagnostic and prognostic value and may monitor the effects of valve replacement on vascular and cardiac function. Treatment guided to improve VAC through improvement of both or each one of its components may delay incidence of heart failure and possibly improve prognosis in heart failure. In this consensus document, we describe the pathophysiology, the methods of assessment as well as the clinical implications of VAC in cardiac diseases and heart failure. Finally, we focus on interventions that may improve VAC and thus modify prognosis.

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Incremental Value of Pulse Wave Velocity in the Determination of Coronary Microcirculatory Dysfunction in Never-treated Patients With Essential Hypertension

Abstract: Elevated LV diastolic compressive forces on coronary microcirculation and the presence of generalized vascular damage may explain the association between PWV and CFR. PWV has an incremental value in the determination of impaired coronary microcirculation in hypertensive patients.

Cited by 87 publications

References 41 publications

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

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

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

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