Site-specific association between distal aortic pulse wave velocity and peripheral arterial stenosis severity: a prospective cardiovascular magnetic resonance study

Abstract

BackgroundVascular disease expression in one location may not be representative for disease severity in other vascular territories, however, strong correlation between disease expression and severity within the same vascular segment may be expected. Therefore, we hypothesized that aortic stiffening is more strongly associated with disease expression in a vascular territory directly linked to that aortic segment rather than in a more remote segment. We prospectively compared the association between aortic wall stiffness, expressed by pulse wave velocity (PWV), sampled in the distal aorta, with the severity of peripheral arterial occlusive disease (PAOD) as compared to atherosclerotic markers sampled in remote vascular territories such as PWV in the proximal aorta and the normalized wall index (NWI), representing the vessel wall thickness, of the left common carotid artery.MethodsForty-two patients (23 men; mean age 64±10 years) underwent velocity-encoded cardiovascular magnetic resonance (CMR) in the proximal and distal aorta, whole-body contrast-enhanced MR angiography (CE-MRA) and carotid vessel wall imaging with black-blood CMR in the work-up for PAOD. Strength of associations between aortic stiffness, carotid NWI and peripheral vascular stenosis grade were assessed and evaluated with multiple linear regression.ResultsStenosis severity correlated well with PWV in the distal aorta (Pearson rP=0.64, p<0.001, Spearman rS=0.65, p<0.001) but to a lesser extent with PWV in the proximal aorta (rP=0.48, p=0.002, rS=0.22, p=0.18). Carotid NWI was not associated with peripheral stenosis severity (rP=0.17, p=0.28, rS=0.14, p=0.37) nor with PWV in the proximal aorta (rP=0.22, p=0.17) nor in the distal aorta (rP=0.21, p=0.18). Correlation between stenosis severity and distal aortic PWV remained statistically significant after correction for age and gender.ConclusionsDistal aortic wall stiffness is more directly related to peripheral arterial stenosis severity than markers from more remote vascular territories such as proximal aortic wall stiffness or carotid arterial wall thickness. Site-specific evaluation of vascular disease may be required for full vascular risk estimation.

Systemic arteriosclerosis is associated with left ventricular remodeling but not atherosclerosis: a TASCFORCE study

“…Similarly another Rotterdam study showed a significant correlation between carotid plaque and aortic PWV which was lost after adjusting for cardiovascular risk factors [ 6 ]. Limitations of these latter studies is their correlation of one regional measure of arterial stiffness with plaque volume measured in a separate region, however atherosclerosis in one region poorly correlates with disease in other regions [ 8 , 26 ]. In addition these studies examined populations at high risk for or with known cardiovascular disease.…”

Multi-Modality Imaging of Atheromatous Plaques in Peripheral Arterial Disease: Integrating Molecular and Imaging Markers

“…In 2016, Bosch et al discovered that the mean MRA stenosis class (i.e., average stenosis severity visually scored over 27 standardized segments across the body) was a significant independent predictor for all-cause mortality [ 88 ]. They also found that MRA-derived PAD stenosis correlated well with distal aortic stiffness but to a lesser extent with proximal aorta stiffness [ 89 ]. Besides symptomatic PAD patients, MRI has also been used to examine peripheral arterial plaques in non-symptomatic subjects.…”

Review of Journal of Cardiovascular Magnetic Resonance 2015

“…Expression of the disease in one location may not represent disease severity in other vascular territories although strong correlation between disease expression and severity within the same vascular segment may be expected. The authors prospectively compared the association between distal aortic stiffness measured by CMR pulse wave velocity (PWV) with the severity of peripheral arterial occlusive disease [135]. Atherosclerotic markers sampled in remote vascular territories such as PWV in the proximal aorta and left common carotid artery wall thickness was also compared.…”