Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Feb 26, 2016; 8(2): 231-239
Published online Feb 26, 2016. doi: 10.4330/wjc.v8.i2.231
Association of arterial stiffness with coronary flow reserve in revascularized coronary artery disease patients
Vlassis Tritakis, Stavros Tzortzis, Ignatios Ikonomidis, Kleanthi Dima, Georgios Pavlidis, Paraskevi Trivilou, Ioannis Paraskevaidis, Giorgos Katsimaglis, John Parissis, John Lekakis
Vlassis Tritakis, Stavros Tzortzis, Ignatios Ikonomidis, Kleanthi Dima, Georgios Pavlidis, Paraskevi Trivilou, Ioannis Paraskevaidis, Giorgos Katsimaglis, John Parissis, John Lekakis, Second Department of Cardiology, Athens University Medical School, Attikon Hospital, 12462 Athens, Greece
Author contributions: Tritakis V, Tzortzis S, Ikonomidis I, Paraskevaidis I, Parissis J and Lekakis J contributed to study conception and design; Tritakis V, Tzortzis S, Ikonomidis I, Dima K, Pavlidis G, Trivilou P and Katsimaglis G contributed to data acquisition, data analysis and interpretation; Tzortzis S, Tritakis V, Ikonomidis I contributed to writing of article; Tritakis V, Tzortzis S, Ikonomidis I, Paraskevaidis I, Parissis J, Lekakis J contributed to editing, reviewing and final approval of article.
Institutional review board statement: The study was reviewed and approved by the Attikon University Hospital Institutional Review Board, conducted in compliance with the Declaration of Helsinki.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the contributing authors of the present manuscript declare that they have no conflict of interest to report.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at ignoik@otenet.gr. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ignatios Ikonomidis, MD, FESC, Second Department of Cardiology, Athens University Medical School, Attikon Hospital, Rimini 1, Haidari, 12462 Athens, Greece. ignoik@otenet.gr
Telephone: +30-210-5832187 Fax: +30-210-5832351
Received: August 3, 2015
Peer-review started: August 10, 2015
First decision: September 16, 2015
Revised: October 9, 2015
Accepted: December 9, 2015
Article in press: December 11, 2015
Published online: February 26, 2016
Processing time: 203 Days and 7.8 Hours
Abstract

AIM: To investigate the association of arterial wave reflection with coronary flow reserve (CFR) in coronary artery disease (CAD) patients after successful revascularization.

METHODS: We assessed 70 patients with angiographically documented CAD who had undergone recent successful revascularization. We measured (1) reactive hyperemia index (RHI) using fingertip peripheral arterial tonometry (RH-PAT Endo-PAT); (2) carotid to femoral pulse wave velocity (PWVc-Complior); (3) augmentation index (AIx), the diastolic area (DAI%) and diastolic reflection area (DRA) of the central aortic pulse wave (Arteriograph); (4) CFR using Doppler echocardiography; and (5) blood levels of lipoprotein-phospholipase A2 (Lp-PLA2).

RESULTS: After adjustment for age, sex, blood pressure parameter, lipidemic, diabetic and smoking status, we found that coronary flow reserve was independently related to AIx (b = -0.38, r = 0.009), DAI (b = 0.36, P = 0.014), DRA (b = 0.39, P = 0.005) and RT (b = -0.29, P = 0.026). Additionally, patients with CFR < 2.5 had higher PWVc (11.6 ± 2.3 vs 10.2 ± 1.4 m/s, P = 0.019), SBPc (139.1 ± 17.8 vs 125.2 ± 19.1 mmHg, P = 0.026), AIx (38.2% ± 14.8% vs 29.4% ± 15.1%, P = 0.011) and lower RHI (1.26 ± 0.28 vs 1.50 ± 0.46, P = 0.012), DAI (44.3% ± 7.9% vs 53.9% ± 6.7%, P = 0.008), DRA (42.2 ± 9.6 vs 51.6 ± 11.4, P = 0.012) and LpPLA2 (268.1 ± 91.9 vs 199.5 ± 78.4 ng/mL, P = 0.002) compared with those with CFR ≥ 2.5. Elevated LpPLA2 was related with reduced CFR (r = -0.33, P = 0.001), RHI (r = -0.37, P < 0.001) and DRA (r = -0.35, P = 0.001) as well as increased PWVc (r = 0.34, P = 0.012) and AIx (r = 0.34, P = 0.001).

CONCLUSION: Abnormal arterial wave reflections are related with impaired coronary flow reserve despite successful revascularization in CAD patients. There is a common inflammatory link between impaired aortic wall properties, endothelial dysfunction and coronary flow impairment in CAD.

Keywords: LpPLA2; Coronary artery disease; Arterial stiffness; Coronary flow reserve; Reactive hyperemia index

Core tip: The present study is a contribution to investigate the association between the abnormalities in arterial wave reflections and coronary flow reserve. We demonstrated that augmentation of the systolic component of the central aortic pulse wave instead of diastolic is related with impaired coronary flow reserve after adjustment for several other factors potentially influencing coronary microcirculatory function. Furthermore, endothelial dysfunction as assessed by reactive hyperemia index and an inflammatory process as assessed by increased levels of lipoprotein-associated Phospholipase A2 are related with increased arterial stiffness and abnormal wave reflections in coronary artery disease patients.