Relationship between reduced elasticity of extracardiac vessels and left main stem coronary artery disease

Thomas Webera,*, Johann Auera, Bernd Ebera and Michael F. O'Rourkeb

a Cardiology Department, Klinikum der Kreuzschwestern, Grieskirchnerstrasse 42, 4600 Wels, Austria
b St. Vincents Clinic, UNSW Sydney, Australia

Received May 8, 2004; accepted May 26, 2004 * Corresponding author. Tel.: +43 7242 415 2215; fax: +43 7242 415 3992 (E-mail: thomas.weber3{at}liwest.at).

To the Editor,

With great interest we read the study on reduced vessel elasticity in left main stem (LMS) coronary artery disease (CAD) by Hadjinikolaou et al., published recently in the Eur Heart J.1 The authors elegantly showed, by careful ex vivo experiments, that the elasticity of extracardiac arteries and veins is impaired in patients with LMS-CAD compared to non-LMS CAD.

These findings are well in line with our observation that increased arterial stiffness and wave reflections, as assessed by non-invasive pulse waveform analysis (PWA), are independent risk markers for CAD.2 Moreover, we found statistically significant correlations between the extent of CAD and the Augmentation Index (AIx), a measure of increased wave reflections, as well as time-to-return of the reflected wave (Tr), a surrogate for pulse wave velocity and thus arterial stiffness. Both measures provide information about the mechanical properties of the complete arterial system. Extended analysis of our study population revealed even more support for Hadjinikolaou's study: We analysed 394 patients (259 men, mean age 66.4 years), undergoing coronary angiography as well as non-invasive PWA at our institution, with a final diagnosis of CAD, excluding those with valvular heart disease or impaired systolic function, as the AIx is sensitive to these. 23 were found to have LMS-CAD, the others had distal CAD without significant involvement of the LMS. Patients with LMS-CAD had increased wave reflections, as indicated by a higher AIx, as well as higher arterial stiffness, manifested by a shorter Tr (Table 1).


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Table 1. Increased wave reflections (Augmentation Index — AIx) and shorter time-to-return of the reflected wave (Tr — indicating higher pulse wave velocity and arterial stiffness) in patients with left main stem (LMS) coronary artery disease (CAD) compared to patients with non-LMS CAD
 
In conclusion, patients with LMS-CAD are characterised by impaired mechanical properties of their circulatory system. This can be shown likewise by non-invasive PWA and by ex vivo methods1 and might contribute to their worse prognosis, even after revascularisation.3

References

  1. Hadjinikolaou L, Kotidis K, Galinanes M. Relationship between reduced elasticity of extracardiac vessels and left main stem coronary artery disease Eur Heart J 2004;25:508-513.[Abstract/Free Full Text]
  2. Weber T, Auer J, O'Rourke MF, et al. Arterial stiffness, wave reflections, and the risk of coronary artery disease Circulation 2004;109:184-189.[Abstract/Free Full Text]
  3. Volzke H, Engel J, Kleine V, et al. Angiotensin I-converting enzyme insertion/deletion polymorphism and cardiac mortality and morbidity after coronary artery bypass graft surgery Chest 2002;122:31-36.[Abstract/Free Full Text]




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