P-082: Aortic stiffness improves the prediction of both diagnosis and severity of coronary artery disease - 12/02/16
La rigidité aortique améliore le dépistage de la maladie coronaire
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Résumé |
Background |
Myocardial ischemia represents a crucial target of coronary artery disease (CAD) screening. Nevertheless, elective coronography presents a low diagnostic yield for obstructive CAD. The purpose of this study was to determine whether noninvasive aortic stiffness assessment improves diagnostic accuracy of obstructive CAD screening.
Methods |
A cross-sectional study was conducted from January 2013 to September 2014 in our medical center. Electrocardiogram (ECG) stress test coupled with nuclear imaging was performed in 367 consecutive patients routinely followed-up, for myocardial ischemia screening. Aortic pulse wave velocity (PWV) was assessed by applanation tonometry in overall population. Forty-two patients underwent elective coronography because of ischemia. Theoretical PWV was calculated according to age, blood pressure and gender. Results were expressed as an index [(measured PWV – theoretical PWV) / theoretical PWV] for each patient.
Results |
Ten patients presented with obstructive CAD, 16 patients had nonobstructive CAD and 16 patients had normal coronary angiography. PWV index and severity of CAD were positively correlated (p=0.001) (Table 1). Glomerular filtration rate (GFR) was negatively associated with severity of CAD (p=0.014). Diagnostic accuracy of stress test coupled with nuclear imaging was improved when using PWV index in case of discordant clinical/nuclear results (performance index without versus with PWV index: 0.41 versus 0.69) (Table 2).
Conclusions |
Aortic PWV index should be considered as clinically useful to rule out the presence of obstructive CAD and to reduce the rate of unnecessary angiographies. Prospective studies, taking into account renal function, shall have the potential to further evaluate PWV index as a marker of CAD.
Abstract P-082 – Table 1Clinical, biological and hemodynamic parameters of the study cohort (N=42)Normal coronary angiography (N=16)Non Obstructive coronary lesions (N=16)Obstructive coronary lesions (N=10)P-valueGender/ female (%)6 (37.5)0 (0)1 (10)0.99Age (years)61 ± 761 ± 1468 ± 80.14BMI (Kg/m2)28.6 ± 4.527.3 ± 4.127.0 ± 3.40.64Smoking* (%)9 (56)8 (50)8 (80)0.16Dyslipidemia** (%)7 (54)10 (63)9 (90)0.12Hypertension (%)8 (50)12 (75)10 (100)0.04Diabetes (%)4 (25)7 (44)8 (80)0.03Coronary heart disease §0 (0)5 (31)7 (70)0.002Previous MI0 (0)2 (13)3 (30)0.08Carotid plaque (%)11 (69)11 (69)9 (90)0.53LVH (%)5 (31)5 (31)6 (60)0.15Previous Stroke (%)1 (6)1 (6)1 (10)0.99Peripheral arterial disease (%)1 (6)1 (6)4 (40)0.02Glycated Hemoglobin (%)5.96 ± 0.856.87 ± 1.527.00 ± 1.290.05Creatinine clearance (ml/mn)§§81 ± 2091 ± 2268 ± 170.014Heart rate (bpm)66 ± 1064 ± 969 ± 100.69Brachial SBP (mm Hg)133 ± 12134 ± 13140 ± 190.75Brachial DBP (mm Hg)80 ± 1380 ± 1078 ± 90.81Brachial PP (mm Hg)53 ± 853 ± 962±170.27MAP (mm Hg)98 ± 1298 ± 1098 ± 100.99Aortic PWV (m/sec)9.09 ± 2.0710.98 ± 3.4012.94 ± 2.880.003Aortic PWV index (%)−10.61 ± 19.697.44 ±22.3315.78 ± 15.870.001Continuous variables are presented as mean ± standard deviation. BMI, Body Mass Index; MI, Myocardial Infarction; LVH, Left Ventricular Hypertrophy; SBP, systolic blood pressure; DBP, diastolic blood pressure; PP, pulse pressure; MAP, mean arterial pressure; PWV, pulse wave velocity;*Past and current smokers;**Patients receiving lipid lowering medication or classified as dyslipidemic;§Coronary heart disease defined as previous documented myocardial infarction, coronary revascularization or epicardial coronary artery disease diagnosed during coronography for patients with symptoms or typical electrocardiographic modifications.§§creatinine clearance estimated using MDRD formula. Aortic PWV index defined as the difference between observed and theoretical PWV divided by theoretical PWV for each subject
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| Continuous variables are presented as mean ± standard deviation. BMI, Body Mass Index; MI, Myocardial Infarction; LVH, Left Ventricular Hypertrophy; SBP, systolic blood pressure; DBP, diastolic blood pressure; PP, pulse pressure; MAP, mean arterial pressure; PWV, pulse wave velocity; |
[**] Patients receiving lipid lowering medication or classified as dyslipidemic;
[§] Coronary heart disease defined as previous documented myocardial infarction, coronary revascularization or epicardial coronary artery disease diagnosed during coronography for patients with symptoms or typical electrocardiographic modifications.
[§§] creatinine clearance estimated using MDRD formula. Aortic PWV index defined as the difference between observed and theoretical PWV divided by theoretical PWV for each subject
Abstract P-082 – Table 2Performance of cardiac stress test without and with aortic pulse wave velocity (PWV) index for obstructive coronary artery disease (CAD) screening in the study cohort (N=42). Performance index (ranged from 0 to 1) is defined as the sum of sensitivity and specificity minus 1.Presence of obstructive CADSensitivity (%)Specificity (%)Performance indexYes (n=10)No (n=32)Cardiac stress test without PWV index§Abnormal5*3**50 [19-81]91 [80-100]0.41Discordant 529Cardiac stress test with PWV index§§Abnormal101010069 [53 - 85]0.69Normal022*All patients had positive Pulse wave velocity index,**One patient had negative pulse wave velocity index.§Abnormal test was defined as abnormal ECG stress test and abnormal scintigraphy;Discordance between nuclear and clinical results was defined as discordant test.§§Abnormal test was defined as abnormal ECG stress test and abnormal nuclear imaging or discordance between nuclear and clinical results associated with positive PWV index.
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[**] One patient had negative pulse wave velocity index.
[§] Abnormal test was defined as abnormal ECG stress test and abnormal scintigraphy;Discordance between nuclear and clinical results was defined as discordant test.
[§§] Abnormal test was defined as abnormal ECG stress test and abnormal nuclear imaging or discordance between nuclear and clinical results associated with positive PWV index.
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Vol 64 - N° S1
P. S50-S51 - décembre 2015 Retour au numéro
Article précédent
- P-081: Gender differences in early outcomes following PCI in different age groups of patients with STEMI
- N. Sharashidze, L. Gujejiani, Z. Pagava, G. Saatashvili
- P-083: Study of aorta central pressure in young population
- K. Lehachi, S. Taleb, A. Hedjeres, R. Derguine, M. Chahi
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