European Heart Journal Advance Access originally published online on April 15, 2005
European Heart Journal 2005 26(11):1143; doi:10.1093/eurheartj/ehi263
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Relationship between reduced elasticity of extracardiac vessels and left main stem coronary artery disease
Kalina Kawecka-Jaszcz
I Department of Cardiology
Collegium Medicum
Jagiellonian University
Kraków, Poland
E-mail address: piotr_jankowski{at}interia.pl
We read with great interest the extended analysis by Weber et al.1 of their previous publication and the elegant work by Hadjinikolaou et al.2 concerning the relationship between arterial stiffness and elasticity and the presence of left main stem coronary artery disease.
Their findings agree with our observation that ascending aortic blood pressure-derived indices are independently related to coronary atherosclerosis.3 The values of these indices depend on the interaction between heart and vascular bed. Extended analysis of our study population provides more information about the relationship between left main stem atherosclerosis and blood pressure-derived indices. Among 423 study subjects with angiographically confirmed coronary artery disease and preserved left ventricular function, 16 were found to have left main stem stenosis of at least 50%, 76 patients had stenosis <50%, and 331 had no plaque detected on angiography. Patients with significant stenosis, as well as those with insignificant plaque in their left main stem, had significantly higher intra-aortic pulse pressure (77.3±18.7 vs. 71.1±18.5 vs. 65.6±8.1 mmHg), aortic pulsatility (0.79±0.20 vs. 0.76±0.17 vs. 0.69±0.15), and pulsatility index (1.10±0.40 vs. 1.04±0.32 vs. 0.92±0.27) when compared with the group without any main stem atherosclerosis detectable on angiography. There was no significant difference in mean ejection fraction or heart rate among the groups, which suggests that the difference in vascular properties influence the outcome measures. Moreover, pulse pressure, pulsatility, and pulsatility index correlated with the per cent of left main stenosis (r=0.15, P<0.01; r=0.20, P<0.001; r=0.21, P<0.001, respectively). None of the other aortic blood pressure-derived indices or brachial pressure-derived indices was significantly correlated with left main stem atherosclerosis.
In conclusion, patients with left main stem atherosclerotic plaque are characterized by impaired mechanical properties of their vessels leading to increased aortic pulse pressure and pulsatility. Indeed, this can lead to poor prognosis of such patients.
References
- Thomas Weber T, Auer J, Eber B et al. Relationship between reduced elasticity of extracardiac vessels and left main stem coronary artery disease. Eur Heart J 2004;25:1966–1967.
[Free Full Text] - 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] - Jankowski P, Kawecka-Jaszcz K, Czarnecka D et al. Ascending aortic, but not brachial blood pressure-derived indices are related to coronary atherosclerosis. Atherosclerosis 2004;176:151–155.[CrossRef][ISI][Medline]
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