Copyright © 2000 by the European Society of Cardiology.
Aortic stiffness as a risk factor for recurrent acute coronary events in patients with ischaemic heart disease
Hippokration Hospital, Department of Cardiology, University of Athens, Greece
revised June 15, 1999; accepted June 16, 1999
Abstract
Aims Aortic elasticity is an important determinant of left ventricular performance and coronary blood flow. Moreover, it has been shown that aortic elastic properties deteriorate in patients with coronary artery disease. However, the predictive role of aortic elasticity in the occurrence of coronary events, has not been addressed so far. Therefore, we set out to test prospectively the hypothesis that invasive as well as non-invasive measures of aortic elastic properties, assessed at rest from pressure–diameter relationships, could predict the development of recurrent coronary events.
Methods and Results Clinical variables and measures of aortic function were assessed in 54 normotensive patients with coronary artery disease. The aortic pressure–diameter relationship was derived invasively with a high-fidelity Y shaped catheter (developed in our Institution) for aortic diameter measurements, simultaneously with a Millar catheter for aortic pressure measurements. Aortic root distensibility was assessed by non-invasive techniques. During an average of 3 years follow-up, 12 of 54 patients either developed unstable angina (n=8) or acute myocardial infarction (n=4). By multivariate Cox model analysis, aortic stiffness was the strongest predictor of progression to any end-point (relative risk: 3·24, CI: 1·79 to 5·83;P=0·000). When aortic stiffness was not considered, aortic distensibility was the only independent predictor for acute coronary syndromes (relative risk: 0·37 CI: 0·21 to 0·65;P=0·000).
Conclusion In patients with coronary artery disease, aortic elastic properties are powerful and independent risk factors for recurrent acute coronary events.
Key Words: Acute coronary syndromes, aortic stiffness, aortic distensibility, Cox proportional hazards models
f1 Correspondence: Christodoulos Stefanadis, MD, FESC, FACC, 9 Tepeleniou Str., 15452 Paleo Psychico, Athens, Greece.
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