Coronary Artery Disease
and Arterial Stiffness
박 창 규
Korea University Guro Hospital
Aortic stiffness and all-cause mortality
Laurent S et al. Hypertension.2001
Augmentation; pressure, index
Forward wave
reflected wave
olbserved wave
+
younger older
MAP
Circulation. 1983; 68: 50–58
PWV with Age
Relation between 10-year CVD risk and Aortic PWV
Hypertension. 1999;33:1111-1117
MI CHD CHD mortality Stroke CVD CV mortalityPWV>13.5m/s 3.5 4.6 4.9 6.1 5.3 7.1
Odds Ratio of Being in High-Risk Group
Stiffness of systemic arteries inpatients with myocardial infarction.A noninvasive method to predictseverity of coronary atherosclerosis.
Hirai T, Sasayama S, Kawasaki T, Yagi S.
Circulation 1989;80:1946.
Aortic stiffness CAD Control p
Aorto-iliac pulse wave velocity (PWV) was measured between aortic arch (A), just distal to
the left subclavian artery ostium and right common iliac artery (B).
A B
PWV by Cardiac Catherization
∆t
Aortic arch pulse wave
Femoral artery pulse wave
∆t is the time interval between two pulse waves.
PWV, m/s 12.5 10.2 <0.001
Park CG et al. BLOOD PRESSURE 2004;13:369-375
PWV, m/s No. CAD(%) Crude OR Adjusted OR Tertile 1(<8.9) 108 34.3 1.0 1.0Tertile 2(8.9-11.8) 109 40.4 1.30 1.09Tertile 3(<11.8) 109 59.6 2.84** 1.60*
Odds ratio of coronary artery disease
Park CG et al. BLOOD PRESSURE 2004;13:369-375
Park CG et al. BLOOD PRESSURE 2004;13:369-375
Severity of coronary artery disease
Correlation between PWV and coronary artery calcification
No calcification ca: 1,2 segment ca: above 3 segment
n=141 n=27 n=18
PWV 10.15+/- 0.37 13.14+/- 0.84 16.62+/-1.05
P < 0.001
P=0.001
P=0.096
Han SH, Park CG et al. J Hypertens. 2002;20:S157
AP; augmented pressureAIx; AP/PP (%)
AIx and presence of CADin younger patients(up to 60 yo)
57.1
71.2
81.8
91.7
0
10
20
30
40
50
60
70
80
90
100
Quartile 1 Quartile 2 Quertile 3 Quartile 4
CAD
%
-17 to 9 10 to 21 22 to 28 29 to 60
Circulation 2004;109:184-9
Adjusted OR 1.00 2.21 5.42* 16.81*
Circulation 2004;109:184-9
Augm
ente
d p
ressure
mm
Hg
HR of MACEPer 10mmHg increase in AP 1.20For each 10% increase in AIx 1.28
AP; augmented pressureAIx; AP/PP (%)
Aortic Stiffness and LVH
Correlation between PWV and LVMI
7.06
8.57
LVH(-) LVH(+)
P < 0.001
PWV (m/s)
Park CG et al. J Hypertens. 2002;20:S384
Aortic Distensibility and Cerebrovascular Disease
9.4
13.8
0
2
4
6
8
10
12
14
16
18
20
Control Cb dz
Clin Sci 1995;89:247-253
PWV (m/s)
0.082
0.049
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
Control Cb dz
Aortic distensibility
P<0.0002 P<0.0007
Aortic Stiffness and Diabetes
Hypertension and type II DM on Aortic Stiffness
11.811
13.8
9.4
0
2
4
6
8
10
12
14
16
DM HT DM+HT Healthy
Journal of Human Hypertension 2004;18:469-73
PW
V (
m/s
)
adiponectin (ug/mL)
50403020100-10
PW
V (
m/s)
30
20
10
0
r=-0.557; p<0.001
Correlation between plasma adiponectin and PWV
Park CG et al. BLOOD PRESSURE 2004;13:236-242
0
2
4
6
8
10
12
14
Normotens ion Hyper tens ion
PWV (m/s)
P<0.01
PWV in Non-Diabetic Hemodialysis Patients
0
2
4
6
8
10
<40 40-49 50-59 >60 Total
Control
NonDM-ESRD
*;p<0.05**;p<0.01
**
J Am Soc Nephrol 1998;9:1277-84
*** * *
Age
PWV (m/s)
PWV and Obesity
MenWomen
Normal
Obesity
16.2
14.6
10.6
9.7
0
2
4
6
8
10
12
14
16
18
20
Normal
Obesity
Am Heart J 1986;112:136-140
**
*;p<0.05
PWV (m/s)
(내장지방)
baPWV change
흡연
PWV and Endothelial Function
0
500
1000
1500
2000
2500
3000
3500
-2 0 2 4 6 8 10 12 14
r= -0.391P <0.05
% FMD
PW
V (
cm
/s)
Hypertens Res 2000;23:233-8
Prognostic Value of Forearm Vascular Endothelial Dysfunction (FMD)In hypertensive patients
Survival ratio
Clinical Science 2004; 107:415–422
Correlation between PWV and
Aortic Valve Calcification, and
Aortic Valve Stenosis
Odds ratio 95% CI P value
Univariate analysis
Diabetes mellitus 3.4 1.5–6.1 0.01
Increased PWV 3.1 1.4–9.0 0.01
Systemic hypertension 2.6 1.3–6.6 0.01
Severe CAD ( two-vessel disease) 2.2 1.5–4.7 0.03
Increased AV calcification 2.2 1.3–2.9 0.01
Lower LV ejection fraction 2.0 0.8–3.8 0.1
Increased age 1.7 0.8–3.8 0.2
Multivariate analysis
Increased PWV 3.0 1.3–9.9 0.01
Diabetes mellitus 2.3 1.6–10.5 0.01
Systemic hypertension 2.2 1.1–5.2 0.03
Clinical Science 2004; 107:415–422
Cox proportional analysis for significant AS
CI, confidence interval.
Arterial stiffness
Central Aortic press
DBP SBP
CHD, CHF, Arrhythmia, AS
Carotid AtherosclerosisRenal Atherosclerosis
Stroke ESRD
Risk factors;DM, salt, obesity, smoking
Local PP
Coronary perfusion LVH, EF