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