Aortic stiffness affects the coronary blood flow response to percutaneous coronary intervention

• Published in: American journal of physiology. Heart and circulatory physiology 2006-02, Vol.290 (2), p.H624-H630
• Main Authors: Leung, Michael C. H, Meredith, Ian T, Cameron, James D
• Format: Article
• Language: English
• Subjects: Adenosine - pharmacology; Aged; Angina Pectoris - complications; Angina Pectoris - physiopathology; Angina Pectoris - therapy; Angioplasty, Balloon, Coronary; Aorta - physiopathology; Blood Flow Velocity; Blood Pressure; Blood Volume - drug effects; Coronary Circulation; Coronary Stenosis - complications; Elasticity; Female; Humans; Male; Middle Aged; Pulse; Vasodilator Agents - pharmacology
• ISSN: 0363-6135; 1522-1539
• DOI: 10.1152/ajpheart.00380.2005

Cardiovascular Research Centre, Monash Medical Centre and Monash University, Melbourne, Australia Submitted 19 April 2005 ; accepted in final form 30 August 2005 We examined the hypothesis that a stiff aorta is associated with reduced coronary blood flow (CBF) and CBF response to percutaneous coronary intervention (PCI). Aortic mechanical properties are thought to affect CBF, with increased stiffness associated with decreased coronary perfusion. Animal studies are conflicting, and human evidence is lacking. Even less is known about the effects of aortic stiffness on the CBF response to successful PCI. In 18 subjects undergoing elective PCI, a Doppler velocity guidewire was positioned proximal to a severe coronary stenosis to measure resting and adenosine-induced hyperemic CBF before and after PCI. Stenosis severity was assessed with Doppler velocity and pressure guidewires. Aortic mechanical indexes measured included central pulse-wave velocity (cPWV) and central pulse pressure (cPP). PCI was successful in all subjects (diameter stenosis: 88 ± 9% to 2 ± 7%; coronary flow velocity reserve: 1.8 ± 0.6 to 3.0 ± 0.8; fractional flow reserve: 0.57 ± 0.19 to 0.92 ± 0.06; all P < 0.001). With the adjustment for age and gender, resting and hyperemic CBF were inversely related to cPWV irrespective of the presence of stenosis (resting: before PCI, r 2 = 0.452, P < 0.01; after PCI, r 2 = 0.261, P = 0.043; hyperemic: before PCI r 2 = 0.503, P = 0.005; after PCI r 2 = 0.500, P = 0.002), whereas they were related to cPP in absence of stenosis (resting: r 2 = 0.368, P = 0.022; hyperemic: r 2 = 0.370, P = 0.016). Hyperemic CBF response ( P = 0.005) and hyperemic CBF improvement from PCI ( P = 0.025) were less marked in a stiff aorta than a compliant aorta. A stiff aorta is associated with a reduction in CBF, a lower hyperemic CBF response, and may reduce the improvement in hyperemic CBF after successful PCI. aorta; elasticity; angioplasty; ischemia Address for reprint requests and other correspondence: I. T. Meredith, Cardiovascular Research Centre, Monash Medical Centre and Monash Univ., 246 Clayton Rd., Clayton 3160, Victoria, Australia (email: ian.meredith{at}med.monash.edu.au )