Aortic distensibility and extent and complexity of coronary artery disease in patients with stable hypertensive and nonhypertensive coronary artery disease

OBJECTIVE

To assess the relationship between aortic distensibility (AD) and the extent and complexity of atherosclerotic lesions assessed with SYNTAX score (SS) in patients with stable coronary artery disease.

SUBJECTS AND METHODS

Three hundred and seventy-six consecutive patients (230 males and 146 females; mean age: 61.6 ± 9.9 years) with angiographically proven coronary artery disease were included in the study. The SS was calculated using the SS algorithm on the baseline diagnostic angiogram in the 376 patients. AD was calculated from the echocardiographically derived ascending aorta diameters and hemodynamic pressure measurements in all patients. Frequencies of risk factors, biochemical and hematological data were recorded. The patients were divided into two groups according to the median AD value as AD(low) and AD(high) groups.

RESULTS

The SS was higher in the AD(low) group compared with the AD(high) group (18.5 ± 10.2 vs. 8.3 ± 5.9, p < 0.001). The AD was independently related to age (β = -0.104, p = 0.019), hypertension (β = -0.202, p < 0.001) and SS (β = -0.457, p < 0.001) and was more strongly associated with SS in hypertensive patients compared to nonhypertensive patients (r = -0.524 vs. r = -0.414, p < 0.001 for all).

CONCLUSION

The findings showed that impaired AD might be an independent predictor for the severity of coronary atherosclerosis, particularly in patients with hypertension.

Central Diastolic Blood Pressure Is Associated With the Degree of Coronary Collateral Development

Coronary collaterals (CCs) serve as alternative conduits for blood flow in obstructive coronary artery disease. We investigated the association of various components of blood pressure (BP) parameters with the the degree of coronary collateralization. Patients (n = 245) who underwent coronary angiography were included. Intraarterial BP in the ascending aorta was determined using a standard fluid-filled system. Readings of the conventional peripheral pressure were measured using a manual sphygmomanometer. All blood samples were drawn at admission, before coronary angiography. A total of 65 patients were found to have adequate CC development. Central diastolic BP and peripheral diastolic BP were found to be lower in the group with adequate CC. In multivariate logistic regression model, central diastolic BP and Gensini score were found to be independent predictors of adequate CC. In conclusion, low central diastolic BP in the case of severe coronary stenosis may be an important stimulus for adequate CC development.