Aortic Pulse Wave Velocity and Carotid-Femoral Pulse Wave Velocity: Similarities and Discrepancies

1151 Hypertens Res Vol.30 (2007) No.12 p.1151-1158 Original Article Aortic Pulse Wave Velocity and Carotid-Femoral Pulse Wave Velocity: Similarities and Discrepancies Piotr PODOLEC1), Grzegorz KOPEĆ1), Jakub PODOLEC2), Piotr WILKOL ⁄ EK1), Marek KROCHIN1), Pawel⁄ RUBIŚ1), Marcin CWYNAR3), Tomasz GRODZICKI3), Krzysztof ŻMUDKA2), and Wiesl⁄ awa TRACZ1) The objectives of this study were to determine the relationship between carotid-femoral (cfPWV) and aortic pulse wave velocity (aPWV) and to compare their modulators and association with coronary artery disease (CAD). We studied 107 consecutive patients (68 men) with a mean age of 60.49 ± 8.31 years who had stable angina and had been referred for coronary angiography. cfPWV and aPWV were measured simultaneously during cardiac catheterization using the Complior® device and aortic pressure waveform recordings, respectively. Based on the presence or absence of significant coronary artery stenosis (CAS) patients were subdivided into a CAS+ or CAS– group. The mean values of cfPWV and aPWV were 10.65 ± 2.29 m/s and 8.78±2.24 m/s, respectively. They were significantly higher in the CAS+ (n = 71) compared with the CAS– (n = 36) group and predicted significant CAS independently of cardiovascular risk factors and mean or systolic aortic blood pressure. aPWV and cfPWV were significantly correlated (r = 0.70; p < 0.001) but the degree of correlation differed significantly (p < 0.03) between the CAS+ (r = 0.74, p < 0.001) and CAS– group (r = 0.46, p = 0.003). Age and mean aortic blood pressure were independent predictors for aPWV as well as cfPWV. In the receiver operating characteristic (ROC) analysis, aPWV and cfPWV had similar accuracy in identification of significant CAS (AUC [area under the ROC curve] = 0.76 and 0.69, respectively; p = 0.13). However, neither cfPWV nor aPWV was effective at differentiating the extent of CAD. In conclusion, aPWV and cfPWV are highly correlated parameters with similar determinants and comparable accuracy in predicting significant CAS. The strength of correlation between these two indices differed significantly between subjects with and those without CAS. (Hypertens Res 2007; 30: 1151–1158) Key Words: aortic pulse wave velocity, carotid-femoral pulse wave velocity, stiffness, coronary artery disease Introduction Carotid-femoral pulse wave velocity (cfPWV) is a commonly used index of aortic pulse wave velocity (aPWV). It has been shown to predict cardiovascular risk and all-cause mortality, particularly in elderly patients (1) and patients with end-stage renal failure (2–4), hypertension (5, 6), and diabetes mellitus (7, 8). It also appeared to be an independent predictor of cor- onary heart disease and stroke in a large population of apparently healthy adults (9). cfPWV is a marker of the presence and quantity of calcium in the coronary arteries of healthy subjects (10) and of coronary artery disease (CAD) severity in CAD patients with chronic kidney disease (11). Recently, the age-specific reference intervals for cfPWV have been determined (12). However, the relationship between aPWV and cfPWV is not known. Thus, the aim of this study was to 1) assess the correlation between cfPWV and aPWV, 2) com- From the 1)Department of Cardiac and Vascular Diseases, 2)Department of Hemodynamics and Angiocardiography, and 3)Department of Internal Medicine and Gerontology, Jagiellonian University, Collegium Medicum, Kraków, Poland. This research was supported by the State Committee for Scientific Research Grant No 2 PO5B 150 30 for the years 2006–2007. Address for Reprints: Piotr Podolec, M.D., Ph.D., Department of Cardiac and Vascular Diseases, John Paul II Hospital, ul. Pra˛dnicka 80, 31–202 Kraków, Poland. E-mail: Received March 13, 2007; Accepted in revised form July 3, 2007. 1152 Hypertens Res Vol. 30, No. 12 (2007) Table 1. Clinical Characteristics of the Study Group Age (years) Height (m) aSBP (mmHg) aDBP (mmHg) aPP (mmHg) aMBP (mmHg) bSBP (mmHg) bDBP (mmHg) bPP (mmHg) bMBP (mmHg) HR (beats/min) aPWV (m/s) cfPWV (m/s) Sex (men) (n (%)) Obesity (n (%)) Hyperlipidemia (n (%)) DM (n (%)) Smoking (current) (n (%)) Medication (n (%)) β-Blockers ACEI Aspirin Statins Fibrates Nitrates Diuretics Calcium antagonists All patients (n=107) CAS− (n=36) CAS+ (n=71) p 60.49±8.31 1.69±0.09 137.74±25.08 71.67±10.98 65.84±22.08 95.25±14.42 126.21±16.51 78.35±10.78 47.86±12.34 94.31±11.58 6.90±11.49 8.78±2.24 10.65±2.29 68 (64) 36 (34) 100 (93) 27 (25) 12 (11) 58.11±8.19 1.67±0.09 133.28±23.71 71.55±9.51 61.05±22.41 92.56±14.85 128.47±18.24 79.61±12.42 48.86±12.25 95.89±13.43 68.58±9.94 7.44±1.44 9.58±1.54 16 (44) 15 (42) 33 (92) 6 (17) 3 (8) 61.70±8.17 1.70±0.08 140.00±25.62 71.73±11.72 68.27±21.66 96.61±14.11 125.07±15.57 77.72±9.87 47.35±12.5 93.50±10.54 66.03±12.18 9.46±2.28 11.19±2.42 52 (73) 21 (30) 67 (94) 21 (30) 9 (13) 0.03 0.07 0.19 0.94 0.12 0.17 0.33 0.35 0.56 0.31 0.12 <0.0001 0.001 0.004 0.21 0.59 0.15 0.73 85 (79) 90 (84) 107 (100) 86 (80) 4 (3.7) 51 (48) 41 (38) 32 (30) 26 (72) 28 (78) 36 (100) 26 (72) 0 17 (47) 17 (47) 15 (42) 59 (83) 62 (87) 71 (100) 60 (85) 4 (5.6) 34 (48) 24 (34) 17 (24) 0.19 0.20 — 0.13 0.37 0.95 0.09 0.06 Continuous variables are reported as means±SD. Categorical variables are reported as counts (%). CAS− group, without significant coronary artery stenosis; CAS+ group, with significant stenosis in at least one coronary artery; aSBP (DBP, PP, MBP), aortic systolic (diastolic, pulse, mean) blood pressure; bSBP (DBP, PP, MBP), systolic (diastolic, pulse, mean) blood pressure measured with standard sphygmomanometer in resting conditions; aPWV, aortic pulse wave velocity; cfPWV, carotid-femoral pulse wave velocity; DM, diabetes mellitus; ACEI, angiotensin-converting enzyme inhibitor. pare their risk factor profiles, and 3) assess their association with CAD. Methods Study Population We studied 107 consecutive patients (68 men) with a mean age of 60.49±8.31 years who had stable angina and had been referred for coronary angiography. The characteristics of the study group are shown in Table 1. A history was obtained and physical examination and laboratory tests were performed in all the subjects. A blood sample was drawn after an overnight fast. Patients with irregular heart rhythm, heart failure and significant valvular heart disease were excluded from the study. The institutional ethics committee approved the study protocol, and informed consent was obtained from each patient before starting the study. The presence of type 2 diabetes mellitus was defined as a fasting blood glucose of ≥ 7.0 mmol/L confirmed on a different day; or a plasma glucose concentration of ≥ 1.0 mmol/L 2 h after a 75 g oral glucose load; or the use of blood glucose–lowering medication (13). Hyperlipidemia was defined as low-density lipoprotein (LDL) cholesterol > 3.0 mmol/L, triglyceride > 1.7 mmol/L, or the use of a lipid-lowering drug. Body mass index was calculated as weight divided by he (...truncated)