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Coronary artery disease
Original research article
Impact of aortic stiffness on myocardial ischaemia in non-obstructive coronary artery disease
  1. Mai Tone Lønnebakken1,2,
  2. Ingeborg Eskerud1,
  3. Terje Hjalmar Larsen2,3,
  4. Helga Bergljot Midtbø2,
  5. Marina Victorovna Kokorina2 and
  6. Eva Gerdts1
  1. 1Department of Clinical Science, University of Bergen, Bergen, Norway
  2. 2Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
  3. 3Department of Biomedicine, University of Bergen, Bergen, Norway
  1. Correspondence to Dr Mai Tone Lønnebakken, Universitetet i Bergen Det medisinske fakultet, Bergen, Norway; mai.lonnebakken{at}k2.uib.no

Abstract

Objective High aortic stiffness may reduce myocardial perfusion pressure and contribute to development of myocardial ischaemia. Whether high aortic stiffness is associated with myocardial ischaemia in patients with stable angina and non-obstructive coronary artery disease (CAD) is less explored.

Methods Aortic stiffness was assessed as carotid-femoral pulse wave velocity (PWV) by applanation tonometry in 125 patients (62±8 years, 58% women) with stable angina and non-obstructive CAD participating in the Myocardial Ischemia in Non-obstructive CAD project. PWV in the highest tertile (>8.7 m/s) was taken as higher aortic stiffness. Stress-induced myocardial ischaemia was detected as delayed myocardial contrast replenishment during stress echocardiography, and the number of left ventricular (LV) segments with delayed contrast replenishment as the extent of ischaemia.

Results Patients with higher aortic stiffness were older with higher LV mass index and lower prevalence of obesity (all p<0.05), while angina symptoms, sex, prevalence of hypertension, diabetes, smoking or LV ejection fraction did not differ between groups. Stress-induced myocardial ischaemia was more common (73% vs 42%, p=0.001) and the extent of ischaemia was larger (4±3 vs 2±3 LV segments, p=0.005) in patients with higher aortic stiffness. In multivariable logistic regression analysis, higher aortic stiffness was associated with stress-induced myocardial ischaemia independent of other known covariables (OR 4.74 (95% CI 1.51 to 14.93), p=0.008).

Conclusions In patients with stable angina and non-obstructive CAD, higher aortic stiffness was associated with stress-induced myocardial ischaemia. Consequently, assessment of aortic stiffness may add to the diagnostic evaluation in patients with non-obstructive CAD.

Trial registration number NCT01853527.

  • aortic stiffness
  • myocardial ischemia
  • non-obstructive coronary artery disease
  • stable angina

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2018-000981

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    Footnotes

    • Presented at The abstract has previously been presented in European Heart Journal 39(suppl_1) DOI: 10.1093/eurheartj/ehy563.P3652

    • Contributors MTL has contributed to study design, acquisition, analysis and interpretation of data, drafting the article and final approval of the article. IE, THL, MVK and HBM have contributed to the acquisition of data, revising the article for important intellectual content and final approval of the article. EG have contributed to study design, supervision, revising the article for important intellectual content and final approval of the article. All authors are accountable for all aspects of the work and take responsibility for the accuracy and integrity of the work.

    • Funding Financial support was obtained from the MedViz Consortium, a collaboration between the University of Bergen, Haukeland University Hospital and Christian Michelsen Research, all Bergen, Norway and the Western Norwegian Regional Health Authorities. None of the sponsors had any involvement in study design, data collection, analysis or interpretation of data, writing of the report or in the decision to submit the paper for publication.

    • Disclosure The authors report no conflict of interest.

    • Competing interests None declared.

    • Patient consent for publication Not Required

    • Ethics approval The Myocardial Ischemia in Non-obstructive CAD study was approved by the regional ethics committee for medical research and conducted according to the Helsinki declaration.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.