Abstract
The normal human aorta is not a stiff tube but is characterized by elastic properties with a buffering Windkessel function. Aortic stiffening may cause an increase in aortic pulse pressure, left ventricular load, and ultimately left ventricular hypertrophy. This, together with the decreased diastolic transmyocardial pressure gradient interacts with coronary flow and flow reserve. In recent studies, significant correlations between coronary flow reserve and aortic stiffness have been demonstrated in different patient populations. The aim of the present review is to describe the current echocardiographic modalities to measure aortic stiffness and coronary flow reserve and to overview our knowledge about the relationship between aortic stiffness and coronary flow reserve. Copyright © 2007 Wiley Periodicals, Inc.
Keywords: aortic stiffness, coronary flow reserve, echocardiography
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References
- 1. Bader H: Importance of the gerontology of elastic arteries in the development of essential hypertension. Clin Physiol Biochem 1983; 1: 36–56. [PubMed] [Google Scholar]
- 2. Belz GG: Elastic properties and Windkessel function of the human aorta. Cardiovasc Drugs Ther 1995; 9: 73–83. [DOI] [PubMed] [Google Scholar]
- 3. O'Rourke M: Arterial stiffness, systolic blood pressure, and logical treatment of arterial hypertension. Hypertension 1990; 15: 339–547. [DOI] [PubMed] [Google Scholar]
- 4. Mohiaddin RH, Underwood SR, Bogren HG, Firmin DN, Klipstein RH, et al.: Regional aortic compliance studied by magnetic resonance imaging: the effects of age, training, and coronary artery disease. Br Heart J 1989; 62: 90–96. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Laogun AA, Gosling RG: In vivo arterial compliance in man. Clin Phys Physiol Meas 1982; 3: 201–212. [DOI] [PubMed] [Google Scholar]
- 6. Pasipoularides A: Complementarity and competitiveness of the intrinsic and extrinsic components of the total ventricular load: demonstration after valve replacement in aortic stenosis. Am Heart J 2007; 153: 4–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Stefanadis C, Stratos C, Boudoulas H, Kourouklis C, Toutouzas P: Distensibility of the ascending aorta: comparison of invasive and non‐invasive techniques in healthy men and in men with coronary artery disease. Eur Heart J 1990; 11: 990–996. [DOI] [PubMed] [Google Scholar]
- 8. Drozdz J, Krzeminska‐Pakuola M, Lipiec P, Orczykowski M, Chrzanowski O, et al.: Regional aortic function is correlated with intima‐media thickness‐insights from three‐dimensional echocardiography. J Am Soc Echocardiogr 2005; 18: 789–794. [DOI] [PubMed] [Google Scholar]
- 9. Nemes A, Geleijnse ML, Soliman OI, Anwar AM, Vletter WB, et al.: Real‐time three‐dimensional echocardiography for regional evaluation of aortic stiffness. Eur J Echocardiogr 2007; 8: 161–162. [DOI] [PubMed] [Google Scholar]
- 10. Gould KL, Lipscomb K: Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol 1974; 34: 48–55. [DOI] [PubMed] [Google Scholar]
- 11. Vogel R, Indermuhle A, Reinhardt J, Meier P, Siegrist PT, et al.: The quantification of absolute myocardial perfusion in humans by contrast echocardiography: algorithm and validation. J Am Coll Cardiol 2005; 45: 754–762. [DOI] [PubMed] [Google Scholar]
- 12. Nemes A, Forster T, Gruber N, Csanady M: Coronary flow velocity reserve and indices describing aortic distensibility in patients after coronary angiography. Int J Cardiol 2004; 96: 29–33. [DOI] [PubMed] [Google Scholar]
- 13. Iliceto S, Marangelli V, Memmola C, Rizzon P: Transesophageal Doppler echocardiography evaluation of coronary blood flow velocity in baseline conditions and during dipyridamole‐induced coronary vasodilation. Circulation 1991; 83: 61–69. [DOI] [PubMed] [Google Scholar]
- 14. Kozakova M, Palombo C, Pratali L, Bigalli G, Marzilli M, et al.: Assessment of coronary reserve by transoesophageal Doppler echocardiography. Direct comparison between different modalities of dipyridamole and adenosine administration. Eur Heart J 1997; 18: 514–523. [DOI] [PubMed] [Google Scholar]
- 15. Rigo F, Gherardi S, Galderisi M, Cortigiani L: Coronary flow reserve evaluation in stress‐echocardiography laboratory. J Cardiovasc Med (Hagerstown) 2006; 7: 472–479. [DOI] [PubMed] [Google Scholar]
- 16. Rigo F, Cortigiani L, Pasanisi E, Richieri M, Cutaia V, et al.: The additional prognostic value of coronary flow reserve on left anterior descending artery in patients with negative stress echo by wall motion criteria. A Transthoracic Vasodilator Stress Echocardiography Study. Am Heart J 2006; 151: 124–130. [DOI] [PubMed] [Google Scholar]
- 17. Rigo F, Gherardi S, Galderisi M, Pratali L, Cortigiani L, et al.: The prognostic impact of coronary flow‐reserve assessed by Doppler echocardiography in non‐ischaemic dilated cardiomyopathy. Eur Heart J 2006; 27: 1319–1323. [DOI] [PubMed] [Google Scholar]
- 18. Tona F, Caforio AL, Montisci R, Gambino A, Angelini A, et al.: Coronary flow velocity pattern and coronary flow reserve by contrast‐enhanced transthoracic echocardiography predict long‐term outcome in heart transplantation. Circulation 2006; 114: I49–I55. [DOI] [PubMed] [Google Scholar]
- 19. Kingwell BA, Waddell TK, Medley TL, Cameron JD, Dart AM: Large artery stiffness predicts ischemic threshold in patients with coronary artery disease. J Am Coll Cardiol 2002; 40: 773–779. [DOI] [PubMed] [Google Scholar]
- 20. Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, et al.: Aortic stiffness is an independent predictor of all‐cause and cardiovascular mortality in hypertensive patients. Hypertension 2001; 37: 1236–1241. [DOI] [PubMed] [Google Scholar]
- 21. Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, et al.: Aortic pulse‐wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation 2002; 106: 2085–2090. [DOI] [PubMed] [Google Scholar]
- 22. Blacher J, Safar ME, Guerin AP, Pannier B, Marchais SJ, et al.: Aortic pulse wave velocity index and mortality in end‐stage renal disease. Kidney Int 2003; 63: 1852–1860. [DOI] [PubMed] [Google Scholar]
- 23. Meaume S, Benetos A, Henry OF, Rudnichi A, Safar ME: Aortic pulse wave velocity predicts cardiovascular mortality in subjects > 70 years of age. Arterioscler Thromb Vasc Biol 2001; 21: 2046–2050. [DOI] [PubMed] [Google Scholar]
- 24. Sutton‐Tyrrell K, Najjar SS, Boudreau RM, Venkitachalam L, Kupelian V, et al.: Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well‐functioning older adults. Circulation 2005; 111: 3384–3390. [DOI] [PubMed] [Google Scholar]
- 25. Willum‐Hansen T, Staessen JA, Torp‐Pedersen C, Rasmussen S, Thijs L, et al.: Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 2006; 113: 664–670. [DOI] [PubMed] [Google Scholar]
- 26. Mattace‐Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, et al.: Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation 2006; 113: 657–663. [DOI] [PubMed] [Google Scholar]
- 27. Bouvrain Y, Levy B: ”Windkessel” and coronary debit. Arch Mal Coeur Vaiss 1981; 74: 635–639. [PubMed] [Google Scholar]
- 28. Ohtsuka S, Kakihana M, Watanabe H, Sugishita Y: Chronically decreased aortic distensibility causes deterioration of coronary perfusion during increased left ventricular contraction. J Am Coll Cardiol 1994; 24: 1406–1414. [DOI] [PubMed] [Google Scholar]
- 29. Watanabe H, Ohtsuka S, Kakihana M, Sugishita Y: Decreased aortic compliance aggravates subendocardial ischaemia in dogs with stenosed coronary artery. Cardiovasc Res 1992; 26: 1212–1218. [DOI] [PubMed] [Google Scholar]
- 30. Watanabe H, Ohtsuka S, Kakihana M, Sugishita Y: Coronary circulation in dogs with an experimental decrease in aortic compliance. J Am Coll Cardiol 1993; 21: 1497–1506. [DOI] [PubMed] [Google Scholar]
- 31. Wang GH, Hu DY: Effect of pulse wave velocity on coronary flow reserve in patients with essential hypertension. Zhonghua Yi Xue Za Zhi 2005; 85: 54–57. [PubMed] [Google Scholar]
- 32. Fukuda D, Yoshiyama M, Shimada K, Yamashita H, Ehara S, et al.: Relation between aortic stiffness and coronary flow reserve in patients with coronary artery disease. Heart 2006; 92: 759–762. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33. Leung MC, Meredith IT, Cameron JD: Aortic stiffness affects the coronary blood flow response to percutaneous coronary intervention. Am J Physiol Heart Circ Physiol 2006; 290: H624–H630. [DOI] [PubMed] [Google Scholar]
- 34. Nemes A, Forster T, Csanady M, Gruber N: Indices of aortic distensibility and coronary flow velocity reserve in patients with different grades of aortic atherosclerosis. Int J Cardiovasc Imag 2004; 20: 271–277. [DOI] [PubMed] [Google Scholar]
- 35. Nemes A, Forster T, Csanady M: Decreased aortic distensibility and coronary flow velocity reserve in patients with significant aortic valve stenosis with normal epicardial coronary arteries. J Heart Valve Dis 2004; 13: 567–573. [PubMed] [Google Scholar]
- 36. Nemes A, Forster T, Csanady M: Simultaneous evaluation of coronary flow velocity reserve and aortic distensibility indices in hypertension. Heart Vessels 2007; 22: 73–78. [DOI] [PubMed] [Google Scholar]
- 37. Nemes A, Forster T, Csanady M: Reduced aortic distensibility and coronary flow velocity reserve in diabetes mellitus patients with a negative coronary angiogram. Can J Cardiol 2007; 23: 445–450. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38. Nemes A, Forster T, Csanady M: Impaired coronary flow velocity reserve and aortic distensibility in patients with untreated hypercholesterolemia‐an echocardiographic study. Int J Cardiovasc Imag 2007; 23: 15–23. [DOI] [PubMed] [Google Scholar]
- 39. Nemes A, Forster T, Csanady M: Relationship between coronary flow velocity reserve and aortic stiffness. Am J Physiol Heart Circ Physiol 2006; 290: H1311. [DOI] [PubMed] [Google Scholar]