title: Aortic pulse pressure is associated with the localization of coronary artery disease based on coronary flow lateralization.
abstract: BACKGROUND
  Aortic pulse pressure (APP) is related to arterial stiffness and associated with the presence and extent of coronary artery disease (CAD). Besides, the left coronary artery (LCA) has a predominantly diastolic flow while the right coronary artery (RCA) receives systolic and diastolic flow. Thus, we hypothesized that increased systolic-diastolic pressure difference had a greater atherogenic effect on the RCA than on the LCA.
  
  
  METHODS
  A random sample of 433 CAD patients (145 females, 288 males, mean age 65.0 ± 11.1 years) undergoing coronary angiography at Staten Island University Hospital between January 2005 and May 2008 was studied. Coronary lesion was defined as a ≥50% luminal stenosis. Patients were divided into three groups, with isolated LCA lesions (n = 154), isolated RCA lesions (n = 36) or mixed LCA and RCA lesions (n = 243).
  
  
  RESULTS
  APP differed significantly between groups, being highest when the RCA alone was affected (67.6 ± 20.3 mm Hg for LCA vs. 78.8 ± 22.0 for RCA vs. 72.7 ± 22.6 for mixed, P = 0.008 for analysis of variance (ANOVA)). Age and gender were not associated with CAD location. Heart rate was associated with CAD location, lowest in RCA group, and negatively correlated with APP. However, left ventricular ejection fraction (LVEF) was lower in the mixed CAD group and positively correlated with APP. The association between APP and right-sided CAD persisted in multivariate logistic regression adjusting for confounders, including heart rate, LVEF and medication use. A similar but less significant pattern was seen with brachial arterial pressures.
  
  
  CONCLUSIONS
  Aortic pulse pressure may affect CAD along with coronary flow phasic patterns.
authors: Department of Cardiology, Staten Island University Hospital, New York, USA.
authors: Georges
authors: G
authors: Khoueiry
authors: Basem
authors: B
authors: Azab
authors: Estelle
authors: E
authors: Torbey
authors: Nidal
authors: N
authors: Abi Rafeh
authors: Jean-Paul
authors: JP
authors: Atallah
authors: Kathleen
authors: K
authors: Ahern
authors: James
authors: J
authors: Malpeso
authors: Donald
authors: D
authors: McCord
authors: Elie R
authors: ER
authors: Chemaly
mesh_terms: D000368:Aged; D062186:Arterial Pressure; D015986:Confounding Factors, Epidemiologic; D003324:Coronary Artery Disease / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged