title: How arterial stiffness may affect coronary blood flow: a challenging pathophysiological link.
abstract: OBJECTIVE
  A relationship between arterial stiffening and coronary flow abnormalities, although not fully elucidated, has been observed. The purpose of this study was to investigate the relationship among carotid stiffness, measured using echo-tracking, and Doppler parameters of coronary blood flow, sampled at the left anterior descending (LAD) artery.
  
  
  METHODS
  We studied 88 consecutive patients (49 men, mean age 51.2 ± 16.2 years) with cardiovascular risk factors but without history of cardiovascular diseases. Each patient underwent echocardiographic evaluation for measurement of the diastolic velocity time integral (DVTI) and calculation of the diastolic velocity time integral coronary index (DVTICI), the ratio between DVTI and total velocity time integral of LAD artery flow × 100, and carotid ultrasound for measurement of carotid intima media thickness (IMT) and stiffness parameters such as β index and elastic modulus (Ep).
  
  
  RESULTS
  DVTICI was significantly greater in men than in women (median 82, interquartile range 78-86 vs. median 80, interquartile range 73-83, respectively; P < 0.016). After correlating DVTICI with other variables, a significant inverse relation was obtained with β index (Rho = -0.449, P < 0.001), Ep (Rho = -0.478, P < 0.001), age (Rho = -0.52, P < 0.001), left ventricular mass index (Rho = -0.543, P < 0.001), E/E' (Rho = -0.411, P < 0.001), pulse pressure (Rho = -0.417, P < 0.001) and IMT (Rho = -0.480, P < 0.001). With linear multiple regression analysis, only β index (P < 0.001), Ep (P < 0.001), male sex (P < 0.001) and left ventricular mass index (P = 0.008) were independently associated with reduction of DVTICI.
  
  
  CONCLUSIONS
  Increased arterial stiffness, directly affecting coronary perfusion, is associated with reduced diastolic coronary flow. Echo-tracking for feasible measurement of carotid artery stiffness parameters may be valuable in more accurate cardiovascular risk stratification.
authors.affiliation: aClinical and Experimental Department of Medicine, University of Messina, Messina, Italy bAurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA cCardiology Unit, ARC, S. Maria degli Angeli Hospital, Pordenone dCardiology Unit, O.C. San Antonio, San Daniele del Friuli, Udine eCardiac Thoracic and Vascular Department, University of Pisa, Pisa fInternal Medicine, Villa Sofia Hospital, Palermo, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cusmà-Piccione
authors.forename: Concetta
authors.initials: C
authors.lastname: Zito
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Khandheria
authors.forename: Fausto
authors.initials: F
authors.lastname: Pizzino
authors.forename: Gianluca
authors.initials: G
authors.lastname: Di Bella
authors.forename: Francesco
authors.initials: F
authors.lastname: Antonini-Canterin
authors.forename: Olga
authors.initials: O
authors.lastname: Vriz
authors.forename: Vito Antonio Di
authors.initials: VA
authors.lastname: Bello
authors.forename: Carmelo
authors.initials: C
authors.lastname: Zimbalatti
authors.forename: Salvatore
authors.initials: S
authors.lastname: La Carrubba
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Oreto
authors.forename: Scipione
authors.initials: S
authors.lastname: Carerj
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D059168:Carotid Intima-Media Thickness; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D059289:Vascular Stiffness / Q000502:physiology*