title: Association of aortic stiffness and wave reflections with coronary flow reserve in women without obstructive coronary artery disease: An ancillary study from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE).
abstract: BACKGROUND
  Increased aortic stiffness and reduced coronary flow reserve (CFR) independently predict adverse outcomes. But information about relationships between arterial properties and CFR in subjects without obstructive coronary artery disease (CAD) is limited.
  
  
  METHODS
  CFR was measured (Doppler flow wire and intracoronary adenosine) in 50 women (age 53 ± 11 years) with symptoms and signs of myocardial ischemia without obstructive CAD. Aortic pulse wave velocity (aPWV), a measure of aortic stiffness, was obtained via catheter pullback; radial artery pressure waves were measured by applanation tonometry and central aortic pressure synthesized.
  
  
  RESULTS
  Overall, CFR (mean 2.61 ± 0.47) was significantly correlated with aPWV (r = -0.51), pulse wave amplification (r = 0.45), augmented pressure (r = -0.48), augmentation index (AIx, r = -0.44), aortic systolic pressure (r = -0.49), left ventricular wasted energy (LVEw, r = -0.47) (all P < .001), systolic pressure time index (r = -0.37, P < .008), and rate pressure product (r = -0.29, P < .04). In the multiple regression model including aPWV, CFR was still significantly correlated with aPWV (P < .008) and aortic systolic pressure (P < .01). No other measures contributed significant additional information. Women with CFR ≤2.5 versus those with CFR >2.5 had greater aPWV (894 ± 117 vs 747 ± 93 cm/s, P < .001), augmented pressure (14 ± 4.9 vs 11 ± 4.1 mmHg, P < .008), AIx (32 ± 6.6 vs 27 ± 6.6%, P < .003), LVEw (30 ± 12 vs 21 ± 10 dyne-s/cm(2) × 10(2), P < .02) and reduced pulse pressure amplification (1.20 ± .07 vs 1.26 ± .10, P < .008) and pressure wave travel time (133 ± 7.3 vs 138 ± 6.9 milliseconds, P < .04).
  
  
  CONCLUSIONS
  Among symptomatic women without obstructive CAD, CFR was inversely related to aortic systolic pressure and indices of aortic stiffness. These changes in arterial properties increase left ventricular afterload requiring the ventricle to generate additional, but wasted, energy that increases indices of myocardial oxygen demand, reduces CFR and increases vulnerability to ischemia.
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, FL.
authors.forename: Wilmer W
authors.initials: WW
authors.lastname: Nichols
authors.affiliation: Division of Cardiovascular Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Denardo
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, FL.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Davidson
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, FL.
authors.forename: Tianyao
authors.initials: T
authors.lastname: Huo
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, FL. Electronic address: carl.pepine@medicine.ufl.edu.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
mesh_terms: D000328:Adult; D062186:Arterial Pressure / Q000502:physiology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D063177:Pulse Wave Analysis / Q000379:methods; D013223:Statistics as Topic; D059289:Vascular Stiffness / Q000502:physiology*