title: Association of arterial stiffness with coronary flow reserve in revascularized coronary artery disease patients.
abstract: OBJECTIVE
  To investigate the association of arterial wave reflection with coronary flow reserve (CFR) in coronary artery disease (CAD) patients after successful revascularization.
  
  
  METHODS
  We assessed 70 patients with angiographically documented CAD who had undergone recent successful revascularization. We measured (1) reactive hyperemia index (RHI) using fingertip peripheral arterial tonometry (RH-PAT Endo-PAT); (2) carotid to femoral pulse wave velocity (PWVc-Complior); (3) augmentation index (AIx), the diastolic area (DAI%) and diastolic reflection area (DRA) of the central aortic pulse wave (Arteriograph); (4) CFR using Doppler echocardiography; and (5) blood levels of lipoprotein-phospholipase A2 (Lp-PLA2).
  
  
  RESULTS
  After adjustment for age, sex, blood pressure parameter, lipidemic, diabetic and smoking status, we found that coronary flow reserve was independently related to AIx (b = -0.38, r = 0.009), DAI (b = 0.36, P = 0.014), DRA (b = 0.39, P = 0.005) and RT (b = -0.29, P = 0.026). Additionally, patients with CFR < 2.5 had higher PWVc (11.6 ± 2.3 vs 10.2 ± 1.4 m/s, P = 0.019), SBPc (139.1 ± 17.8 vs 125.2 ± 19.1 mmHg, P = 0.026), AIx (38.2% ± 14.8% vs 29.4% ± 15.1%, P = 0.011) and lower RHI (1.26 ± 0.28 vs 1.50 ± 0.46, P = 0.012), DAI (44.3% ± 7.9% vs 53.9% ± 6.7%, P = 0.008), DRA (42.2 ± 9.6 vs 51.6 ± 11.4, P = 0.012) and LpPLA2 (268.1 ± 91.9 vs 199.5 ± 78.4 ng/mL, P = 0.002) compared with those with CFR ≥ 2.5. Elevated LpPLA2 was related with reduced CFR (r = -0.33, P = 0.001), RHI (r = -0.37, P < 0.001) and DRA (r = -0.35, P = 0.001) as well as increased PWVc (r = 0.34, P = 0.012) and AIx (r = 0.34, P = 0.001).
  
  
  CONCLUSIONS
  Abnormal arterial wave reflections are related with impaired coronary flow reserve despite successful revascularization in CAD patients. There is a common inflammatory link between impaired aortic wall properties, endothelial dysfunction and coronary flow impairment in CAD.
authors.affiliation: Vlassis Tritakis, Stavros Tzortzis, Ignatios Ikonomidis, Kleanthi Dima, Georgios Pavlidis, Paraskevi Trivilou, Ioannis Paraskevaidis, Giorgos Katsimaglis, John Parissis, John Lekakis, Second Department of Cardiology, Athens University Medical School, Attikon Hospital, 12462 Athens, Greece.
authors.forename: Vlassis
authors.initials: V
authors.lastname: Tritakis
authors.affiliation: Vlassis Tritakis, Stavros Tzortzis, Ignatios Ikonomidis, Kleanthi Dima, Georgios Pavlidis, Paraskevi Trivilou, Ioannis Paraskevaidis, Giorgos Katsimaglis, John Parissis, John Lekakis, Second Department of Cardiology, Athens University Medical School, Attikon Hospital, 12462 Athens, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Tzortzis
authors.affiliation: Vlassis Tritakis, Stavros Tzortzis, Ignatios Ikonomidis, Kleanthi Dima, Georgios Pavlidis, Paraskevi Trivilou, Ioannis Paraskevaidis, Giorgos Katsimaglis, John Parissis, John Lekakis, Second Department of Cardiology, Athens University Medical School, Attikon Hospital, 12462 Athens, Greece.
authors.forename: Ignatios
authors.initials: I
authors.lastname: Ikonomidis
authors.affiliation: Vlassis Tritakis, Stavros Tzortzis, Ignatios Ikonomidis, Kleanthi Dima, Georgios Pavlidis, Paraskevi Trivilou, Ioannis Paraskevaidis, Giorgos Katsimaglis, John Parissis, John Lekakis, Second Department of Cardiology, Athens University Medical School, Attikon Hospital, 12462 Athens, Greece.
authors.forename: Kleanthi
authors.initials: K
authors.lastname: Dima
authors.affiliation: Vlassis Tritakis, Stavros Tzortzis, Ignatios Ikonomidis, Kleanthi Dima, Georgios Pavlidis, Paraskevi Trivilou, Ioannis Paraskevaidis, Giorgos Katsimaglis, John Parissis, John Lekakis, Second Department of Cardiology, Athens University Medical School, Attikon Hospital, 12462 Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Pavlidis
authors.affiliation: Vlassis Tritakis, Stavros Tzortzis, Ignatios Ikonomidis, Kleanthi Dima, Georgios Pavlidis, Paraskevi Trivilou, Ioannis Paraskevaidis, Giorgos Katsimaglis, John Parissis, John Lekakis, Second Department of Cardiology, Athens University Medical School, Attikon Hospital, 12462 Athens, Greece.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Trivilou
authors.affiliation: Vlassis Tritakis, Stavros Tzortzis, Ignatios Ikonomidis, Kleanthi Dima, Georgios Pavlidis, Paraskevi Trivilou, Ioannis Paraskevaidis, Giorgos Katsimaglis, John Parissis, John Lekakis, Second Department of Cardiology, Athens University Medical School, Attikon Hospital, 12462 Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Paraskevaidis
authors.affiliation: Vlassis Tritakis, Stavros Tzortzis, Ignatios Ikonomidis, Kleanthi Dima, Georgios Pavlidis, Paraskevi Trivilou, Ioannis Paraskevaidis, Giorgos Katsimaglis, John Parissis, John Lekakis, Second Department of Cardiology, Athens University Medical School, Attikon Hospital, 12462 Athens, Greece.
authors.forename: Giorgos
authors.initials: G
authors.lastname: Katsimaglis
authors.affiliation: Vlassis Tritakis, Stavros Tzortzis, Ignatios Ikonomidis, Kleanthi Dima, Georgios Pavlidis, Paraskevi Trivilou, Ioannis Paraskevaidis, Giorgos Katsimaglis, John Parissis, John Lekakis, Second Department of Cardiology, Athens University Medical School, Attikon Hospital, 12462 Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Parissis
authors.affiliation: Vlassis Tritakis, Stavros Tzortzis, Ignatios Ikonomidis, Kleanthi Dima, Georgios Pavlidis, Paraskevi Trivilou, Ioannis Paraskevaidis, Giorgos Katsimaglis, John Parissis, John Lekakis, Second Department of Cardiology, Athens University Medical School, Attikon Hospital, 12462 Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Lekakis
keywords: Arterial stiffness; Coronary artery disease; Coronary flow reserve; LpPLA2; Reactive hyperemia index