Development of Coronary Pulse Wave Velocity: New Pathophysiological Insight Into Coronary Artery Disease.
Although aortic stiffness assessed by pulse wave velocity (PWV) is a strong predictor of coronary artery disease, the significance of local coronary stiffness has never been tackled. The first objective of this study was to describe a method of measuring coronary PWV (CoPWV) invasively and to describe its determinants. The second objective was to assess both CoPWV and aortic PWV in patients presenting with acute coronary syndromes or stable coronary artery disease.



In 53 patients, CoPWV was measured from the delay in pressure wave and distance traveled as a pressure wire was withdrawn from the distal to the proximal coronary segment. Similarly, aortic PWV was measured invasively when the wire was pulled across the ascending aorta; carotid-femoral PWV was also measured noninvasively using the SphygmoCor system (AtCor Medical). Mean CoPWV was 10.3±6.1 m/s. Determinants of increased CoPWV were fractional flow reserve, diastolic blood pressure, and previous stent implantation in the recorded artery. CoPWV was lower in patients with acute coronary syndromes versus stable coronary artery disease (7.6±3 versus 11.5±6.4 m/s; P=0.02), and this persisted after adjustment for confounders. In contrast, aortic stiffness, assessed by aortic and carotid-femoral PWV, did not differ significantly.



CoPWV seems associated with acute coronary events more closely than aortic PWV. High coronary compliance, whether per se or because it leads to a distal shift in compliance mismatch, may expose vulnerable plaques to high cyclic stretch. CoPWV is a new tool to assess local compliance at the coronary level; it paves the way for a new field of research.
Cardiology Department, European Society of Hypertension Excellence Center Hôpital de la Croix-Rousse Hospices Civils de Lyon, Lyon, France.|CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1 Hospices Civils de Lyon Université de Lyon, France.
Brahim
B
Harbaoui
Cardiology Department, European Society of Hypertension Excellence Center Hôpital de la Croix-Rousse Hospices Civils de Lyon, Lyon, France.|CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1 Hospices Civils de Lyon Université de Lyon, France.
Pierre-Yves
PY
Courand
Cardiology Department, European Society of Hypertension Excellence Center Hôpital de la Croix-Rousse Hospices Civils de Lyon, Lyon, France.
Andrei
A
Cividjian
Cardiology Department, European Society of Hypertension Excellence Center Hôpital de la Croix-Rousse Hospices Civils de Lyon, Lyon, France pierre.lantelme@chu-lyon.fr.|CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1 Hospices Civils de Lyon Université de Lyon, France.
Pierre
P
Lantelme
D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow / Q000502:physiology*; D063177:Pulse Wave Analysis / Q000379:methods*; D015203:Reproducibility of Results
acute coronary syndromes; aortic stiffness; compliance; coronary artery; fractional flow reserve; plaque rupture; pulse wave velocity; stiffness