Association of arterial stiffness with coronary flow reserve in revascularized coronary artery disease patients

AIM: 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 A(2) (LpPLA(2)). 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). CONCLUSION: 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.