P6292Age-dependent associations of carotid-to-femoral pulse wave velocity with coronary artery disease, cardiovascular risk and myocardial aging in high-risk patients

Abstract

Background: Current guidelines encourage the implementation of carotid-tofemoral pulse wave velocity (cf-PWV) for optimizing diagnosis and management in high cardiovascular (CV) risk patients. However the relationship between increased arterial stiffness and coronary artery disease (CAD) and/or diastolic dysfunction (DD) may be attenuated in the elderly. Purpose(s): To investigate if cf-PWV is related to the severity of CAD and DD in elderly (i.e. older than 65 years) high-risk patients. Method(s): One-hundred ninety two high-risk subjects who underwent coronary artery angiography and assessment of aortic stiffness by measuring cf-PWV were consecutively recruited. High-risk criteria included the presence of at least one of the following: CAD or stroke, HeartScore >=5%, presence of significant (causing >50% stenosis) plaque in the carotid or femoral arteries, diabetes type 2, glomerulal filtration rate (GFR) measured by the MDRD equation of <60ml/min/1.73m2, familial hypercholesterolaemia or severe (grade 3) hypertension defined as systolic >=180 and/or diastolic blood pressure >=110 mmHg. In addition, all patients underwent cardiac ultrasound and indices of diastolic dysfunction were measured, including the volume of the left atrium and the ratio of early transmitral peak velocity (E) to the mitral annular (septum) early diastolic velocity (E') as an approximation of mean left atrial pressure (E/E'). Result(s): By multivariable regression analysis, cf-PWV was an independent determinant of Gensini score in patients <65 years old, after adjustment for traditional risk factors (TRFs), including age, gender, diabetes mellitus (DM), hypertension, smoking, dyslipidemia and GFR [standardized coefficient=0.207, 95% confidence intervals (CIs): 0.015-0.398, p=0.023], but not in older patients. In addition, cf- PWV was associated in patients<65 years with the presence of CAD [adjusted odds ratio (OR) =1.34, 95% CIs: 1.05-1.72, p=0.02] and increased number of diseased coronary vessels (adjusted OR=1.17 for being diagnosed with ascending number of coronary arteries with stenoses, 95% CIs: 1.016-1.34, p=0.029), independently of the aforementioned TRFs. In a subset of patients without CAD (n=82) and younger than 65 years, cf-PWV was related with HeartScore (standardized coefficient=0.345, 95% CIs 0.087-0.604, p=0.009. In contrast, this association was not significant in older patients (p>0.05). Finally, cf-PWV correlated with E/E' (standardized coefficient=0.246, 95% CIs 0.025-0.467, p=0.019) and increased the odds by 18% (OR=1.17, 95% CIs 1.01-1.35, p=0.039) for being classified in more severe DD stage only in young patients<65 years as compared to elderly ones. Conclusion(s): This is the first study to report an age-dependent association of cf-PWV with the presence and severity of CAD and with left ventricular diastolic dysfunction in a cohort of high risk patients. These findings suggest that measurement of PWV in elderly patients may be of less clinical value. (Figure Presented).