The relation of non-invasively and invasively assessed aortic pulsatile indices to the presence and severity of coronary artery disease

Figures & data

Table I. Baseline clinical characteristics of the study population.

Variable	No CAD (n = 13)	CAD (n = 45)	p-value
Age (years)	62.2 ± 13.8	63.7 ± 10.0	0.73
Gender (male), n (%)	5 (38.5%)	33 (73.3%)	0.043
Current smokers, n (%)	3 (23.1%)	9 (20.0%)	1.00
Hypertension, n (%)	12 (92.3%)	34 (75.6%)	0.26
Diabetes, n (%)	3 (23.1%)	9 (20.0%)	1.00
Previous MI, n (%)	0 (0%)	5 (11.1%)	0.58
Body mass index (kg/m^2)	25.1 ± 3.5	24.1 ± 2.4	0.34
Total cholesterol (mg/dl)	168.9 ± 31.0	184.6 ± 46.2	0.18
LDL-cholesterol (mg/dl)	99.1 ± 22.8	114.6 ± 32.4	0.06
HDL-cholesterol (mg/dl)	48.8 ± 11.6	48.4 ± 10.3	0.92
Triglyceride (mg/dl)	155.3 ± 81.7	148.7 ± 94.3	0.81
Fasting glucose (mg/dl)	103.5 ± 36.3	119.3 ± 41.6	0.22
Hs CRP (mg/dl)	0.17 ± 0.22	0.18 ± 0.23	0.88
ESR (mm/h)	12.9 ± 6.3	15.2 ± 13.3	0.62
Fibrinogen (mg/dl)	263.0 ± 28.1	290.1 ± 67.6	0.08
Mean platelet volume (fl)	10.3 ± 1.0	10.8 ± 0.7	0.15
Creatinine (mg/dl)	0.98 ± 0.21	1.04 ± 0.19	0.34
MDRD GFR (ml/min/1.73 m^2)	72.3 ± 14.9	72.5 ± 11.7	0.97
Heart rate (beats/min)	65.6 ± 7.1	63.8 ± 9.7	0.45

CAD, coronary artery disease; MI, myocardial infarction; LDL, low-density lipoprotein; HDL, high-density lipoprotein; Hs CRP, high sensitivity C-reactive protein; ESR, erythrocyte sedimentation rate; MDRD, modification of diet in renal disease; GFR, glomerular filtration rate.

Table II. Mean values of hemodynamic indices according to the presence of coronary artery disease.

Variable	No CAD (n = 13)	CAD (n = 45)	p-value
Brachial SBP (mmHg)	136.9 ± 15.1	135.0 ± 17.1	0.70
Brachial DBP (mmHg)	75.9 ± 11.2	76.6 ± 10.5	0.85
Brachial MBP (mmHg)	98.5 ± 11.9	97.2 ± 12.3	0.75
Brachial PP (mmHg)	61.0 ± 13.8	58.4 ± 14.4	0.56
Brachial FPP	0.63 ± 0.17	0.60 ± 0.14	0.64
Brachial PI	0.83 ± 0.28	0.78 ± 0.23	0.54
NIA aortic SBP (mmHg)	127.8 ± 16.8	126.2 ± 16.9	0.76
NIA aortic DBP (mmHg)	77.1 ± 11.4	77.4 ± 10.7	0.93
NIA aortic MBP (mmHg)	94.0 ± 12.0	93.6 ± 11.3	0.92
NIA aortic PP (mmHg)	50.7 ± 13.0	48.5 ± 13.9	0.61
NIA aortic FPP	0.54 ± 0.14	0.52 ± 0.14	0.59
NIA aortic PI	0.67 ± 0.21	0.64 ± 0.22	0.62
IA aortic SBP (mmHg)	117.1 ± 18.8	127.3 ± 20.0	0.11
IA aortic DBP (mmHg)	69.9 ± 9.3	69.9 ± 10.3	1.00
IA aortic MBP (mmHg)	89.6 ± 12.9	93.2 ± 13.0	0.38
IA aortic PP (mmHg)	47.2 ± 14.9	57.4 ± 14.7	0.043
IA aortic FPP	0.52 ± 0.14	0.61 ± 0.12	0.027
IA aortic PI	0.68 ± 0.23	0.83 ± 0.21	0.032

CAD, coronary artery disease; NIA, non-invasively assessed; IA, invasively assessed; SBP, systolic blood pressure; DBP, diastolic blood pressure; MBP, mean blood pressure; PP, pulse pressure; FPP, fractional pulse pressure; PI, pulsatility index.

Table III. Odds ratios for the association between NIA and IA aortic MBP and pulsatile indices and risk of presence of significant coronary artery disease.

	Univariate analysis		Multivariate analysis^a
Variable	Odds ratio (95% CI)	p	Odds ratio (95% CI)	p
NIA aortic MBP per 10 mmHg	1.03 (0.58–1.84)	0.92	1.09 (0.46–2.56)	0.85
NIA aortic PP per 10 mmHg	0.89 (0.56–1.40)	0.61	1.01 (0.51–1.99)	0.98
NIA aortic FPP per 0.1	0.88 (0.57–1.37)	0.57	0.96 (0.49–1.86)	0.89
NIA aortic PI per 0.1	0.93 (0.70–1.24)	0.63	0.97 (0.63–1.51)	0.90
IA aortic MBP per 10 mmHg	1.26 (0.76–2.08)	0.37	1.77 (0.88–3.55)	0.11
IA aortic PP per 10 mmHg	1.71 (1.02–2.88)	0.041	2.51 (1.12–5.63)	0.025
IA aortic FPP per 0.1	1.80 (1.05–3.09)	0.034	3.30 (1.25–8.72)	0.016
IA aortic PI per 0.1	1.42 (1.02–1.98)	0.038	1.88 (1.09–3.23)	0.023

NIA, non-invasively assessed; IA, invasively assessed; MBP, mean blood pressure; PP, pulse pressure; FPP, fractional pulse pressure; PI, pulsatility index and CI, confidence interval. ^aAge, gender, smoking, hypertension, diabetes, body mass index, the history of myocardial infarction, cholesterol and creatinine were included into the initial model.

Figure 1. The correlation of invasively assessed aortic SBP and pulsatile indices and the severity of coronary artery disease using the Gensini score in univariate linear regression analysis. Invasively assessed aortic (A) SBP, (B) PP, (C) FPP and (D) PI had a positive correlation with Gensini score. IA, invasively assessed; SBP, systolic blood pressure; PP, pulse pressure; FPP, fractional pulse pressure; PI, pulsatility index.

Table IV. The linear regression analysis of non-invasively and invasively assessed aortic pulsatile indices and the severity of coronary artery disease using Gensini score.

	Univariate analysis		Multivariate analysis^a
Variable	r^2	p	r^2	p
NIA aortic SBP (mmHg)	0.005	0.62	0.083	0.81
NIA aortic MBP (mmHg)	0.005	0.61	0.082	0.95
NIA aortic PP (mmHg)	0.002	0.77	0.088	0.59
NIA aortic FPP	0.000	1.00	0.091	0.51
NIA aortic PI	0.000	0.99	0.091	0.51
IA aortic SBP (mmHg)	0.126	0.007	0.205	0.013
IA aortic MBP (mmHg)	0.072	0.05	0.144	0.08
IA aortic PP (mmHg)	0.152	0.003	0.264	0.002
IA aortic FPP	0.098	0.019	0.247	0.004
IA aortic PI	0.095	0.021	0.244	0.004

NIA, non-invasively assessed; IA, invasively assessed; SBP, systolic blood pressure; MBP, mean blood pressure; PP, pulse pressure; FPP, fractional pulse pressure; PI, pulsatility index. ^aAge, gender, smoking, hypertension, diabetes, body mass index, the history of myocardial infarction, cholesterol, creatinine were included into the general linear model.

Table V. Mean values of hemodynamic indices of study population and mean differences between non-invasively and invasively assessed indices of aortic pressure waveform

Variable	Mean ± SD
Brachial SBP (mmHg)	135.5 ± 17.8
NIA aortic SBP (mmHg)	126.5 ± 16.7
IA aortic SBP (mmHg)	125.0 ± 20.0
IA – NIA aortic SBP difference (mmHg)	−1.5 ± 18.76
Brachial DBP (mmHg)	76.0 ± 11.3
NIA aortic DBP (mmHg)	77.3 ± 10.7
IA aortic DBP (mmHg)	69.9 ± 10.0
IA – NIA aortic DBP difference (mmHg)	−7.5 ± 9.2
Brachial PP (mmHg)	59.5 ± 14.6
NIA aortic PP (mmHg)	49.0 ± 13.6
IA aortic PP (mmHg)	55.1 ± 15.2
IA – NIA aortic PP difference (mmHg)	6.1 ± 15.8

NIA, non-invasively assessed; IA, invasively assessed; SBP, systolic blood pressure; DBP, diastolic blood pressure; PP, pulse pressure.