Aortic-brachial stiffness gradient in patients with stable coronary artery disease and peripheral arterial disease

Abstract

Aim. To assess the indices of regional vascular stiffness and aortic-brachial stiffness gradient (abSG) in patients with coronary artery disease (CAD) depending on the prevalence of atherosclerosis of peripheral arteries.
Material and methods. The study included 140 patients with stable CAD. All patients underwent ultrasound scanning of carotid arteries and lower limb arteries. Patients were divided into three groups, depending on the results of duplex scanning. The first group included patients with CAD and intact peripheral arteries (absence of atherosclerotic plaques), the second group included patients with plaque in one of the vascular pools, in the third group - patients with CAD and plaque in both vascular pools. The regional aortic stiffness and stiffness of the muscular arteries was measured by appllanation tonometry. After measuring of the carotid-femoral pulse wave velocity (cfPWV) and the carotid-radial pulse wave velocity (crPWV) was calculated as the ratio abSG cfPWV/crPWV.
Results. According to the measurement of vascular stiffness, the values of cfPVW and crPWV were not significantly different between groups of patients. At the same time, the values of cfPWV/crPWV were statistically significantly higher in the third group of patients compared to both the first group of patients (p = 0.023) and the second group (p = 0.047). The increase in abSG was associated with an increase in the age of the patients (r = 0.392; p = 0.0001), carotid artery stenosis (r = 0.222; p = 0.007) and lower limb arteries (r = 0.243; p = 0.004), carotid arteries (r = 0.306; p = 0.0001). When carrying out a polynomial logistic regression adjusted for factors such as gender, hypertension, smoking, obesity, diabetes mellitus, low-density lipoprotein cholesterol, C-reactive protein, glomerular filtration rate, inversion of the gradient of vascular stiffness increased the relative risk of multifocal atherosclerosis in 3.52 times (95% confidence interval 1.27-9.77; p = 0.015).
Conclusion. Patients with CAD and concomitant atherosclerosis of the carotid arteries and lower limb arteries had statistically significantly higher values of abSG compared with patients with CAD and atherosclerosis in one peripheral artery pool, as well as with CAD and intact peripheral arteries. Inversion of abSG was associated with an increased risk of combined peripheral arterial disease.