Harbaoui Brahim, Courand Pierre-Yves, Cividjian Andrei, Lantelme Pierre
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.
J Am Heart Assoc. 2017 Feb 2;6(2):e004981. doi: 10.1161/JAHA.116.004981.
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In 53 patients, CoPWV was measured from the delay in pressure wave and distance traveled as a pressure wire was withdrawn from the distal to the proximal coronary segment.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.
尽管通过脉搏波速度（PWV）评估的主动脉僵硬度是冠状动脉疾病的有力预测指标，但局部冠状动脉僵硬度的意义从未得到探讨。本研究的首要目标是描述一种有创测量冠状动脉PWV（CoPWV）的方法并阐述其决定因素。第二个目标是评估急性冠状动脉综合征或稳定型冠状动脉疾病患者的CoPWV和主动脉PWV。
在53例患者中，通过压力波延迟和压力导丝从冠状动脉远端回撤至近端过程中所经过的距离来测量CoPWV。同样，当导丝穿过升主动脉时，有创测量主动脉PWV；还使用SphygmoCor系统（AtCor Medical）无创测量颈股PWV。CoPWV均值为10.3±6.1米/秒。CoPWV升高的决定因素为血流储备分数、舒张压以及记录动脉先前的支架植入情况。急性冠状动脉综合征患者的CoPWV低于稳定型冠状动脉疾病患者（7.6±3对11.5±6.4米/秒；P=0.02），在对混杂因素进行校正后该差异仍然存在。相比之下，通过主动脉和颈股PWV评估的主动脉僵硬度无显著差异。
CoPWV似乎比主动脉PWV与急性冠状动脉事件的关联更为密切。高冠状动脉顺应性，无论是其本身还是因为它导致顺应性失配向远端转移，都可能使易损斑块暴露于高循环拉伸。CoPWV是评估冠状动脉局部顺应性的新工具；它为一个新的研究领域铺平了道路。
