Rahimi Arash, Geraiely Babak, Vahidi Hamed, Eftekhari Mohammadreza, Rahimi Darehbagh Ramyar, Mohammadi Somayeh, Ghaffari Golrokh, Khoshavi Meysam
Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran.
BMC Cardiovasc Disord. 2025 Feb 1;25(1):71. doi: 10.1186/s12872-024-04444-3.
Arterial stiffness is a well-established predictor of cardiovascular events and mortality. However, its relationship with right ventricular (RV) function in patients with coronary artery disease (CAD) remains unclear. We aimed to investigate the association between aortic augmentation index (AIx), a marker of arterial stiffness, and RV dysfunction in CAD patients.
In this cross-sectional study, 121 patients with stable CAD or acute coronary syndrome who underwent coronary angiography were enrolled. AIx was measured using radial artery applanation tonometry. Comprehensive echocardiography was performed to assess RV function using conventional and speckle-tracking derived parameters. Multivariable linear and logistic regression analyses were used to evaluate the relationship between AIx and RV function, adjusting for potential confounders.
Patients with high AIx (> 80%, n = 53) had significantly worse RV systolic function compared to those with normal AIx (≤ 80%, n = 68), as evidenced by lower tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), RV free wall longitudinal strain (RVLS), and RV systolic velocity (RV S') (all P < 0.05). AIx correlated negatively with TAPSE (r=-0.421), FAC (r=-0.376), RVLS (r=-0.428), and RV S' (r=-0.355) (all P < 0.001), and positively with pulmonary artery systolic pressure (r = 0.467, P < 0.001) and pulmonary vascular resistance (r = 0.297, P = 0.001). In multivariable analyses, AIx remained an independent predictor of RV dysfunction (adjusted odds ratio 3.42, 95% confidence interval 1.56-7.51, P = 0.002) after adjusting for age, sex, hypertension, diabetes, dyslipidemia, smoking, left ventricular ejection fraction, and Gensini score.
Increased aortic stiffness assessed by AIx is independently associated with RV dysfunction in patients with CAD. This association is evident across multiple echocardiographic parameters of RV systolic function and is independent of traditional cardiovascular risk factors, left ventricular systolic function, and the extent of coronary artery disease. Our findings suggest that arterial stiffness may play a role in the development of RV dysfunction in CAD patients and highlight the potential importance of assessing and targeting arterial stiffness in this population.
动脉僵硬度是心血管事件和死亡率的公认预测指标。然而，其与冠状动脉疾病（CAD）患者右心室（RV）功能的关系仍不清楚。我们旨在研究动脉僵硬度标志物主动脉增强指数（AIx）与CAD患者RV功能障碍之间的关联。
在这项横断面研究中，纳入了121例接受冠状动脉造影的稳定型CAD或急性冠状动脉综合征患者。使用桡动脉压平式眼压计测量AIx。采用传统参数和斑点追踪衍生参数进行全面超声心动图检查以评估RV功能。使用多变量线性和逻辑回归分析来评估AIx与RV功能之间的关系，并对潜在混杂因素进行校正。
与AIx正常（≤80%，n = 68）的患者相比，AIx高（>80%，n = 53）的患者RV收缩功能明显更差，三尖瓣环平面收缩期位移（TAPSE）、面积变化分数（FAC）、RV游离壁纵向应变（RVLS）和RV收缩速度（RV S'）更低均证明了这一点（所有P < 0.05）。AIx与TAPSE（r = -0.421）、FAC（r = -0.376）、RVLS（r = -0.428）和RV S'（r = -0.355）呈负相关（所有P < 0.001），与肺动脉收缩压（r = 0.467，P < 0.001）和肺血管阻力（r = 0.297，P = 0.001）呈正相关。在多变量分析中，在调整年龄、性别、高血压、糖尿病、血脂异常、吸烟、左心室射血分数和Gensini评分后，AIx仍然是RV功能障碍的独立预测指标（调整后的优势比为3.42，95%置信区间为1.56 - 7.51，P = 0.002）。
通过AIx评估的主动脉僵硬度增加与CAD患者的RV功能障碍独立相关。这种关联在RV收缩功能的多个超声心动图参数中都很明显，并且独立于传统心血管危险因素、左心室收缩功能和冠状动脉疾病的程度。我们的研究结果表明，动脉僵硬度可能在CAD患者RV功能障碍的发生中起作用，并强调了在该人群中评估和针对动脉僵硬度的潜在重要性。
