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Observational Study
. 2013 May;13(3):227-34.
doi: 10.5152/akd.2013.068. Epub 2013 Jan 30.

Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study

Derya Tok  1 , Fırat Özcan, İskender Kadife, Osman Turak, Kumral Çağlı, Nurcan Başar, Zehra Gölbaşı, Sinan Aydoğdu
Affiliations
Observational Study

Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study

Derya Tok et al. Anadolu Kardiyol Derg. 2013 May.

Abstract
in English, Turkish

Objective: Metabolic syndrome (MetS) is a strong predictor of cardiovascular events and coronary flow reserve (CFR), an indicator of microvascular function, has been found to be impaired in MetS. Aortic stiffness (AS) is a simple and effective method for assessing arterial elasticity. The aim of this study was to evaluate whether there is an independent association of impaired coronary flow and aortic elasticity in patients with MetS.

Methods: Forty-six patients (mean age 47.3 ± 6.6 years) with the diagnosis of MetS according to the ATP III update criteria and 44 age and gender matched controls (mean age 46.0 ± 6.1 years) were included into the cross-sectional observational study. Peak diastolic coronary flow velocities were measured in left anterior descending artery by pulsed wave Doppler at baseline and after adenosine infusion, and CFR was calculated as the ratio of hyperemic to baseline velocities. Aortic strain, distensibility and stiffness were calculated by M-mode echocardiography. Statistical analysis was performed by using Student t-test, Chi-square test, Pearson correlation and linear regression analyses.

Results: CFR was significantly lower in patients with MetS than in controls (2.3 ± 0.2 vs 2.7 ± 0.2, p<0.001). In the MetS group, aortic distensibility (10.4 ± 3.5 cm².dyn⁻¹.10⁻⁶ vs. 12.7 ± 3.4 cm2.dyn⁻¹.10⁻⁶, p=0.002) was decreased and AS was significantly increased (6.5 ± 2.0 vs. 3.2 ± 0.8, p<0.001). In multivariate linear regression analysis, AS (β=-0.217, p=0.047), systolic blood pressure (β=-0.215, p=0.050) and waist circumference (β=-0.272, p=0.012) had an independent relationship with impaired CFR.

Conclusion: This study demonstrated that coronary flow reserve is impaired in patients with MetS and there is an independent relationship between impaired CFR and increased aortic stiffness, systolic blood pressure or waist circumference.

AMAÇ: Metabolik sendrom (MetS) kardiyovasküler olayların güçlü bir belirleyicisidir. Koroner akım rezervi (KAR) mikrovasküler fonksiyonun göstergesidir ve MetS'de bozulduğu gösterilmiştir. Arteriyel elastikiyetin değerlendirilmesinde aortik sertlik (AS) basit ve önemli bir metottur. Bu çalışmada MetS'li hastalarda bozulmuş koroner akım ve aortik elastisite arasında bağımsız bir ilişki olup olmadığının değerlendirilmesi amaçlanmıştır. YÖNTEMLER: Enine kesitli gözlemsel çalışmaya güncellenmiş ATP III kriterlerine göre MetS tanısı alan 46 hasta (ortalama yaş 47.3±6.6 yıl) ve 44 kontrol (ortalama yaş 46.0±6.1 yıl) hastası alındı. Pik diyastolik koroner akım, distal sol ön koroner arterden adenozin infüzyonu öncesi ve sonrasında transtorasik nabız dalga Doppler ile ölçüldü ve hiperemik pik diyastolik hızın başlangıç zirve diyastolik hıza oranı KAR olarak kabul edildi. M-mode ekokardiyografi ile aortik strain, distensibilite ve sertlik hesaplandı. İstatistiksel analizde Student t-testi, Ki-kare testi, Pearson korelasyon ve lineer regresyon analizleri kullanıldı. BULGULAR: MetS'li hastalarda kontrol grubuna kıyasla KAR'ı düşük (2.3±0.2'ye karşılık 2.7±0.2, p<0.001), aortik distensibilite düşük (10.4±3.5'e karşılık 12.7±3.4, p=0.002) ve sertlik ise anlamlı yüksek saptandı (6.5±2.0'e karşılık 3.2±0.8, p<0.001). Lineer regresyon analizinde, AS (β=-0.217, p=0.047), sistolik kan basıncı (β=-0.215, p=0.050) ve bel çevresi (β=-0.272, p=0.012) ile KAR'daki bozulma arasında bağımsız bir ilişki olduğu saptandı. SONUÇ: MetS'li hastalarda koroner akım rezervi bozulmuştur ve artmış aort sertliği, bel çevresi ve sistolik kan basıncı ile azalmış koroner akım rezervi arasında bağımsız bir ilişki vardır.

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