Arterial Stiffness and its Correlation with the Extent of Coronary Artery Disease

Document Type: Original Article


1 Echocardiologist, Atherosclerosis Prevention research Center, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran

2 Cardiologist, Atherosclerosis Prevention research Center , Mashhad University of Medical sciences, Mashhad, Iran

3 Cardiologist, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran

4 Medical Student, Student Research Committee, Faculty Of Medicine, Mashhad University Of Medical Sciences, Mashhad, Iran

5 Community Medicine Specialists, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: Coronary artery disease secondary to atherosclerosis is the most common cause of mortality. Coronary angiography is the most precise method for determining the extent of disease in the coronary vascular bed. Arterial stiffness has been proposed as a marker of atherosclerosis in some studies. One of the noninvasive methods for the determination of arterial stiffness is Doppler echocardiography. In this study, we aimed to find the correlation between arterial stiffness as measured by echocardiography and the extent of coronary artery disease as evaluated through angiography.
Materials and Methods: Aortic pulse wave velocity (APWV) was measured by using the Doppler method in 70 patients, who were candidates for coronary angiography. The extent of coronary artery disease was determined quantitatively in terms of Friesinger index and semi-quantitatively as the number of vessels with stenosis of over 50%. Then, the correlation between arterial stiffness and these factors was evaluated.
Results: The mean APWV was 9.1±5 m/s. There was a direct relationship between APWV and Friesinger index, which was not statistically significant (P=0.67). The mean APWV for patients with one-vessel disease was 4.4±1.8 m/s, while it was 9.9±3.6 m/s in patients with two and 7.9±4 m/s in three-vessel disease which did not show statistically significant difference.
Conclusion: Doppler echocardiography to measure APWV was not considered as a promising tool to predict the extent of coronary artery disease.



1.         Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999;99(18):2434-9.

2.         Blacher J, Pannier B, Guerin AP, Marchais SJ, Safar ME, London GM. Carotid arterial stiffness as a predictor of cardiovascular and all-cause mortality in end-stage renal disease. Hypertension. 1998;32(3):570-4.

3.         Boutouyrie P, Tropeano AI, Asmar R, Gautier I, Benetos A, Lacolley P, et al. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients. Hypertension. 2002;39(1):10-5.

4.         Covic A, Haydar AA, Bhamra-Ariza P, Gusbeth-Tatomir P, Goldsmith DJ. Aortic pulse wave velocity and arterial wave reflections predict the extent and severity of coronary artery disease in chronic kidney disease patients. Journal of nephrology. 2005;18(4):388-96.

5.         Cunha RS, Pannier B, Benetos A, Siché J-P, London GM, Mallion JM, et al. Association between high heart rate and high arterial rigidity in normotensive and hypertensive subjects. Journal of hypertension. 1997;15(12):1423-30.

6.         Danchin N, Benetos A, Lopez-Sublet M, Demicheli T, Safar M, Mourad J-J. Aortic pulse pressure is related to the presence and extent of coronary artery disease in men undergoing diagnostic coronary angiography: a multicenter study. American journal of hypertension. 2004;17(2):129-33.

7.         Dart A, Lacombe F, Yeoh J, Cameron J, Jennings G, Laufer E, et al. Aortic distensibility in patients with isolated hypercholesterolaemia, coronary artery disease, or cardiac transplant. The Lancet. 1991;338(8762):270-3.

8.         Fukuda D, Yoshiyama M, Shimada K, Yamashita H, Ehara S, Nakamura Y, et al. Relation between aortic stiffness and coronary flow reserve in patients with coronary artery disease. Heart. 2006;92(6):759-62.

9.         Granér M, Varpula M, Kahri J, Salonen RM, Nyyssönen K, Nieminen MS, et al. Association of carotid intima-media thickness with angiographic severity and extent of coronary artery disease. The American journal of cardiology. 2006;97(5):624-9.

10.       Guérin AP, London GM, Marchais SJ, Metivier F. Arterial stiffening and vascular calcifications in end‐stage renal disease. Nephrology Dialysis Transplantation. 2000;15(7):1014-21.

11.       Mitchell GF, Parise H, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, et al. Changes in arterial stiffness and wave reflection with advancing age in healthy men and women. Hypertension. 2004;43(6):1239-45.

12.       Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM. Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension. 2001;38(4):938-42.

13.       Philippe F, Chemaly E, Blacher J, Mourad J-J, Dibie A, Larrazet F, et al. Aortic pulse pressure and extent of coronary artery disease in percutaneous transluminal coronary angioplasty candidates. American journal of hypertension. 2002;15(8):672-7.

14.       Sangiorgi G, Rumberger JA, Severson A, Edwards WD, Gregoire J, Fitzpatrick LA, et al. Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. Journal of the American College of Cardiology. 1998;31(1):126-33.

15.            Grzegorz Styczynski G, Rdzanek A, Pietrasik A ,Kochman J,Huczek Z,et al. Echocardiographic Assessment of Aortic Pulse-Wave Velocity: Validation against Invasive Pressure Measurements. Journal of the American Society of Echocardiography  2016;29(11): 1109 - 16

16.              Bonapace S, Rossi A, Cicoira M, Cicoira M, Targher G, Valbusa F,  Benetos A, et al. Increased Aortic Pulse Wave Velocity as Measured by Echocardiography Is Strongly Associated with Poor Prognosis in Patients with Heart Failure. Journal of the American Society of Echocardiography.  2013; 26 (7): 714 – 720.

17.           Tanaka H, Munakata M, Kawano Y, Ohishi M, Shoji T, Sugawara J, et al. Comparison between carotid-femoral and brachial-ankle pulse wave velocity as measures of arterial stiffness. Journal of hypertension. 2009;27(10):2022-7.

18.       Toussaint ND, Lau KK, Strauss BJ, Polkinghorne KR, Kerr PG. Associations between vascular calcification, arterial stiffness and bone mineral density in chronic kidney disease. Nephrology Dialysis Transplantation. 2007;23(2):586-93.

19.       Weber T, Auer J, O’Rourke MF, Kvas E, Lassnig E, Berent R, et al. Arterial stiffness, wave reflections, and the risk of coronary artery disease. Circulation. 2004;109(2):184-9.

20.       Xiong Z, Zhu C, Zheng Z, Wang M, Wu Z, Chen L, et al. Relationship between arterial stiffness assessed by brachial-ankle pulse wave velocity and coronary artery disease severity assessed by the SYNTAX score. Journal of atherosclerosis and thrombosis. 2012;19(11):970-6.