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Relationship between vascular damage and left ventricular concentric geometry in patients undergoing coronary angiography

a multicenter prospective study

Salvetti, Massimoa; Paini, Annaa; Facchetti, Ritad; Moreo, Antonellac; Carerj, Scipionee; Maloberti, Alessandroc; Gaibazzi, Nicolag; Faggiano, Pompiliob; Mureddu, Gianfrancof; Rigo, Faustoh; Giannattasio, Cristinac,d; Muiesan, Maria Lorenzaa on behalf of the APRES Study Group

doi: 10.1097/HJH.0000000000002052

Background: Vascular structural (intima–media thickness) and functional (carotid pulse wave velocity, cPWV) alterations are related to different patterns of left ventricular (LV) geometry in general population samples and in hypertensive patients. The relationship between vascular damage, evaluated by both echotracking ultrasound and coronary angiography, and LV geometry has not been prospectively analyzed.

Methods: In eight Italian centers, 399 consecutive patients, without history of prior coronary artery disease and with clinical indication to coronary angiography, prospectively underwent cardiac standard ultrasound examination for the evaluation of LV mass, indexed by height to 2.7 power (LVMi g/m2.7) and relative wall thickness (RWT), the measurement of Doppler flow in the left anterior descending artery (LAD) and the echocardiographic calcium score (eCS). In all patients measurement of common carotid intima–media thickness (cIMT) and cPWV by carotid ultrasound, with the realtime echotracking system was performed. The noninvasive evaluations were performed blindly to clinical information, before coronary angiography.

Results: cIMT and cPWV were higher in patients with concentric LV hypertrophy (LVH) (LVMi ≥ 49 g/m2.7 in men and ≥47 g/m2.7 in women and RWT ≥ 0.42) as compared with those with normal LVMi and geometry (N: LVMi < 49 g/m2.7 in men and <47 g/m2.7 in women and RWT < 0.42) and to those with concentric remodeling (normal LVMi and RWT ≥ 0.42). Distal LAD velocity and eCS were greater in patients with concentric LVH than in others groups. At coronary angiography the prevalence of coronary stenosis (>50%) was greater in patients with concentric LVH and concentric remodeling, as compared with N. Patients with both concentric LVH and concentric remodeling showed higher values of cIMT and cPWV and distal LAD velocity and a greater prevalence of coronary stenosis (>50%) than patients with RWT less than 0.42.

Conclusion: Our results further reinforced the observation that in patients undergoing elective coronary angiography, concentric geometry is associated with structural and functional carotid alterations, with higher distal LAD flow velocity and eCS. In this large group of patients, concentric geometry is associated with a greater prevalence of coronary stenosis, as assessed by coronary angiography. These results might contribute to explain the greater cardiovascular risk associated with concentric remodeling and LVH.

aInternal Medicine, University of Brescia & Spedali Civili Brescia

bCardiology, Spedali Civili, Brescia

cDipartimento Cardiotoracovascolare De Gasperis, Bicocca University and Ospedale Niguarda Ca’ Granda

dDepartment Scienze della Salute, Bicocca University, Milan

eDepartment of Cardiology, Messina University, Messina

fOspedale San Giovanni-Addolorata, Rome

gUniversity of Parma, Parma

hDepartment of Cardiology, Ospedale ‘dell’Angelo’, Mestre-Venezia, Italy

Correspondence to Maria Lorenza Muiesan, Internal Medicine, University of Brescia & Spedali Civili Brescia, Brescia, Italy. E-mail:

Abbreviations: CAD, coronary artery disease; cIMT, carotid intima–media thickness; eCS, echocardiographic calcium score; LAD, left anterior discending artery; LVH, left ventricular hypertrophy

Received 21 October, 2018

Revised 28 December, 2018

Accepted 2 January, 2019

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