Skip to main content

Advertisement

SpringerLink
Log in

Volume elastic modulus of the brachial artery and coronary artery stenosis in patients with suspected stable coronary artery disease

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

This study aimed to examine the association between the non-invasive measurement of the brachial artery volume elastic modulus (V E), an index of arterial stiffness, and the presence of coronary artery stenosis in patients with suspected stable coronary artery disease (CAD). A total of 135 patients with suspected stable CAD (87 men, mean age, 64 ± 12 years) underwent oscillometric measurement of the brachial artery to obtain V E. Coronary angiography was thereafter carried out to diagnose CAD, defined as having ≥75 % stenosis in the epicardial coronary arteries. V E was significantly higher in patients with CAD (1.94 ± 0.34 mmHg/%) than in those without CAD (1.71 ± 0.35 mmHg/%, P < 0.001). In multiple logistic regression analysis, V E was an independent predictor for the presence of CAD (odds ratio 1.19 per 0.1 mmHg/% increase, 95 % CI 1.04–1.51) even after adjusting for multiple potential confounders including the Framingham risk score (FRS). The area under the curve of the receiver operating characteristic curve analysis for discriminating CAD increased significantly after the addition of V E to the FRS (from 0.75 to 0.81, P = 0.034). The category-free net reclassification improvement and the integrated discrimination improvement by adding V E to the FRS were 0.476 (95 % CI 0.146–0.806) and 0.086 (95 % CI 0.041–0.132), respectively. In conclusion, the brachial V E was significantly associated with the presence of coronary artery stenosis. The additional measurement of V E to the FRS improved the ability to identify patients with coronary artery stenosis among those with suspected stable CAD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gehi AK, Ali S, Na B, Whooley MA (2007) Self-reported medication adherence and cardiovascular events in patients with stable coronary heart disease: the heart and soul study. Arch Intern Med 167:1798–1803

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bauters C, Deneve M, Tricot O, Meurice T, Lamblin N, Investigators C (2014) Prognosis of patients with stable coronary artery disease (from the CORONOR Study). Am J Cardiol 113:1142–1145

    Article  PubMed  Google Scholar 

  3. Kawashiri M, Sakata K, Gamou T, Kanaya H, Miwa K, Ueda K, Higashikata T, Mizuno S, Michishita I, Namura M, Nitta Y, Katsuda S, Okeie K, Hirase H, Tada H, Uchiyama K, Konno T, Hayashi K, Ino H, Nagase K, Terashima M, Yamagishi M (2015) Impact of combined lipid lowering with blood pressure control on coronary plaque regression: rationale and design of MILLION study. Heart Vessels. doi:10.1007/s00380-014-0522-7

    Google Scholar 

  4. Pfisterer ME, Zellweger MJ, Gersh BJ (2010) Management of stable coronary artery disease. Lancet 375:763–772

    Article  CAS  PubMed  Google Scholar 

  5. Wilson PW (1994) Established risk factors and coronary artery disease: the Framingham Study. Am J Hypertens 7:7S–12S

    CAS  PubMed  Google Scholar 

  6. Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, Ellis SG, Lincoff AM, Topol EJ (2003) Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 290:898–904

    Article  Google Scholar 

  7. Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, Ducimetiere P, Benetos A (2001) Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 37:1236–1241

    Article  CAS  PubMed  Google Scholar 

  8. Vlachopoulos C, Aznaouridis K, Stefanadis C (2010) Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 55:1318–1327

    Article  PubMed  Google Scholar 

  9. Mitchell GF, Hwang SJ, Vasan RS, Larson MG, Pencina MJ, Hamburg NM, Vita JA, Levy D, Benjamin EJ (2010) Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation 121:505–511

    Article  PubMed  Google Scholar 

  10. Otsuka T, Munakata R, Kato K, Kodani E, Ibuki C, Kusama Y, Seino Y, Kawada T (2013) Oscillometric measurement of brachial artery cross-sectional area and its relationship with cardiovascular risk factors and arterial stiffness in a middle-aged male population. Hypertens Res 36:910–915

    Article  CAS  PubMed  Google Scholar 

  11. World Medical Association (2001) World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ 79:373–374

    PubMed Central  Google Scholar 

  12. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, A Collaborators Hishida developing the Japanese equation for estimated GFR (2009) Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 53:982–992

    Article  CAS  PubMed  Google Scholar 

  13. D’Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB (2008) General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 117:743–753

    Article  PubMed  Google Scholar 

  14. Tomiyama Y, Yoshinaga K, Fujii S, Ochi N, Inoue M, Nishida M, Aziki K, Horie T, Katoh C, Tamaki N (2015) Accurate quantitative measurements of brachial artery cross-sectional vascular area and vascular volume elastic modulus using automated oscillometric measurements: comparison with brachial artery ultrasound. Hypertens Res. doi:10.1038/hr.2015.6

    PubMed  PubMed Central  Google Scholar 

  15. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, McGoon DC, Murphy ML, Roe BB (1975) A reporting system on patients evaluated for coronary artery disease. Report of the ad hoc committee for grading of coronary artery disease, council on cardiovascular surgery, American Heart Association. Circulation 51:5–40

    Article  CAS  PubMed  Google Scholar 

  16. Gensini GG (1983) A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 51:606

    Article  CAS  PubMed  Google Scholar 

  17. DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845

    Article  CAS  PubMed  Google Scholar 

  18. Pencina MJ, D’Agostino RB, Vasan RS (2010) Statistical methods for assessment of added usefulness of new biomarkers. Clin Chem Lab Med 48:1703–1711

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Nam HJ, Jung IH, Kim J, Kim JH, Suh J, Kim HS, Kim HK, Jung YJ, Kang JW, Lee S (2012) Association between brachial-ankle pulse wave velocity and occult coronary artery disease detected by multi-detector computed tomography. Int J Cardiol 157:227–232

    Article  PubMed  Google Scholar 

  20. Park JB, Park HE, Choi SY, Kim MK, Oh BH (2013) Relation between cardio-ankle vascular index and coronary artery calcification or stenosis in asymptomatic subjects. J Atheroscler Thromb 20:557–567

    Article  PubMed  Google Scholar 

  21. Tsuchiya M, Suzuki E, Egawa K, Nishio Y, Maegawa H, Inoue S, Mitsunami K, Morikawa S, Inubushi T, Kashiwagi A (2004) Stiffness and impaired blood flow in lower-leg arteries are associated with severity of coronary artery calcification among asymptomatic type 2 diabetic patients. Diabetes Care 27:2409–2415

    Article  Google Scholar 

  22. Calvet D, Touze E, Laurent S, Varenne O, Sablayrolles JL, Boutouyrie P, Mas JL (2014) Aortic stiffness measurement improves the prediction of asymptomatic coronary artery disease in stroke/transient ischemic attack patients. Int J Stroke 9:291–296

    Article  PubMed  Google Scholar 

  23. Koji Y, Tomiyama H, Ichihashi H, Nagae T, Tanaka N, Takazawa K, Ishimaru S, Yamashina A (2004) Comparison of ankle-brachial pressure index and pulse wave velocity as markers of the presence of coronary artery disease in subjects with a high risk of atherosclerotic cardiovascular disease. Am J Cardiol 94:868–872

    Article  PubMed  Google Scholar 

  24. Kim KM, Yoo BS, Ko A, Kim JM, Kim HS, Lee JW, Kim JY, Youn YJ, Ahn SG, Lee SH, Yoon J (2013) Do different arterial stiffness parameters provide similar information in high-risk patients for coronary artery disease? Korean Circ J 43:819–824

    Article  PubMed  PubMed Central  Google Scholar 

  25. Urbina EM, Brinton TJ, Elkasabany A, Berenson GS (2002) Brachial artery distensibility and relation to cardiovascular risk factors in healthy young adults (The Bogalusa Heart Study). Am J Cardiol 89:946–951

    Article  PubMed  Google Scholar 

  26. Yamamoto T, Miura S, Suematsu Y, Kuwano T, Sugihara M, Ike A, Iwata A, Nishikawa HSaku K (2015) A relative difference in systolic blood pressure between arms by synchronal measurement and conventional cardiovascular risk factors are associated with the severity of coronary atherosclerosis. Heart Vessels. doi:10.1007/s00380-015-0683-z

    Google Scholar 

  27. Greenwald SE (2007) Ageing of the conduit arteries. J Pathol 211:157–172

    Article  CAS  PubMed  Google Scholar 

  28. Yasmin McEniery CM, O’Shaughnessy KM, Harnett P, Arshad A, Wallace S, Maki-Petaja K, McDonnell B, Ashby MJ, Brown J, Cockcroft JR, Wilkinson IB (2006) Variation in the human matrix metalloproteinase-9 gene is associated with arterial stiffness in healthy individuals. Arterioscler Thromb Vasc Biol 26:1799–1805

    Article  CAS  PubMed  Google Scholar 

  29. Garcia-Touchard A, Henry TD, Sangiorgi G, Spagnoli LG, Mauriello A, Conover C, Schwartz RS (2005) Extracellular proteases in atherosclerosis and restenosis. Arterioscler Thromb Vasc Biol 25:1119–1127

    Article  CAS  PubMed  Google Scholar 

  30. Lee HY, Oh BH (2010) Aging and arterial stiffness. Circ J 74:2257–2262

    Article  PubMed  Google Scholar 

  31. Kuvin JT, Patel AR, Sliney KA, Pandian NG, Rand WM, Udelson JE, Karas RH (2001) Peripheral vascular endothelial function testing as a noninvasive indicator of coronary artery disease. J Am Coll Cardiol 38:1843–1849

    Article  CAS  PubMed  Google Scholar 

  32. Jambrik Z, Venneri L, Varga A, Rigo F, Borges A, Picano E (2004) Peripheral vascular endothelial function testing for the diagnosis of coronary artery disease. Am Heart J 148:684–689

    Article  PubMed  Google Scholar 

  33. Neunteufl T, Katzenschlager R, Hassan A, Klaar U, Schwarzacher S, Glogar D, Bauer P, Weidinger F (1997) Systemic endothelial dysfunction is related to the extent and severity of coronary artery disease. Atherosclerosis 129:111–118

    Article  CAS  PubMed  Google Scholar 

  34. London GM, Guerin AP (1999) Influence of arterial pulse and reflected waves on blood pressure and cardiac function. Am Heart J 138:220–224

    Article  CAS  PubMed  Google Scholar 

  35. Boutouyrie P, Tropeano AI, Asmar R, Gautier I, Benetos A, Lacolley P, Laurent S (2002) Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension 39:10–15

    Article  CAS  PubMed  Google Scholar 

  36. Weber T, Auer J, O’Rourke MF, Kvas E, Lassnig E, Lamm G, Stark N, Rammer M, Eber B (2005) Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions. Eur Heart J 26:2657–2663

    Article  PubMed  Google Scholar 

  37. Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, Asmar R, Reneman RS, Hoeks AP, Breteler MM, Witteman JC (2006) Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation 113:657–663

    Article  PubMed  Google Scholar 

  38. Kullo IJ, Malik AR, Bielak LF, Sheedy PF 2nd, Turner ST, Peyser PA (2007) Brachial artery diameter and vasodilator response to nitroglycerine, but not flow-mediated dilatation, are associated with the presence and quantity of coronary artery calcium in asymptomatic adults. Clin Sci (Lond) 112:175–182

    Article  CAS  Google Scholar 

  39. Rodriguez-Niedenfuhr M, Vazquez T, Nearn L, Ferreira B, Parkin I, Sanudo JR (2001) Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature. J Anat 199:547–566

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Valsecchi O, Vassileva A, Musumeci G, Rossini R, Tespili M, Guagliumi G, Mihalcsik L, Gavazzi A, Ferrazzi P (2006) Failure of transradial approach during coronary interventions: anatomic considerations. Catheter Cardiovasc Interv 67:870–878

    Article  PubMed  Google Scholar 

  41. Yoo BS, Yoon J, Ko JY, Kim JY, Lee SH, Hwang SO, Choe KH (2005) Anatomical consideration of the radial artery for transradial coronary procedures: arterial diameter, branching anomaly and vessel tortuosity. Int J Cardiol 101:421–427

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan

    Ryo Munakata, Saori Uchiyama, Tetsuro Shimura, Osamu Kurihara, Nakahisa Kimata, Toru Inami, Daisuke Murakami, Takayoshi Ohba, Masamichi Takano, Chikao Ibuki & Yoshihiko Seino

  2. Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo City, 113-8602, Japan

    Toshiaki Otsuka

  3. Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo City, 113-8602, Japan

    Wataru Shimizu

Authors
  1. Ryo Munakata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toshiaki Otsuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Saori Uchiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tetsuro Shimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Osamu Kurihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nakahisa Kimata
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Toru Inami
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daisuke Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Takayoshi Ohba
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Masamichi Takano
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Chikao Ibuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yoshihiko Seino
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Wataru Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryo Munakata.

Ethics declarations

Conflict of interests

A&D Company offered the Health Chronos TM-2771 prototype for oscillometric measurements in the present study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 97 kb)

Supplementary material 2 (DOCX 23 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Munakata, R., Otsuka, T., Uchiyama, S. et al. Volume elastic modulus of the brachial artery and coronary artery stenosis in patients with suspected stable coronary artery disease. Heart Vessels 31, 1467–1475 (2016). https://doi.org/10.1007/s00380-015-0769-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-015-0769-7

Keywords

Search

Navigation