Ascending Aortic Stiffness Analysis Using Tissue Doppler Imaging for the Diagnosis of Coronary Artery Stenosis in Suspected Stable Angina: A Retrospective Study

Abstract

Background: Coronary artery disease (CAD) and arterial stiffening may coexist. Stable angina pectoris (SAP) is one of the common types of CAD. However, the association between SAP and aortic stiffness metrics remains poorly understood. Tissue Doppler imaging (TDI) measurement of ascending aorta motion velocity may be used to employed to assess the elastic properties of the great arteries. We hypothesized that non-CAD individuals may exhibit higher. TDI velocities in the ascending aorta. Aim: To explore the correlation between ascending aortic stiffness and SAP using parameters derived from two-dimensional and TDI echocardiography of the ascending aorta. Methods: This study comprised 118 patients with clinically suspected SAP. Two-dimensional echocardiography, TDI, electrocardiogram (ECG), and coronary angiography (CAG) were performed on all patients. Patients with coronary lumen area stenosis ≥70% were categorized as having significant CAD (CAD Group n=57) and were compared with patients without significant CAD (non-CAD Group n=61). Using TDI, aortic systolic velocity (SAo), early diastolic velocity (EAo), and late diastolic velocity (AAo) were measured from the anterior wall of the ascending aorta 3 cm above the aortic cusps in the parasternal long-axis view. Aortic stiffness index (β), aortic distensibility (D), and pressure-strain elastic modulus (Ep) were calculated from aortic diameters measured by two-dimensional M-mode echocardiography and blood pressure obtained by sphygmomanometry. Results: SAo was significantly higher in the non-CAD group (11.70 ±1.53 cm/s vs.12.80 ±2.21 cm/s, p < 0.05). EAo and AAo velocities of ascending aorta were similar in control and CAD groups. Based on the receiver operating characteristic curve (ROC curve) for diagnosing non-CAD, the optimal cut-off value of SAo was ≥13.35 cm/s (sensitivity, 85.96%; specificity, 40.98%; area under curve (AUC)=0.64; P<0.05). There was a significant correlation between SAo velocity and β (r=−0.34, P<0.05), D (r=0.32, P<0.05) and Ep (r =−0.29, P<0.05). Conclusions: Arterial stiffness is lower in patients without significant CAD. Measuring SAo of the anterior ascending aorta using TDI echocardiography has good sensitivity but poor specificity in patients without significant coronary artery stenosis in SAP.