Impact of Aortic Stiffness on Exercise Tolerance and Left Ventricular Filling Pressure after Percutaneous Coronary Intervention for Patients with Chronic Stable Coronary Artery Disease

Abstract

Background and Aim: In patients with stable coronary artery disease aortic rigidity may contribute to exercise intolerance and impaired left ventricular (LV) function after coronary intervention. However, this relationship has not yet been investigated. We aimed to assess the impact of aortic stiffness on both exercise tolerance and left ventricular diastolic filling pressure after percutaneous coronary intervention (PCI). Methods: A percutaneous coronary intervention and stenting was performed in 98 consecutive patients with stable coronary artery disease (CAD) and positive exercise ECG. Before and after PCI, echocardiographic study, exercise stress test and aortic stiffness indices were calculated. Results: Aortic stiffness index was significantly higher in patients with CAD (19.5 ± 4.9vs 5.6 ± 2.1; P<0.0001), and still elevated even after successful PCI (11.5 ± 2.7; P<0.002). METs was significantly correlated with Aortic beta index (r = 0.64, P< 0.0001), LAVI (r= 0.49, P<0.001) and E/E? (r = 0.53, P < 0.001). ASI of <15 and < 16.5 were the best cut-off values for prediction of improved exercise tolerance and LV filling pressure after PCI. The AUROC was calculated as 0.93 and 0.94 respectively (P<0.001). Conclusion: In patients with stable coronary artery disease, increase in aortic rigidity, as assessed by aortic beta index, was independently correlated with reduced exercise tolerance and increased LV filling pressures, after PCI. ASI<15 and <16.5 were powerful predictors for improved exercise tolerance and decreased LV filling pressures after PCI.