관상동맥경화와 허혈성 심질환의 예측인자로서대동맥경직도 측정의 의의 = High Aortic Stiffness Assessed by Pulse Wave Velocity is anIndependent Predictor of Coronary Artery Calcification andStenosis in Suspected Coronary Artery Disease Patients

다국어 초록 (Multilingual Abstract)

Background and Objectives ：Aortic stiffness is an independent predictor of cardiovascular mortality and of al other causes in hypertensive patients. The object of this study was to investigate whether aortic stiffness, mea -sured by pulse wave velocity (PWV), could be used as an independent predictor for detecting coronary artery atherosclerosis. Subjects and Methods ：PWV was measured by an invasive method. All patients (n= 187, M/F= 77/11CAD was classified as that with or without calcification and stenosis and was classified by the calcification segments and stenotic vessel numbers. Results：Coronary artery calcification was significantly associated with diabetes mellitus (p<0.0 1), the waist/hip circumference ratio (p=0.0 12), hypertension (p=0.002), age (p<0.00 1) and PWV (p<0.00 1). Multiple logistic regression analysis revealed that coronary artery calcification was highly associated with age (OR= 1.052, p=0.023) and PWV (OR= 1.213, p<0.00 1). Significant coronary artery stenosis was associated with hypertension (p=0.02), diabetes melitus (p=0.0 15), age (p=0.004), waist/hip circumference ratio (p=0.0 19), systolic blood presure (p=0.007), pulse presure (p=0.0 16), low density lipoprotein levels (p=0.004) and PWV (p<0.00 1). Multivariate analysis showed that PWV (OR= 1.370, p<0.00 1) and low density lipoprotein levels (OR= 1.022, p=0.006) were the best predictors of coronary artery stenosis. Patients with severe coronary atheosclerosis exhibited a greater increased aortic PWV. Conclusion ：A high aortic PWV is an independent marker for coronary artery stenosis and calcification in suspected CAD patients. The aortic PWV could be used as an independent predictor for ischemic heart disease in patients with suspected CAD. (Korean Circulation J 2004 ;34(5):468-476)

국문 초록 (Abstract)

배경 및 목적： 증가된 대동맥 경직도는 심혈관 질환의 예후에 관한 독립된 예측인자로 알려지고 있다. 이에 대동맥 경직도의 관상동맥 석회화와 협착에 대한 독립적인 예측인자 혹은 위험요인으로서 역할을 알아 보고자 하였다. 방 법： 허혈성 심질환이 의심되어 관상동맥 조영술을 실시한 환자(n=187)를 대상으로, 허혈성 심질환 위험요인, 관상동맥 조영술 소견 상 석회화 침착, 유의한 관상동맥 협착(50%이상의 관동맥 내경 협착), 대동맥 경직도 지표인 대동맥 맥파 전파속도(pulse wave velocity：PWV)를 측정하고 분석하였다.
결 과：
관상동맥석회화(n=46)는 고령(p<0.001), 증가된 허리/
둔부 표면 둘레 비율(p=0.012), 고혈압(p=0.002), 당
뇨병(p<0.001), 높은 PWV 군(p<0.001)에서 많았다.
유의한 관상동맥 협착(n=79)은 고령(p=0.004), 증가
된 허리/둔부 표면 둘레 비율(p=0.019), 높은 수축기
혈압(p=0.007), 증가된 맥압(p=0.016), 높은 총콜레
스테롤(p=0.009), 낮은 고밀도 지단백 콜레스테롤(p=
0.042), 높은 저밀도 지단백 콜레스테롤(p=0.004), 고
혈압(p=0.002), 당뇨병(p=0.015)과 높은 PWV 군(p<
0.001)에서 많았다. 다중회귀분석을 통한 관상동맥 석
회화의 가장 주요한 위험요인은 PWV(OR=1.213, p<
0.001), 나이(OR=1.052, p=0.023)이었고, 관상동맥
협착의 가장 주요한 위험요인은 PWV(OR=1.370, p<
0.001), 높은 저밀도 지단백 콜레스테롤(OR=1.022, p=
0.006)이었다. PWV와 정규분포를 위해 변환된 log PWV
는 나이와 수축기, 확장기혈압을 보정하고도 관상동맥
석회화 분절 수 및 협착 관상동맥 수에 따라 유의한 차
이를 보였다.
결 론：
증가된 대동맥 경직도는 관상동맥 동맥경화와 유의한
연관성이 있으며 고전적 허혈성 심질환의 위험요인과 비
교하여 관상동맥 동맥경화의 예측인자로 이용될 수 있다.

참고문헌 (Reference)

• 1 "The pulse wave velocity as an early indicator of atherosclerosis in dia-betic subjects" 25 : 533-539, 1962
• 2 "The function of the aorta in ischemic heart disease: a magnetic resonance and angiographic study of aortic compliance and blood flow pat-terns" 118 : 234-247, 1989
• 3 "Stiffness of systemic arteries in patients with myocardial infarction: a noninvasive method to predict severity of coronary atherosclerosis" 80 : 78-86, 1989
• 4 "Stiffness indices beta of the common carotid and femoral arteries are associated with insulin resistance in NIDM" 21 : 178-182, 1998
• 5 "Relation between coronary artery disease, aortic stiffnes, and left ventricular structure in a population sample" 32 : 575-578, 1998
• 6 "Pulse wave velocity in healthy subjects and in patients with various disease states"
• 7 "Impact of aortic stiffnes on survival in end-stage renal disease" 99 : 2434-2439, 19
• 8 "Effects of aging on arterial distensibility in populations with high and low prevalence of hypertension: comparison between urban and rural comunities in China" 71 : 202-210, 1985
• 9 "Effects of aging on arterial distensibility in populations with high and low prevalence of hypertension: comparison between urban and rural comunities in China" 71 : 202-210, 1985
• 10 "Effect of age on pulse wave velo-city and aortic ejection time in healthy men and in men with coronary artery disease" 22 : 126-129, 1960
• 11 "Different effects of hypertension, athero-sclerosis and hyperlipidaemia on arterial distensibility" 13 : 1712-1717, 195
• 12 "Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area: a histopathologic corelative study" 92 : 2157-2162, 1995
• 13 "Carotid arterial stiffness as a predictor of car-diovascular and all-cause mortality in end-stage renal disease" 32 : 570-574, 1998
• 14 "Asociation between arterial stiffness and ate-rosclerosis" 32 : 454-460, 201
• 15 "Asesment of arterial disten-sibility by automatic pulse wave velocity measurement: vali-dation and clinical application studies" 26 : 485-490, 1995
• 16 "Arterial wall com-pliance in diabetes" 9 : 14-19, 1992
• 17 "Arterial elasticity in man in relation to age as evaluated by the pulse wave velocity method" 54 : 770-798, 1934
• 18 "Arterial distensibility and ambulatory blood pressure monito-ring in essential hypertension" 61 : 1066-1070, 1988
• 19 "Aortic stiffnening does not predict coronary and extracoronary atherosclerosis in asymptomatic men at risk for cardiovascular disease" 11 : 293-301, 1998
• 20 "Aortic stiffening does not predict coronary and extracoronary atherosclerosis in asymptomatic men at risk for cardiovascular disease" 11 : 293-301, 1998
• 21 "Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integra-ted index of vascular function?" 106 : 2085-2090, 2002
• 22 "Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients" 33 : 11-17, 1999
• 23 "Aortic distensibility in normoten-sive, untreated and treated hypertensive patients" 4 : 48-54, 1995
• 24 "Anatomic correlates of aortic pulse wave velocity and carotid artery elasticity during atherosclerosis progression and regression in monkeys" 83 : 1754-1763, 1991
• 25 "Abnormalities of lipid metabolism and arterial rigidity in young subjects with borderline hypertension" 17 : 42-51, 1994
• 26 "A comparative study of the effect of coronary artery disease on ascending and abdominal aorta distensibility and pulse wave velocity" 48 : 221-223, 1993