Arterial wave reflection is associated with severity of extracoronary atherosclerosis in patients with coronary artery disease

Background Arterial wave reflection is a major determinant of left ventricular function, coronary perfusion and cardiovascular risk. We investigated whether arterial wave reflection may detect atherosclerosis of peripheral arteries in patients with documented coronary artery disease (CAD). Methods Radial artery applanation tonometry and pulse wave analysis was performed in 184 patients with documented CAD at coronary angiography; central blood pressures and augmentation index (Al) were measured. Ankle-brachial (ABI) index and intima-media thickness (IMT) were used as indices of atherosclerosis of the lower limbs and the carotid arteries respectively. Results Patients with abnormal IMT (>0.7 mm, first tertile) or ABI (<0.94, first tertile) had higher Al than patients with lower IMT or higher ABI (24 +/- 17 versus 17 +/- 16% and 23 +/- 18 versus 18 +/- 13%, respectively, P<0.05). In multivariate analysis, increasing Al was associated with age, female gender, heart rate, mean blood pressure, hyperlipidaemia, and use of statins (regression coefficient (beta) = 0.50, beta = 0.15, beta = - 0.60, beta = 0.23, beta = 0.16 and beta = - 0.14, respectively, P< 0.05). Increasing Al was associated with an adjusted-odds ratio of 1.035 [95% confidence interval (CI), 1.005-1.066], P=0.02 for an abnormal IMT and of 1.08 (95% Cl, 1.024-1.146), P= 0.005 for ABI after adjustment for age, gender, heart rate, height, blood pressure, atherosclerotic risk factors, obesity and medication. No relation was found between Al and Gensini score or for the number of diseased coronary vessels. Conclusion Augmentation index is a marker of extensive extracoronary atherosclerosis in patients with CAD.