American heart journal plus : cardiology research and practice · 2026
Aortic pressure-velocity loop: a potential tool for assessing risk associated with midsystolic forward compression waves in patients with chronic atherosclerotic coronary artery disease.
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Hanya Shizuo, Yamakage Hajime, Kondoh Yukiyoshi, Sugawara Motoaki
Аннотация
STUDY OBJECTIVE: To evaluate whether impaired ventriculo-aretrial interaction characterizes chronic ischemic heart disease (CIHD) caused by stable chronic obstructive coronary artery disease (CAD), using wave intensity and aortic pressure-velocity (PU) loop analyses.
DESIGN: Retrospective observational study.
SETTING: Single-center invasive hemodynamic assessment using high-fidelity multisensor catheters.
PARTICIPANTS: Thirty-one patients with CIHD, including 21 with chronic atherosclerotic CAD and 10 with non-CAD CIHD.
INTERVENTIONS: None.
MAIN OUTCOME MEASURES: Wave intensity-derived indices of ventriculo-arterial interaction, including the initial PU-loop slope (S1), second ascending slope (S2), backward compression wave (BCW), midsystolic forward compression wave (m-FCW), and their relative magnitudes. Discriminatory ability for CAD was assessed using receiver operating characteristic (ROC) curve analysis.
RESULTS: In CAD patients, midsystolic flow was supported by a previously unreported m-FCW that emerged in response to an early-onset BCW during ventricular acceleration, reflected by higher S2 values. In contrast, midsystolic flow in non-CAD CIHD patients was primarily maintained by blood inertia and lower S1 values. S2 strongly correlated with the relative magnitude of m-FCW (r = -0.936, P < 0.001). The relative magnitude of m-FCW showed greater discriminatory ability for CAD than BCW (AUC 0.976 vs. 0.771). The S2:S1 ratio correlated closely with the relative magnitude of m-FCW and demonstrated the highest AUC (0.986).
CONCLUSIONS: Chronic atherosclerotic CAD is characterized by impaired ventriculo-aortic interaction, with midsystolic flow dependent on compensatory m-FCW rather than blood inertia. Aortic PU-loop parameters, particularly the S2:S1 ratio, may provide a potential diagnostic marker for distinguishing chronic atherosclerotic CAD from other forms of CIHD.
DESIGN: Retrospective observational study.
SETTING: Single-center invasive hemodynamic assessment using high-fidelity multisensor catheters.
PARTICIPANTS: Thirty-one patients with CIHD, including 21 with chronic atherosclerotic CAD and 10 with non-CAD CIHD.
INTERVENTIONS: None.
MAIN OUTCOME MEASURES: Wave intensity-derived indices of ventriculo-arterial interaction, including the initial PU-loop slope (S1), second ascending slope (S2), backward compression wave (BCW), midsystolic forward compression wave (m-FCW), and their relative magnitudes. Discriminatory ability for CAD was assessed using receiver operating characteristic (ROC) curve analysis.
RESULTS: In CAD patients, midsystolic flow was supported by a previously unreported m-FCW that emerged in response to an early-onset BCW during ventricular acceleration, reflected by higher S2 values. In contrast, midsystolic flow in non-CAD CIHD patients was primarily maintained by blood inertia and lower S1 values. S2 strongly correlated with the relative magnitude of m-FCW (r = -0.936, P < 0.001). The relative magnitude of m-FCW showed greater discriminatory ability for CAD than BCW (AUC 0.976 vs. 0.771). The S2:S1 ratio correlated closely with the relative magnitude of m-FCW and demonstrated the highest AUC (0.986).
CONCLUSIONS: Chronic atherosclerotic CAD is characterized by impaired ventriculo-aortic interaction, with midsystolic flow dependent on compensatory m-FCW rather than blood inertia. Aortic PU-loop parameters, particularly the S2:S1 ratio, may provide a potential diagnostic marker for distinguishing chronic atherosclerotic CAD from other forms of CIHD.