Arq. Bras. Cardiol. 2022; 118(5): 972-973
Aortic Stiffness by Cardiac Magnetic Resonance: Prognostic tool or Bystander?
Sérgio Figueiredo Câmara, Henrique Barbosa Ribeiro
This Short Editorial is referred by the Research article "Prognostic Value of Aortic Stiffness using Cardiovascular Magnetic Resonance in The Elderly with Known or Suspected Coronary Artery Disease".
Arterial stiffness increases with age and may relate to higher rates of cardiovascular events, including mortality. – This predictive capacity has been demonstrated in various longitudinal cohorts, including ‘healthy’ community population studies and those with diabetes, hypertension, chronic kidney disease, and established coronary artery disease. , There are several ways to measure arterial stiffness, such as doppler-ultrasound, carotid-femoral tonometer, and cardiac magnetic resonance (CMR). CMR provides information regarding cardiac function, perfusion, and myocardial scarring in a single exam and may also be the preferred method for assessing arterial stiffness using aortic pulse wave velocity (PWV). – While the association between aortic stiffness and myocardial ischemia has been demonstrated, as well as the prognostic value of aortic stiffness using CMR, there is limited data regarding the prognostic value of PWV by CMR in elderly patients in whom cardiovascular diseases (CVD) account for the vast majority of mortality causes.
In this issue of the journal, Kaolawanich and Boonyasirinant evaluated the occurrence of major adverse cardiac and cerebrovascular events (MACCE), including cardiac mortality, nonfatal myocardial infarction, hospitalization for heart failure, late revascularization (>180 days after CMR) and ischemic stroke in elderly patients (> 70 years) with suspected or confirmed CAD undergoing adenosine stress CMR including PWV. The main objective was to determine the prognostic value of aortic stiffness using CMR-based PWV in elderly patients with CAD. Two hundred sixty-three consecutive patients (55% female; 77±5 years) between 2010 and 2014 were included with a median follow-up of 59.6 months and a mean PWV of 13.98 ± 9.00 m/s. A higher PWV (>13.98 m/s) was associated with greater MACCE rates (HR 1.75; 95% CI 1.05 – 2.94; p=0.03), as compared to non-elevated PWV (<13.98 m/s). By multivariable analysis, diastolic blood pressure, left ventricular ejection fraction (LVEF), myocardial ischemia and elevated PWV were independent predictors of MACCE at long-term follow-up (p<0.05 for all). PWV had an incremental prognostic value concerning clinical history, LVEF and ischemia (increased global chi-square = 7.25; p=0.01). In this evaluation, elderly patients with elevated PWV also had a higher prevalence of hypertension, diabetes mellitus and higher systolic blood pressure than those with non-elevated PWV, consistent with prior studies in younger populations.
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