P.099 Predictive Value of Aortic Pulse Wave Velocity in Asymptomatic Patients for Carotid Atherosclerosis

Abstract

Background

It’s widely accepted that carotid ultrasonography can help to identify asymptomatic patients at risk of heart attack and stroke as it’s capable of providing direct evidence for the presence and extent of atherosclerosis. Due to limited accessibility of carotid scan the measurement of arterial stiffness is seemed to be suitable functional screening test to select patients who need morphological imaging of arterial tree (eg. carotid scan, multislice-CT or coronarography). However the predictive value of aortic pulse wave velocity for detecting carotid atherosclerosis has been poorly studied.

Method and patients

Authors examined 122 consecutive asymptomatic patients (mean age was 60 ± 9,8 years, 78 female, 44 male) in which arterial stiffness parameters (augmentation index: Aix and aortic pulse wave velocity: PWVao) were measured by an oscillometric device (TensioMed arteriograph). Carotid ultrasonography was performed in all individuals by a blinded investigator (who was unaware of the measured stiffness values).

Results

Mean blood pressure and heart rate was 137/83 mmHg and 72/min. The average Aix was –2,61% and PWV was 10,43 m/s. Carotid atherosclerosis (presence of local plaque in carotid arteries) was confirmed in 72 patients (C+ group) while the arterial wall was intact in 50 patients (C- group). If the upper limit of normal of PWV was drawn at 9,7 m/s, elevated PWVao was measured in 91 of 122 pts (74,5%). Sensitivity of PWVao was 89% (64 pts had high PWV in C+ group), while specificity was 46% (23 pts had low PWV in C-group). Positive predictive value of PWV was 67% (61 pts of 91 with high PWV value were C+) while negative predictive value was 75% (22 pts of 29 with normal PWV was C-).

Conclusions

Elevated aortic pulse wave velocity was strongly associated with the presence of carotid plaques. Measuring arterial stiffness with arteriograph seems to be suitable as a screening method of preclinical atherosclerosis according to its high negative and positive predictive values. Screening of all asymptomatic men over 45 and women over 55 (or at younger age) would be reasonable approach to identify atherosclerosis in early and probably reversible phase if these correlations were confirmed in further large prospective study.