Endocrinol Metab.  2018 Mar;33(1):88-96. 10.3803/EnM.2018.33.1.88.

High Brachial Ankle Pulse Wave Velocity as a Marker for Predicting Coronary Artery Stenosis in Patients with Type 2 Diabetes

• Kim BH
• Jang JS
• Kwon YS
• Kim JH
• Kim IJ
• Lee CW

• KMID: 2407125
• DOI: http://doi.org/10.3803/EnM.2018.33.1.88

Abstract

BACKGROUND
We evaluated the ability of brachial ankle pulse wave velocity (baPWV) to predict coronary artery stenosis (CAS) in patients with type 2 diabetes, and compared the predictive power of baPWV to that of well-known cardiovascular disease (CVD) risk calculators.
METHODS
The study group included 83 consecutive patients over 30 years old with type 2 diabetes who complained of vague chest discomfort. An automatic pulse waveform analyzer was used to measure baPWV. CAS was measured using multi-slice computed tomographic (MSCT) angiography.
RESULTS
Age, maximal baPWV, duration of diabetes, current smoking, the UK Prospective Diabetes Study (UKPDS) Risk Engine score, American College of Cardiology/American Heart Association (ACC/AHA) risk estimator score, the Framingham risk calculator score, and coronary artery calcium score were greater in patients with CAS than in those without CAS. An area under the curve (AUC) indicative of a predictive value for CAS (≥20%) was found for several parameters. The AUC of maximal baPWV, the UKPDS Risk Engine, the ACC/AHA ASCVD risk estimator, and the Framingham risk calculator were 0.672 (95% confidence interval [CI], 0.554 to 0.785; P=0.010), 0.777 (95% CI, 0.675 to 0.878; P < 0.001), 0.763 (95% CI, 0.660 to 0.866; P < 0.001), and 0.736 (95% CI, 0.629 to 0.843; P < 0.001), respectively. The optimal cutoff value of baPWV for the detection of CAS was 1,650 cm/sec (sensitivity, 68.9%; specificity, 63.2%).
CONCLUSION
Maximal baPWV was closely related with CAS detected by MSCT coronary angiography in patients with type 2 diabetes. baPWV has the potential to be a useful, noninvasive screening tool for the prediction of occult CAS in patients with type 2 diabetes.

Keyword

Coronary stenosis; Diabetes mellitus; Pulse wave analysis; Vascular stiffness

MeSH Terms

Angiography
Ankle*
Area Under Curve
Calcium
Cardiovascular Diseases
Coronary Angiography
Coronary Stenosis*
Coronary Vessels*
Diabetes Mellitus
Heart
Humans
Mass Screening
Prospective Studies
Pulse Wave Analysis*
Sensitivity and Specificity
Smoke
Smoking
Thorax
Vascular Stiffness
Calcium
Smoke

Figure

• 

  Fig. 1 Receiver operating characteristic curve to determine the cutoff value of brachial ankle pulse wave velocity for coronary artery stenosis. The cutoff point of 1,650 cm/sec showed a sensitivity of 68.9%, a specificity of 63%, and an area under the curve of 0.672.

• 

  Fig. 2 Pairwise comparison of the receiver operating characteristic curves of maximal brachial ankle pulse wave velocity (baPWV) and 3 cardiovascular disease (CVD) risk estimators, assessing their predictive value for coronary artery stenosis (≥20%). No significant differences were found between maximal baPWV and the three CVD risk estimators (all P values >0.05). UKPDS, United Kingdom Prospective Diabetes Study; ACC/AHA, American College of Cardiology/American Heart Association.

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