Work

Aortic pressure-velocity loop: a potential tool for assessing risk associated with midsystolic forward compression waves in patients with chronic atherosclerotic coronary artery disease

Year: 2026

Type: article

Abstract: 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. Retrospective observational study. Single-center invasive hemodynamic assessment using high-fidelity multisensor catheters. Thirty-one patients with CIHD, including 21 with chronic atherosclerotic CAD and 10 with non-CAD CIHD. None. 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. 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). 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. • Early-onset wave reflection opposing blood inertia increases cardiovascular risk. • The aortic pressure-velocity loop's initial linear slope (S1) reflects blood inertia. • Reduced inertia is indicated by a midsystolic forward compression wave (m-FCW). • The magnitude of the m-FCW is reflected in the loop's second ascending slope (S2). • The S2:S1 ratio reflects cardiovascular risk as a marker of the blood inertia effect.

Source: American Heart Journal Plus Cardiology Research and Practice

DOI: 10.1016/j.ahjo.2026.100787

Authors: Shizuo Hanya, Hajime Yamakage, Yukiyoshi Kondoh, Motoaki Sugawara

Institutions: Tokyo Women's Medical University, Kyoto Medical Center

Language: English

Topic: Cardiovascular Health and Disease Prevention

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,810