Introduction: Atherosclerosis is a multifactorial disease, which is usually initiated by an inflammatory process of the endothelial cells of the blood vessels. While the atherosclerotic process begins early in life with an asymptomatic phase, in some people the process is accelerated – a scenario often referred to as premature atherosclerosis, which often has a more aggressive course than atherosclerosis in the elderly. While the morphological characterization of the vascular wall affected by the premature atherosclerotic process is performed using various imaging techniques, the role of hemodynamic assessment in premature atherosclerosis is becoming more and more important.
Objective: We sought to characterize the aortic mechanics in a cohort of patients with premature atherosclerosis and to compare the results with a normal control group.
Methods: We included in our study 70 consecutive patients under 45 years old with acute ST-segment elevation myocardial infarction. The control group consisted of 70 age and sex-matched patients without known cardiovascular disease. We performed complete echocardiographic assessment for each patient, while focusing on several parameters of aortic mechanics: aortic strain, elastic modulus, aortic stiffness index, aortic distensibility and aortic compliance. All statistical analysis was performed using SPSS version 17.0 statistical software package and we used T-test to compare the echocardi-ographic parameters between the two groups.
Results: The mean age in the study group was 39±4.7 years, whereas the mean age in the control group was 38.8±12.33 years (p=0.87). All the echocardiographic parameters used to assess the mechanics of the ascen-ding aorta were impaired in patients with premature atherosclerosis. The aortic strain was significantly lower in the study group: 5.01±2.52, versus 9.03±3.63 in the control group (p<0.0001). The aortic distensibility was also significantly lower in the premature athe-rosclerosis group: 0.20±0.10, versus 0.39±0.19 in the control group (p<0.0001), as well as the aortic compliance: 0.03±0.01 in the study group versus 0.06±0.02 in the control group (p<0.0001).The elastic modulus was significantly higher in the premature atherosclerosis group: 13.07±6.45, versus 6.16±2.71 in the control group (p<0.0001) and the same trend was seen for the aortic stiffness index, which was significantly higher in the study group: 0.13±0.06, versus 0.07±0.02 in the control group (p<0.0001).
Conclusions: Impaired aortic mechanics might suggest a susceptibility to an early onset of the atherosclerotic process. The echocardiographic assessment of the ascending aorta mechanics involves simple measure-ments, easy to perform at bedside, which might be included in a thorough evaluation of patients at high cardiovascular risk. Consequently, the identification of people who are at risk for premature atherosclerosis may allow proper intervention to decrease the atherosclerotic process and thus reduce the incidence and burden of cardiovascular disease.