From the Guidelines
Arterial elasticity index is a valuable tool for predicting coronary artery disease (CAD) and should be considered in clinical practice to improve risk stratification and preventive intervention. This non-invasive measurement of arterial stiffness provides meaningful insight into vascular health and can help identify patients at higher risk for CAD before symptoms develop. The index works by measuring how well arteries expand and contract with each heartbeat, with reduced elasticity indicating arterial stiffening—an early marker of atherosclerosis. Studies have shown that decreased arterial elasticity correlates significantly with CAD presence and severity, even after adjusting for traditional risk factors like hypertension, diabetes, and hyperlipidemia 1.
Key Points to Consider
- The measurement can be obtained through various methods including pulse wave velocity analysis, augmentation index assessment, or ultrasound-based techniques.
- For clinical implementation, arterial elasticity should be considered alongside traditional risk factors rather than in isolation, as this combined approach improves predictive accuracy.
- The physiological basis for this relationship stems from the fact that arterial stiffening reflects underlying endothelial dysfunction, inflammation, and structural changes in vessel walls that precede clinically evident coronary disease.
- According to the 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline, certain clinical characteristics and noninvasive study findings can suggest a high risk of serious cardiac events, and arterial elasticity index can be a useful addition to these assessments 1.
- While the 2009 ACCF/SCAI/STS/AATS/AHA/ASNC appropriateness criteria for coronary revascularization provide guidance on CAD management, the use of arterial elasticity index in predicting CAD is supported by the underlying principle of identifying high-risk patients for early intervention 1.
Clinical Implementation
- Arterial elasticity index should be used as a complementary tool to traditional risk factors for CAD prediction, enhancing the ability to identify patients at higher risk and potentially improving outcomes by facilitating early preventive measures.
- Clinicians should consider the arterial elasticity index in the context of overall patient risk assessment, incorporating it into a comprehensive evaluation that includes clinical history, physical examination, and other diagnostic tests as appropriate.
From the Research
Arterial Elasticity Index in Predicting CAD
- The arterial elasticity index has been shown to be a predictor of coronary artery disease (CAD) severity and complexity, as assessed by the SYNTAX Score 2.
- Studies have found that decreased aortic strain is an independent predictor of intermediate-high SYNTAX Score, indicating more severe and complex CAD 2.
- Intensive statin therapy has been found to improve arterial elasticity in CAD patients, with increases in large artery elasticity index (LAEI) and small artery elasticity index (SAEI) observed after 6 months of treatment 3.
Association with Endothelial Function
- Arterial elasticity has been found to be modulated by endothelial function, with impaired endothelial function contributing to reduced arterial elasticity in patients with CAD 4.
- Flow-mediated vasodilation (FMD) has been found to correlate with small artery elasticity index, suggesting that endothelial dysfunction is involved in diminished arterial elasticity 4.
Association with Subclinical Atherosclerosis
- Reduced arterial elasticity has been found to be associated with subclinical atherosclerosis, as reflected by the coronary artery calcium score (CACS) 5.
- Both large arterial elasticity (LAE) and small arterial elasticity (SAE) have been found to be significantly associated with a higher CACS, independent of traditional risk factors and inflammation 5.
Clinical Implications
- The arterial elasticity index may be a useful tool in predicting CAD severity and complexity, and in identifying patients at risk of subclinical atherosclerosis 2, 5.
- Improving arterial elasticity through intensive statin therapy or other means may be beneficial in reducing the risk of CAD and cardiovascular events 3, 6.