Impact of renin-angiotensin system targeted therapy on aortic elastic properties assessed by computed tomography

Niya Mileva; Panayot Panayotov; Irina Hristova; Greta Koleva; Despina Georgieva; Raya Ivanova; Dobrin Vassilev

doi:10.1016/j.ijcha.2024.101562

Impact of renin-angiotensin system targeted therapy on aortic elastic properties assessed by computed tomography

Int J Cardiol Heart Vasc. 2024 Nov 22:55:101562. doi: 10.1016/j.ijcha.2024.101562. eCollection 2024 Dec.

Authors

Niya Mileva^{1

2}, Panayot Panayotov^{1

3}, Irina Hristova⁴, Greta Koleva⁴, Despina Georgieva⁴, Raya Ivanova², Dobrin Vassilev^{1

4}

Affiliations

¹ Medica Cor Hospital, 1713 Ruse, Bulgaria.
² Medical Faculty, Medical University of Sofia, 1431 Sofia, Bulgaria.
³ Department of Cardiology, Pulmonology and Endocrinology, Medical Faculty, Medical University of Pleven, Bulgaria.
⁴ Ruse University "Angel Kanchev", Ruse, Bulgaria.

Abstract

Background: Aortic stiffening is a well-known cardiovascular risk factor. Computed tomography (CT) has proven to be a valuable tool in the assessment of aortic elastic properties. Drugs that inhibit the renin-angiotensin system (RAS) play a central role in cardioprotective therapy. We aimed to evaluate the relationship between aortic elastic properties and RAS-targeted therapy in hypertensive patients.

Methods: This is an observational prospective study of hypertensive patients with nonobstructive coronary artery disease who underwent coronary CT angiography (CCTA). Aortic compliance and distensibility were calculated from the ECG-gated CCTA image. Patients were divided into two groups - those with RAS-targeted therapy - RAS(+) and those with non-RAS-targeted therapy - RAS(-). The elastic properties of the aorta were compared between the two groups.

Results: A total of 142 patients were included in the final analysis. 53.5 % of the population were in the RAS(+) group and 46.5 % in the RAS(-) group. Elastic properties of ascending and descending aorta were significantly higher in the RAS(+) group compared to the RAS(-) group: AA compliance 1.42 ± 0.75 mm²/mmHg in the RAS(+) vs 1.03 ± 0.91 mm²/mmHg in the RAS(-), p = 0.024; AA distensibility 2.86 ± 1.11 x10^-3mm³ in the RAS(+) vs 1.82 ± 0.97 x10^-3mm³ in RAS(-), p < 0.001; DA compliance 1.45 ± 1.10 mm²/mmHg in the RAS(+) vs 1.11 ± 0.91 mm²/mmHg in the RAS(-), p 0.031; DA distensibility 2.35 ± 0.84 x10^-3mm³ in the RAS(+) vs 1.73 ± 1.21 x10^-3mm³ in RAS(-), p < 0.001. There was an excellent correlation between RAS therapy and ascending aorta compliance and distensibility (r = 0.901, p < 0.001 and r = 0.875, p < 0.001, respectively).

Conclusion: Patients receiving RAS-blocking treatment revealed significantly higher compliance and distensibility of ascending and descending aorta. In addition, aortic elastic properties were significantly correlated with the RAS-targeted therapy.

Keywords: Aorta; Compliance; Distensibility; Hypertension.