Related Experiment Videos
Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events in patients
Noyan Gokce1, John F Keaney, Liza M Hunter
1Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, USA.
Insights
Impaired brachial artery endothelial function, measured by flow-mediated dilation (FMD), predicts future cardiovascular events in patients with peripheral artery disease. This noninvasive assessment can identify high-risk individuals.
Area of Science:
- Vascular Medicine
- Cardiology
- Diagnostic Imaging
Background:
- Endothelial dysfunction is common in atherosclerosis and associated with coronary risk factors.
- The predictive value of brachial artery endothelial function for long-term cardiovascular events remains unclear.
Purpose of the Study:
- To prospectively evaluate the long-term predictive significance of brachial artery endothelial dysfunction for cardiovascular events.
- To determine if noninvasive assessment of endothelial function can serve as a surrogate marker for cardiovascular risk.
Main Methods:
- Brachial artery endothelial function was assessed using ultrasound in 199 patients with peripheral arterial disease prior to vascular surgery.
- Patients were followed prospectively for an average of 1.2 years post-surgery to record cardiovascular events.
Main Results:
- Patients experiencing cardiovascular events had significantly lower preoperative flow-mediated dilation (FMD) compared to those without events (4.4% vs. 7.0%, p < 0.001).
- Impaired brachial artery endothelial function (FMD <8.1%) was an independent predictor of cardiovascular events, associated with a nine-fold increased risk.
- Age and more invasive surgery were also independent predictors of events.
Conclusions:
- Reduced brachial artery endothelial function independently predicts long-term cardiovascular events in patients with peripheral arterial disease.
- Noninvasive assessment of brachial artery FMD may function as a valuable surrogate endpoint for cardiovascular risk stratification.
Objectives:
The goal of this study was to prospectively examine the long-term predictive value of brachial-artery endothelial dysfunction for future cardiovascular events.
Background:
Brachial-artery endothelial function is impaired in individuals with atherosclerosis and coronary risk factors. The prospective relation between endothelial function determined by brachial-artery ultrasound and long-term cardiovascular risk is unknown.
Methods:
We examined brachial-artery endothelial function using ultrasound in 199 patients with peripheral arterial disease before elective vascular surgery. Patients were prospectively followed with an average follow-up of 1.2 years after surgery.
Results:
Thirty-five patients had an event during follow-up, including cardiac death (5 patients), myocardial infarction (17 patients), unstable angina (10 patients), or stroke (3 patients). Preoperative endothelium-dependent flow-mediated dilation (FMD) was significantly lower in patients with an event (4.4 +/- 2.8%) compared with those without an event (7.0 +/- 4.9%, p < 0.001), whereas endothelium-independent vasodilation to nitroglycerin was similar in both groups. In a Cox proportional-hazards model, independent predictors of events included age (p = 0.003), more invasive surgery (surgery other than carotid endarterectomy, p = 0.02), and impaired brachial-artery endothelial function (p = 0.002). Risk was approximately nine-fold higher in patients with FMD <8.1% (lower two tertiles) compared with those in the upper tertile (odds ratio 9.5; 95% confidence interval 2.3 to 40).
Conclusions:
Impaired brachial-artery endothelial function independently predicts long-term cardiovascular events in patients with peripheral arterial disease. The findings suggest that noninvasive assessment of endothelial function using brachial-artery FMD may serve as a surrogate end point for cardiovascular risk.