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Published on: January 28, 2020
Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events and
Mustafa Akcakoyun1, Ramazan Kargin, Ali Cevat Tanalp
1Kartal Kosuyolu Heart and Education Hospital, Department of Cardiology, Istanbul, Turkey. makcakoyun@yahoo.com
Insights
Impaired endothelial function, measured by brachial artery flow-mediated dilation (FMD), predicts cardiovascular events and in-stent restenosis after percutaneous coronary intervention (PCI). This noninvasive test can help estimate future cardiovascular risk in patients.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Interventional Cardiology
Background:
- Endothelial dysfunction is a key factor in atherosclerosis and predicts cardiovascular events.
- It is improvable with risk reduction therapies.
- Its predictive value for long-term events and in-stent restenosis after percutaneous coronary intervention (PCI) requires further investigation.
Purpose of the Study:
- To determine the predictive capability of endothelial dysfunction for long-term cardiovascular events.
- To assess the association between endothelial dysfunction and in-stent restenosis in patients undergoing PCI.
- To evaluate the utility of noninvasive endothelial function assessment as a surrogate marker for cardiovascular risk.
Main Methods:
- High-resolution ultrasound was used to measure brachial artery flow-mediated dilation (FMD) in 135 patients with coronary artery disease before elective coronary stenting.
- Patients were prospectively followed for an average of 12 months post-PCI.
- Endothelium-dependent vasodilation (FMD) and endothelium-independent vasodilation (nitroglycerin) were assessed.
Main Results:
- Thirty patients experienced a cardiovascular event (cardiac death, myocardial infarction, unstable angina, stroke) or in-stent restenosis during follow-up.
- Significantly lower FMD was observed in patients with events compared to those without (4.7±1.9% vs. 6.0±2.0%, P=0.007).
- FMD was the sole significant predictor of cardiovascular events (P=0.03), with impaired function associated with higher event and restenosis rates. A cutoff of 7.5% FMD showed 93% sensitivity and 95% negative predictive value for events.
Conclusions:
- Impaired brachial artery FMD is linked to long-term cardiovascular events and in-stent restenosis in patients undergoing PCI.
- Noninvasive assessment of endothelial function, specifically FMD, can serve as a valuable surrogate marker for estimating future cardiovascular event risk.
- This method aids in long-term follow-up and risk stratification for patients post-PCI.
Background:
Endothelial dysfunction plays a key role in atherosclerosis and predicts future cardiovascular events in individuals with or without coronary artery disease and improves with risk reduction therapy. We sought to determine the predictive value of endothelial dysfunction for long-term cardiovascular events and in-stent restenosis in patients undergoing percutaneous coronary intervention (PCI).
Methods:
Using high-resolution ultrasound, we assessed endothelial function by using the brachial artery flow-mediated dilation (FMD) method in 135 patients with coronary artery disease before elective coronary stenting. Patients were prospectively followed up for an average of 12 months after PCI.
Results:
Thirty patients had an event during follow-up including cardiac death (four patients), myocardial infarction (nine patients), unstable angina/non-ST elevation myocardial infarction (15 patients), and stroke (two patients) and in-stent restenosis was determined in 16 of these patients. Endothelium-dependent FMD was significantly lower in patients who had an event compared with those without an event (4.7+/-1.9 vs. 6.0+/-2.0%, P=0.007), whereas endothelium-independent vasodilation to nitroglycerin was similar in both groups. FMD was the only predictor of cardiovascular events (P=0.03). Impaired endothelial function was associated with a significantly higher incidence of cardiovascular events and in-stent restenosis by Kaplan-Meier analysis. When a cutoff point of 7.5% was used, flow-mediated dilation had a sensitivity of 93%, specificity of 37%, and negative predictive value of 95% for cardiovascular events.
Conclusion:
Impaired brachial artery FMD is associated with long-term cardiovascular events and in-stent restenosis in patients undergoing PCI. Noninvasive assessment of endothelial function may serve as a surrogate marker for the estimation of future cardiovascular event risk and long-term follow-up in these patients.