[Assessment of endothelial function reliably predicts the existence and the severity of coronary disease]

Endothelial dysfunction has been proven to be a cornerstone of atherosclerosis occurrence, development and progression. However, its use in clinical practice is still unclearly defined.

To prospectively assess how accurately endothelial function assessment predicts the existence and the extensiveness of significant coronary artery disease.

Fifty adults (37 men and 13 women, mean age of 59.9 +/- 12.6 years) were randomly included among candidates for a coronary angiography. They previously underwent endothelial function assessment by the Flow-mediated dilation technique (FMD) according to ACC guidelines. The FMD% was expressed as maximal percent change in brachial artery diameter from baseline and the test was considered positive when FMD% was below 5%.

Endothelial function impairment has been diagnosed in 36 patients and at least one significant coronary artery stenosis (>50%) in 38 patients. Endothelial dysfunction predicted significant coronary stenosis with a sensibility and a specificity of 89.5% and 83% respectively; positive predictive and negative predictive values were 94.4% and 71.4% respectively. Statistical correlation has been found between FMD% and the number of significantly diseased coronary vessels (rs = -0.44; p = 0.001). An FMD% less than 8% reliably predicted all multivessel coronary-diseased patients. In multivariate analysis, endothelial dysfunction was the only independent predictive factor of coronary disease (p = 0.02).

Endothelial dysfunction has been proven to be highly correlated to the existence of significant coronary stenosis at coronary angiography (PPV = -94.4%). The severity of endothelial dysfunction assessed by the FMD% has also been significantly correlated to the extensiveness of coronary disease.