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Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
Endothelial function assessment: flow-mediated dilation and constriction provide different and complementary
Tommaso Gori1, Selina Muxel, Ana Damaske
1Department of Cardiology and Angiology, University Medical Center Mainz, Germany.
Insights
Assessing endothelial function, including flow-mediated dilation (FMD) and low-flow-mediated constriction (L-FMC), provides valuable insights for predicting coronary artery disease (CAD) risk.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Diagnostic Accuracy
Background:
- Traditional risk factors for atherosclerosis are insufficient for precise individual prediction of coronary artery disease (CAD).
- The added value of assessing endothelial function, beyond established risk factors, in predicting CAD remains unclear.
Purpose of the Study:
- To determine if endothelial function parameters provide additive information to traditional risk factors in predicting coronary artery disease (CAD).
- To evaluate the predictive capability of flow-mediated dilation (FMD) and low-flow-mediated constriction (L-FMC) in patients undergoing coronary angiography.
Main Methods:
- Flow-mediated dilation (FMD) and low-flow-mediated constriction (L-FMC) were measured in 451 patients prior to coronary angiography.
- Logistic regression and receiver operating characteristic (ROC) analyses were employed to assess the predictive value of endothelial function parameters.
- The study compared the predictive power of models including traditional risk factors alone versus those incorporating endothelial function measures.
Main Results:
- Both FMD and L-FMC decreased significantly with an increasing number of diseased coronary vessels.
- L-FMC demonstrated a significant linear correlation with the SYNTAX score, a measure of coronary artery disease complexity.
- Adding L-FMC alone, or in combination with FMD, to a model with traditional risk factors significantly improved the prediction of CAD presence.
- L-FMC reclassified 19% of patients, while FMD reclassified 5%, indicating substantial incremental predictive value.
Conclusions:
- Endothelial function assessment, specifically L-FMC and FMD, offers statistically significant, albeit modest, additional information for predicting coronary artery disease (CAD).
- These findings suggest that evaluating endothelial function can enhance the accuracy of CAD risk prediction in clinical practice.
Aims:
A number of risk factors for atherosclerosis have been identified, but it remains difficult, on an individual patient basis, to predict how these factors interact in determining the development of coronary artery disease (CAD). It also remains unclear whether the study of endothelial function provides information that is additive to that of traditional risk factors.
Methods And Results:
Flow-mediated dilation (FMD) and low-flow-mediated constriction (L-FMC) were measured in 451 consecutive patients before coronary angiography. Low-flow-mediated constriction (P< 0.0001) and FMD (P=0.0005) progressively decreased with the number of diseased vessels, and L-FMC showed a significant linear correlation with the SYNTAX score (R=0.38; P< 0.0001). Logistic regression analysis confirmed the association between endothelial function parameters and CAD (P=0.001 for L-FMC, P=0.02 for FMD). Receiver operating characteristic analysis demonstrated that the addition of L-FMC alone and of the combination of FMD and L-FMC improved the predictive power of a model based on traditional risk factors for CAD (area under the curve of the risk factor model=0.716; risk factor model + FMD=0.734, P=0.1 compared with risk factor model; risk factor model + L-FMC=0.771, P=0.004; risk factor model + L-FMC + FMD=0.779, P=0.002). Reclassification statistics showed that the introduction of FMD to the model based on the traditional risk factors correctly reclassified an additional 5% of patients, and that the introduction of L-FMC net correctly reclassified 19% of the patients. There was no correlation between different parameters of endothelial function.
Conclusion:
Endothelial function assessment provides modest but statistically significant additional information in predicting the presence of CAD.
