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Updated: May 12, 2026
Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
Predictive value of brachial reactive hyperemia and flow-mediated dilation in stable coronary artery disease
Mir Abolfazl Ostad1, Philipp S Wild2, Boris Schnorbus1
1Department of Medicine II, University Medical Center Mainz, Germany.
Insights
Single measurements of reactive hyperemia do not predict long-term events in stable coronary artery disease (CAD) patients. However, brachial flow-mediated dilation (FMD) evaluation predicts cerebro-cardiovascular events, offering incremental prognostic value beyond traditional risk factors.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Diagnostic Cardiology
Background:
- Coronary artery disease (CAD) management requires accurate prognostic tools.
- Assessing endothelial function aids in predicting cardiovascular events.
Purpose of the Study:
- To evaluate the predictive capability of reactive hyperemia (RH) and brachial flow-mediated dilation (FMD) for long-term cerebro-cardiovascular events in stable CAD patients.
Main Methods:
- Ultrasound assessment of RH and brachial artery FMD in 325 stable CAD patients.
- Median follow-up of 3.7 years for cerebro-cardiovascular events.
- Cox proportional hazard modeling adjusted for cardiovascular risk factors.
Main Results:
- Lower FMD and higher brachial artery resting diameter were associated with subsequent events.
- Reactive hyperemia measurements did not differ between event groups.
- Adjusted Cox model showed a hazard ratio of 0.84 for lower FMD (p=0.01).
Conclusions:
- Single reactive hyperemia measurements lack long-term prognostic value in stable CAD.
- Conduit artery FMD evaluation predicts long-term cerebro-cardiovascular events.
- FMD offers incremental prognostic information beyond traditional risk factors.
Background:
The purpose of this study was to determine the predictive value of a single measurement of reactive hyperemia (RH) and brachial flow-mediated dilation (FMD) in patients with established stable coronary artery disease (CAD).
Methods:
RH and brachial artery FMD were ultrasonographically measured in 325 patients with stable CAD. Patients were followed for cerebro-cardiovascular events. The median follow-up was 3.7 years (range 0.01-5.7 years).
Results:
Sixty-seven patients (20.6%) had an cerebro-cardiovascular event. Patients with subsequent events had lower FMD (4.9 ± 3.3% versus 6.3 ± 3.5%, p = 0.003), higher brachial artery resting diameter (5.1 ± 0.7 mm versus 4.8 ± 0.7 mm, p = 0.002) and lower NMD (11.2 ± 5.1% versus 12.8 ± 5.4%, p = 0.02), while the mean hyperemic flow velocity and shear stress did not differ from patients without cerebro-cardiovascular events. Cox proportional hazard model adjusted for sex, age, BMI, and traditional cardiovascular risk factors revealed a hazard ratio of 0.84 for lower FMD (p = 0.01).
Conclusions:
We conclude that single spot measurements of peak RH do not provide long-term prognostic information, but evaluation of conduit artery FMD predicts long-term cerebro-cardiovascular events in patients with stable CAD. The prognostic value of FMD is incremental to traditional cardiovascular risk factors and may therefore be of clinical importance.
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