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Assessing Endothelial Vasodilator Function with the Endo-PAT 2000
Published on: October 15, 2010
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Reactive Vasodilation Predicts Mortality in Primary Systemic Light-Chain Amyloidosis
Kimon Stamatelopoulos1,2, Georgios Georgiopoulos1,3, Fani Athanasouli1
1From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.).
Circulation Research
|August 13, 2019
Summary
Flow-mediated dilatation (FMD) is elevated in light-chain amyloidosis (AL) patients, indicating vascular dysfunction. Increased FMD independently predicts worse survival and offers significant prognostic value in AL.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Hematology
Background:
- Light-chain amyloidosis (AL) primarily affects the heart and causes hypotension, significantly impacting prognosis.
- Peripheral vascular involvement in AL is suspected but its prognostic significance remains unclear.
- Flow-mediated dilatation (FMD) is a key indicator of vascular reactivity and dysfunction.
Purpose of the Study:
- To investigate the prognostic utility of FMD in newly diagnosed, untreated AL patients.
- To assess vascular dysfunction as a potential therapeutic target in AL.
- To determine if FMD can improve risk stratification beyond established prognostic models.
Main Methods:
- Prospective evaluation of 115 newly diagnosed untreated AL patients and age/sex-matched controls.
- Measurement of FMD and assessment of plasma/exhaled nitric oxide (NO) pathway markers.
- Correlation analysis between FMD, sympathetic stimulation response, and survival outcomes; validation in a separate cohort.
Main Results:
- AL patients exhibited significantly higher FMD compared to controls (4.0% vs 2.32%, P=0.006).
- Elevated FMD (≥4.5%) was independently associated with increased early mortality (HR, 4.36) and worse survival (HR, 2.11), even after adjusting for clinical factors.
- FMD demonstrated significant reclassification value (NRI, 0.61; P=0.001) and improved prognostic models; lower post-treatment FMD correlated with better hematologic response.
Conclusions:
- FMD is elevated in AL patients and serves as an independent predictor of inferior survival.
- FMD offers substantial prognostic reclassification value, suggesting its utility as a novel risk biomarker in AL.
- Reactive vasodilation warrants further investigation as a potential therapeutic target and prognostic indicator in AL.
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