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Published on: August 28, 2018
Association of flow mediated vasodilation and burden of subclinical atherosclerosis by coronary CTA
Suvasini Lakshmanan1, Chandana Shekar2, April Kinninger1
1Los Angeles Biomed Research Institute at Harbor UCLA, Torrance, CA, USA.
Insights
Brachial artery flow-mediated dilation (FMD) is linked to atherosclerosis severity. Lower FMD indicates more subclinical atherosclerosis, as measured by coronary computed tomography angiography (CCTA) and coronary artery calcium (CAC) scores.
Area of Science:
- Cardiovascular research
- Medical imaging
- Vascular biology
Background:
- Endothelial dysfunction and atherosclerosis are interconnected processes.
- Brachial artery flow-mediated dilation (FMD) assesses endothelial function and predicts cardiac events.
- The link between FMD and subclinical atherosclerosis severity via CCTA is unclear.
Purpose of the Study:
- To investigate the association between brachial artery FMD and subclinical atherosclerosis burden.
- To determine if FMD predicts atherosclerosis severity as assessed by CCTA.
Main Methods:
- Retrospective study of 100 intermediate-risk patients with atypical cardiac symptoms.
- Multivariate linear regression analyzed FMD against CCTA markers: CAC score, SIS, SSS, and TPS.
- Coronary computed tomography angiography (CCTA) evaluated plaque burden.
Main Results:
- Brachial FMD was inversely associated with higher CAC, TPS, SIS, and SSS after risk factor adjustment.
- FMD <4.5% predicted CAC >0 and ≤100 (AUC=0.5729).
- FMD <2.7% predicted CAC >100 (AUC=0.6226).
Conclusions:
- Brachial FMD is independently associated with the presence and extent of subclinical atherosclerosis.
- FMD serves as a surrogate marker for systemic endothelial dysfunction and correlates with atherosclerotic burden.
- Findings support FMD's role in assessing atherosclerosis severity via CCTA and CAC.
Background And Aims:
Endothelial dysfunction and atherosclerosis are linked by multiple mechanisms. Brachial artery flow-mediated dilation (FMD) rate is used to evaluate endothelial function and has been independently associated with adverse cardiac outcomes. The relationship between brachial artery FMD rate and severity of subclinical atherosclerosis by coronary computed tomography angiography (CCTA) is not understood. We hypothesized that brachial FMD is inversely associated with burden of subclinical atherosclerosis measured by CCTA.
Methods:
This is a retrospective study of 100 participants with intermediate cardiac risk and atypical symptoms to examine association between brachial artery FMD rate and surrogate markers of severity of subclinical atherosclerosis on CCTA. Multivariate linear regression analysis was used to understand the relationship between brachial artery FMD rate and markers of plaque burden on CCTA including coronary artery calcium (CAC) score, segment involvement score (SIS; total number of segments with any plaque), segment stenosis score (SSS, sum of maximal stenosis score per segment), and total plaque score (TPS, the sum of all segments plaque burden).
Results:
52 participants (42%) were female. Mean age of the cohort was 59.3 ± 10.4 years. After adjusting for traditional risk factors, brachial artery FMD rate was inversely associated with higher CAC, TPS, SIS and SSS (p < 0.05 for all). FMD <4.5 predicted the presence of CAC >0 and ≤ 100 most effectively, with a sensitivity of 62.2% and a specificity of 66.7%, respectively (area under the curve (AUC) of 0.5729, p = 0.0302). FMD <2.7 predicted the presence of CAC >100 most effectively, with a sensitivity of 34% and a specificity of 83% respectively (AUC of 0.6226, p = 0.0095).
Conclusions:
Brachial FMD is independently associated with the presence and extent of subclinical atherosclerosis on CCTA. Our findings provide more detailed evidence that mechanistically, FMD, a surrogate marker of systemic endothelial dysfunction is a correlate of atherosclerotic burden, assessed by CCTA and CAC.
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