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Updated: Dec 11, 2025
Non-invasive Assessment of Microvascular and Endothelial Function
Published on: January 29, 2013
Non-INvasive Functional and Anatomic vascular evaluation for the prediction of coronary artery disease: The NINFA
Fabio Mangiacapra1, Edoardo Bressi1, Michele Mattia Viscusi1
1Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy.
Insights
Combining endothelial function (flow-mediated dilatation) and carotid intima-media thickness significantly improves coronary artery disease prediction beyond traditional risk factors.
Area of Science:
- Cardiovascular Medicine
- Diagnostic Imaging
- Vascular Biology
Background:
- Endothelial dysfunction and carotid atherosclerosis are linked to coronary artery disease (CAD).
- Flow-mediated dilatation (FMD) assesses endothelial function, while carotid intima-media thickness (IMT) measures subclinical atherosclerosis.
- The study aimed to evaluate the combined predictive value of FMD and IMT for CAD.
Purpose of the Study:
- To determine if combined FMD and IMT measurements improve CAD prediction over traditional risk factors.
- To assess the incremental diagnostic value of these biomarkers in patients undergoing coronary angiography.
Main Methods:
- 497 patients undergoing coronary angiography were analyzed.
- Brachial artery FMD and carotid IMT were measured prior to angiography.
- CAD was defined as ≥50% stenosis in a coronary artery; SYNTAX score was calculated.
Main Results:
- Patients with low FMD and high IMT had the highest CAD prevalence and severity (SYNTAX score).
- The combination of low FMD and high IMT was the strongest independent predictor of CAD (OR 3.63).
- Adding FMD and IMT to traditional risk factors improved CAD prediction (AUC 0.715 to 0.780) and reclassified 24.9% of patients.
Conclusions:
- Combined assessment of endothelial function and carotid atherosclerosis enhances CAD identification.
- This approach offers incremental value over traditional risk factors for predicting CAD.
- FMD and IMT are valuable non-invasive markers for cardiovascular risk stratification.
Background:
Endothelial function, as assessed with flow-mediated dilatation (FMD), and carotid intima-media thickness (IMT) correlate with the presence and extent of coronary artery disease (CAD). We investigated the incremental value of a combined evaluation of FMD and IMT in predicting the presence of CAD over traditional cardiovascular risk factors.
Methods:
A total of 497 consecutive patients undergoing elective coronary angiography were enrolled in this study. Brachial artery FMD and ultrasound-based carotid IMT were evaluated prior to angiography. CAD was defined as the presence of a ≥ 50% stenosis in at least one coronary artery. SYNTAX score was also calculated. Patients were categorized based on the presence of FMD and IMT values below or above gender-specific median.
Results:
Patients with both low FMD and high IMT presented the highest prevalence of CAD, number of diseased vessels, and SYNTAX score. At multivariate analysis, the combination of low FMD and high IMT was the strongest predictor of CAD (OR 3.63, 95% CI 2.19-6.02; p < .001). At ROC curve analysis, the addition of FMD and IMT to a model of traditional risk factors improved the predictive power for the presence of CAD (area under the curve [AUC] of risk factors model 0.715; AUC of risk factors + FMD + IMT 0.780; p < .001). The addition of FMD and IMT to the model of risk factors correctly reclassified 24.9% of patients.
Conclusions:
A combined evaluation of endothelial function and subclinical atherosclerosis at the carotid artery level improves the ability of traditional risk factors to identify patients with CAD.
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