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Published on: June 28, 2019
Association between peripheral endothelial function and myocardial perfusion in patients with coronary artery disease
Niklas Vartiainen1, Juha E K Hartikainen2, Tiina M Laitinen1
1Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland.
Insights
Peripheral endothelial function, measured by flow-mediated dilation (FMD), correlates with myocardial blood flow and coronary artery disease severity. However, FMD is not sensitive enough for individual clinical use in patients with coronary artery disease.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- Endothelial dysfunction is a key risk factor for atherosclerosis.
- Assessing peripheral endothelial function can offer insights into systemic vascular health.
Purpose of the Study:
- To investigate the relationship between peripheral endothelial function and myocardial perfusion in patients with coronary artery disease (CAD).
- To determine if flow-mediated dilation (FMD) can predict reduced myocardial blood flow (MBF) in CAD patients.
Main Methods:
- Prospective study of 54 patients with obstructive CAD.
- Myocardial perfusion assessed using (15O)H2O positron emission tomography at rest and during vasodilation.
- Peripheral endothelial function measured by FMD of the brachial artery.
Main Results:
- A significant correlation was found between FMD and hyperemic MBF (r = 0.308, P = 0.023), persisting after adjustments.
- FMD showed an inverse correlation with the severity of coronary stenosis (r = -0.687, P = 0.007).
- Receiver operating characteristic analysis indicated FMD has low sensitivity and specificity for predicting reduced MBF.
Conclusions:
- Peripheral endothelial function is linked to hyperemic MBF and CAD severity.
- FMD is not suitable for individual clinical prediction of reduced MBF due to insufficient sensitivity and specificity.
- FMD can serve as a valuable research tool for assessing endothelial dysfunction in CAD populations.
Aims:
Endothelial dysfunction is a systemic disorder and risk factor for atherosclerosis. Our aim was to assess whether there is a relation between peripheral endothelial function and myocardial perfusion in patients with coronary artery disease (CAD).
Methods And Results:
We prospectively studied 54 patients, who had a positive result for obstructive CAD in coronary CT angiography. Myocardial perfusion (15O)H2O positron emission tomography was imaged at rest and during adenosine-induced maximal vasodilation. Peripheral endothelial function was assessed by measuring flow-mediated dilation (FMD) with ultrasound from the left brachial artery. There was a statistically significant correlation between FMD and global hyperaemic myocardial blood flow (MBF; r = 0.308, P = 0.023). The correlation remained statistically significant when controlling for gender, height, and diastolic blood pressure at rest (r = 0.367, P = 0.008). Receiver operating character analysis, however, yielded an area under curve of only 0.559 (P = 0.492) when FMD was used to predict reduced MBF (below 2.3 mL/g/min). Patients with significantly decreased MBF (n = 14) underwent invasive coronary angiography. FMD showed an inverse correlation with the severity of the most significant stenosis (r = -0.687, P = 0.007).
Conclusion:
Peripheral endothelial function is related with hyperaemic MBF and with the severity of CAD in invasive coronary angiography. Due to insufficient sensitivity and specificity in the identification of reduced MBF, FMD is not suitable for clinical practice at the individual level. However, it works at the population level as a research tool when assessing endothelial dysfunction in patients with CAD.
