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Systemic endothelial dysfunction is related to the extent and severity of coronary artery disease
T Neunteufl1, R Katzenschlager, A Hassan
1Department of Cardiology/Second Medical Department, University of Vienna Medical School, Austria.
Insights
Impaired flow-mediated dilation (FMD) in the brachial artery is linked to coronary artery disease (CAD) extent. This endothelial function marker is significantly reduced in patients with CAD, highlighting its clinical relevance.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Diagnostic Imaging
Background:
- Endothelial function, assessed by flow-mediated dilation (FMD), is a key indicator of cardiovascular health.
- Previous research correlates FMD with cardiovascular risk factors, but its association with established coronary artery disease (CAD) is less understood.
Purpose of the Study:
- To investigate the relationship between brachial artery FMD and the presence, extent, and severity of angiographically confirmed coronary artery disease (CAD).
Main Methods:
- Utilized B-mode high-resolution ultrasound to measure brachial artery vasodilation following reactive hyperemia in 74 angina patients and 14 controls.
- Coronary angiography was performed to assess the extent and severity of CAD.
- Nitroglycerin (NTG)-induced vasodilation was also measured.
Main Results:
- CAD patients exhibited significantly impaired FMD compared to non-CAD patients and controls (P < 0.0001).
- FMD impairment correlated with the extent of coronary disease (1-, 2-, or 3-vessel disease; r = -0.67) and maximum stenosis (r = -0.52).
- Extent of CAD and baseline brachial artery diameter were independent predictors of FMD.
Conclusions:
- Brachial artery FMD is a valuable non-invasive marker reflecting systemic endothelial function.
- Impaired FMD is closely associated with the angiographic extent and severity of coronary artery disease.
Abstract:
Flow-mediated vasodilation (FMD) of systemic arteries, a non-invasive parameter of endothelial function, is correlated with cardiovascular risk factors. The relationship between FMD and morphologically and clinically evident coronary artery disease has not been described. This study was performed to test the hypothesis that an impairment of FMD in the brachial artery is related to the presence and/or extent and severity of coronary artery disease (CAD). We examined 74 patients with angina pectoris and 14 control subjects (age 17 36 years). Angiography revealed coronary artery disease (> or = 30% diameter stenosis) in 44 patients (CAD, age 32 67 years) and smooth coronary arteries in 30 patients (non-CAD, age 22-73 years). Vasodilation following reactive hyperemia and after sublingual nitroglycerin (NTG) was assessed in the brachial artery using B-mode high resolution ultrasound. CAD patients showed markedly impaired FMD compared to the non-CAD group (5.7 +/- 4.8 versus 12.6 +/- 6.7%, P < 0.0001) and to controls (5.7 +/- 4.8 versus 15.7 +/- 3.9%, P < 0.00001). NTG induced similar degrees of vasodilation in the CAD and non-CAD groups but less vasodilation in the CAD patients compared to controls (12.2 +/- 6.3 versus 20.4 +/- 6.9%, P < 0.01). On univariate analysis, impaired FMD in CAD patients and non-CAD patients was related to the extent of coronary disease (1-, 2- or 3-vessel disease; r = -0.67, P < 0.0001), to the maximum percent diameter stenosis in one of the major coronary vessels (r = -0.52, P < 0.0001), brachial artery diameter (r = -0.46, P < 0.0001) and plasma cholesterol level (r = -0.34, P < 0.001). On multiple stepwise regression analysis the extent of coronary disease (r = -0.51, P < 0.0001) and the baseline brachial artery diameter (r = -0.37, P < 0.0001) were independently associated with FMD in CAD and non-CAD patients. The present findings suggest that the impairment of FMD in the brachial artery, a marker of systemic endothelial function, is closely related to the angiographic extent of CAD.