Background-Impaired endothelial function is a key event in the atherosclerosis process and predicts future cardiovascular events in subjects with and without coronary artery disease (CAD). We performed the first prospective study evaluating whether early measurement of brachial artery endothelium-dependent dilation (flow-mediated dilation [FMD]) after coronary stenting could predict occurrence of in-stent-restenosis. Methods and Results-The study population included 136 patients with single-vessel CAD undergoing percutaneous coronary intervention (PCI) with stenting and at least 6 months of follow-up. All patients underwent ultrasound detection of brachial artery reactivity 30 days after PCI; FMD was investigated before and after 5 minutes of occlusion of the brachial artery, and nitroglycerin-mediated dilation was investigated before and after administration of sublingual nitrates. Clinical in-stent restenosis was demonstrated in 20 patients (15%), whereas 116 patients (85%) remained free of signs or symptoms of recurrent ischemia. FMD was significantly impaired in patients with restenosis versus those without restenosis (percent diameter variation 4.6Ϯ5.8% versus 9.5Ϯ6.6%, Pϭ0.002); moreover, 4% of patients with FMD Ն7% (median value) developed in-stent restenosis versus 28% of those with FMD Ͻ7% (Pϭ0.0001). On multivariate analysis, FMD was the strongest predictor of restenosis (OR 4.5, 95% CI 2.4 to 12.0); conversely, nitroglycerin-mediated dilation did not independently predict the risk of restenosis (OR 2.4, 95% CI 0.8 to 6.3). Conclusions-This is the first prospective study indicating that impaired FMD independently predicts occurrence of in-stent restenosis in patients undergoing PCI. Early evaluation of endothelial function after stenting may represent a useful screening tool to stratify patients according to future risk of restenosis.

No abstract

The endothelial dysfunction following cardiopulmonary bypass is improved by the treatment with atorvastatin, by a mechanism unrelated to the drug efficacy of controlling serum cholesterol levels.

Transthoracic echocardiography is not a routine test in the pre-operative cardiac evaluation of patients undergoing non-cardiac surgery but may be considered in those with known heart failure and valvular heart disease or complaining cardiac symptoms. In this setting, hand-held echocardiography (HHE) could find a potential application as an alternative to standard echocardiography in selected patients; however, its utility in this context has not been investigated. The aim of this pilot study was to evaluate the conclusiveness of HHE compared to standard echocardiography in this subset of patients. 100 patients scheduled for non-cardiac surgery were randomized to receive a standard exam with a Philips Ie33 or a bedside evaluation with a pocket-size imaging device (Opti-Go, Philips Medical System). The primary endpoint was the percentage of satisfactory diagnosis at the end of the examination referred as conclusiveness. Secondary endpoints were the mean duration time and the mean waiting time to perform the exams. No significant difference in terms of conclusiveness between HHE and standard echo was found (86 vs 96%; P = 0.08). Mean duration time of the examinations was 6.1 ± 1.2 min with HHE and 13.1 ± 2.6 min with standard echocardiography (P < 0.001). HHE resulted in a consistent save of waiting time because it was performed the same day of clinical evaluation whereas patients waited 10.1 ± 6.1 days for a standard echocardiography (P < 0.001). This study suggests the potential role of HHE for pre-operative evaluation of selected patients undergoing non-cardiac surgery, since it provided similar information but it was faster and earlier performed compared to standard echocardiography.