Association of improvement of brachial artery flow-mediated vasodilation with cardiovascular events

Suessenbacher, Alois; Frick, Matthias; Alber, Hannes; Barbieri, Verena; Pachinger, Otmar; Weidinger, Franz

doi:10.1177/1358863x06075006

Cited by 33 publications

(33 citation statements)

References 24 publications

(40 reference statements)

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“…increased risk of cardiovascular events has been demonstrated in patients with CAD in whom no improvements of the peripheral endothelial function occurred in serial assessments 9,10) . However, this finding could not be confirmed in the present study using the EndoPAT technique.…”

Section: Resultsmentioning

confidence: 99%

“…In patients without documented cardiovascular disease, several trials have demonstrated that peripheral endothelial dysfunction is related to increased cardiovascular risks [1][2][3] . In contrast, studies in patients with established cardiovascular disease have demonstrated conflicting results [4][5][6][7][8][9][10][11] . During the last few years, the EndoPAT ® device, a novel technique used to assess the peripheral endothelial function, has been increasingly used.…”

Section: Introductionmentioning

confidence: 99%

“…1, the PAT-ratio could not be used to predict future cardiovascular events in the investigated patient population. Some data suggest that conducting serial assessments of the peripheral endothelial function enhances the prognostic value of this parameter 9,10) . However, in our study cohort using the EndoPAT ® method, the patients who exhibited deterioration in the endothelial function after six months did not have a higher risk of cardiovascular events compared to those who demonstrated no changes or even an improvement in the PAT-ratio (Fig.…”

mentioning

confidence: 99%

“…Regarding the FMD, data concerning the prognostic value of the peripheral endothelial function are clear in healthy individuals: several trials have demonstrated that peripheral endothelial dysfunction is related to increased cardiovascular risks [1][2][3] . In contrast, studies of patients with established cardiovascular disease have demonstrated conflicting results [5][6][7][8][9][10][11] . Regarding the EndoPAT technique, the prognostic value of the PAT-ratio was recently investigated in a cohort of patients with unexplained chest pain and low-risk findings during stress testing The plus-minus values indicate the mean±SD BL: baseline, LDL: low-density lipoprotein, HDL: high-density lipoprotein, ACE: angiotensin-converting enzyme, AT-Ⅱ: angiotensin Ⅱ, PAT: peripheral arterial tonometry those without CAD with a normal coronary endothelial function.…”

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confidence: 99%

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Prognostic Value of Peripheral Arterial Tonometry in Patients with Coronary Artery Disease and a High Cardiovascular Risk Profile

Suessenbacher

Dörler

Wanitschek

et al. 2014

JAT

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Aim: Data regarding the prognostic value of peripheral endothelial function testing in patients with cardiovascular disease are conflicting. Peripheral arterial tonometry (PAT) is increasingly used to measure the peripheral endothelial function. The prognostic value of this method has not been investigated thus far in patients with cardiovascular disease and/or a high cardiovascular risk profile. Methods: In 96 patients with significant coronary artery disease (CAD) or ＜70% stenosis and ≥ three cardiovascular risk factors, reactive hyperemia was induced following upper arm occlusion and the PAT-ratio between baseline and hyperemia was calculated. The patients were followed for cardiovascular events (revascularization, acute coronary syndrome, ischemic stroke, cardiovascular death, repeat coronary angiography due to chest pain) for 44±14 months. The first event was included in the combined end point. Results: The study cohort was divided according to the median PAT-ratio (1.91). The combined end point occurred in 14 patients with a PAT-ratio below the median (1.91) and in 12 patients with a PAT-ratio of ≥ 1.91 (p= 0.65). In a subgroup of 76 patients, the PAT-ratio was reassessed after six months. No differences in the event rate were found between the patients who exhibited deterioration (n = 50) and those who exhibited an improvement in the PAT-ratio of ＞0.1 (n = 26; 22 vs. 32%, p = 0.32). The combined end point occurred earlier in the patients with a PAT-ratio within the 1st tertile than in those with a PAT-ratio within the 2nd/3rd tertile (11.3±11.0 vs. 27.5±18.6 months, p= 0.03). Conclusions: In patients with established CAD or a high cardiovascular risk profile, the PAT-ratio cannot be used to predict the risk of future cardiovascular events. However, a lower PAT-ratio may be associated with the earlier occurrence of cardiovascular events. J Atheroscler Thromb, 2014; 21:230-238.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Prognostic Value of Peripheral Arterial Tonometry in Patients with Coronary Artery Disease and a High Cardiovascular Risk Profile

Suessenbacher

Dörler

Wanitschek

et al. 2014

JAT

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“…In patients with angiographically significant coronary atherosclerosis, the baseline FMD value did not have a prognostic significance. 12 The change in FMD during a 12-month time interval, however, is significantly correlated with the risk of experiencing a major adverse cardiovascular event. 12 The present study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

Endothelial function in patients with and without diabetes mellitus with different degrees of coronary artery stenosis

Симова

Денчев

Dimitrov

et al. 2008

J of Clinical Ultrasound

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Purpose. To evaluate endothelial function using flow-mediated dilatation (FMD) of the brachial artery in patients with and without diabetes mellitus (DM) with different degrees of coronary artery stenosis.Method. We investigated 293 patients, 69 (23.6%) of whom had DM. FMD and coronary arteriography were performed.Results. Patients with DM had a significantly lower FMD (mean 6 SD, 3.7 6 3.8%) compared with patients without DM (mean 6 SD, 5.2 6 5.3%) (p < 0.05). When the results were broken down by the severity of coronary artery disease (CAD) (no significant coronary artery stenosis, 1-vessel disease, 2-vessel disease, and 3-vessel disease) the only statistically significant difference between diabetics and nondiabetics was found in patients without significant coronary stenosis (mean FMD 6 SD: 5.2 6 4.4% in diabetics, 7.6 6 5.4% in nondiabetics [p < 0.05]).Conclusion. In CAD patients, the presence of DM was associated with endothelial dysfunction. The difference in the FMD was clearly expressed between patients with and without DM in the subgroup without significant coronary stenosis, and was no longer present with advanced coronary atherosclerosis. The increased cardiovascular risk in patients with DM is caused by multiple and not entirely understood factors. Hyperglycemic status itself plays a role, but other cardiovascular risk factors including obesity, dyslipidemia, and arterial hypertension contribute to the progression of the atherosclerotic process. Endothelial dysfunction appears early in the chain of pathophysiologic changes.Endothelium-dependent flow-mediated dilatation (FMD) of the brachial artery is a method capable of detecting endothelial dysfunction. It was first introduced into clinical practice by Celermajer et al. 2 The method evaluates the capacity of endothelial cells to respond to pathologic vasoconstrictive stimuli with an enhanced production and bioavailability of nitric oxide and a consequent vasodilatation. The response of a peripheral artery to an increase in the shear stress reflects the endothelial function and correlates with the degree of coronary artery atherosclerotic involvement. 3 The purpose of this study was to evaluate the endothelial function in patients with and without various degrees of coronary artery stenosis.

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Peripheral Arterial Tonometry for Risk Stratification in Men With Coronary Artery Disease

Heffernan

Karas

Patvardhan

et al. 2010

Clinical Cardiology

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Summary Background Coronary artery disease (CAD) risk is not fully revealed by traditional risk factors. Identification of a simple, non-invasive tool that allows for detection of high risk CAD patients and can be applied in large population/clinical settings would prove valuable. Methods In this study, finger peripheral arterial tonometry (PAT) was used to measure pulse wave amplitude (PWA) during reactive hyperemia (RH) and taken as a measure of microvascular endothelial function in 42 men with stable CAD and well-controlled LDL-cholesterol levels. Plasma levels of high sensitivity C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) were measured and used to re-classify men into high-risk (elevated hs-CRP and Lp-PLA2), moderate risk (either elevated hs-CRP or Lp-PLA2) or low risk (low hs-CRP and Lp-PLA2) groups. Results PWA-RH was significantly lower in the high risk group (1.3±0.04) compared to the moderate risk (1.6±0.07, p<0.05) and low risk (2.0±0.1, p<0.05) groups. According to binary logistic regression, PWA-RH was a significant predictor of high-risk status amongst men with CAD (p<0.05). Conclusion Measurement of peripheral microvascular endothelial function with PAT may be able to distinguish high-risk from moderate and low-risk men with stable CAD and well-controlled LDL-cholesterol levels and thus aid in residual risk stratification in this at risk cohort.

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Association of improvement of brachial artery flow-mediated vasodilation with cardiovascular events

Cited by 33 publications

References 24 publications

Prognostic Value of Peripheral Arterial Tonometry in Patients with Coronary Artery Disease and a High Cardiovascular Risk Profile

Prognostic Value of Peripheral Arterial Tonometry in Patients with Coronary Artery Disease and a High Cardiovascular Risk Profile

Endothelial function in patients with and without diabetes mellitus with different degrees of coronary artery stenosis

Peripheral Arterial Tonometry for Risk Stratification in Men With Coronary Artery Disease

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