Microvascular Function Predicts Cardiovascular Events in Primary Prevention

Anderson, Todd J.; Charbonneau, François; Title, Lawrence M.; Buithieu, Jean; Rose, Michael; Conradson, H.; Hildebrand, Kathy; Fung, Michelle; Verma, Subodh; Lonn, Eva

doi:10.1161/circulationaha.110.953653

Cited by 339 publications

(132 citation statements)

References 37 publications

(30 reference statements)

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“…18 In our own research group, we have shown not only that VTI is related to cardiovascular risk factors, but that it is also predictive of long-term outcomes in low-to intermediaterisk men. 10,11,17 Although our measurement of microvascular function was less complex than the signal-averaging approach, our findings were consistent with the Framingham group. Owing to the variety of hyperaemic velocity measures using first, average, or maximum VTI, it was important to affirm that the VTI of first beat is in fact an acceptable measurement to be used as a biomarker for cardiovascular risk stratification.…”

Section: Discussionsupporting

confidence: 87%

“…10,11,17 In the current analysis, the first 10 beats following cuff release were measured. Further calculations were made to obtain the average and maximum VTI values from these 10 measurements.…”

Section: Ultrasound Image Analysismentioning

confidence: 99%

“…5,6 However, recent evidence suggests that the microvasculature controlling the reactive hyperaemic response may provide important information for risk prediction. [7][8][9][10] One measure of microvascular function that has been reported is the hyperaemic velocity time integral (VTI). Although VTI has been shown to be more closely related to cardiac risk factors than FMD, as well as an independent predictor of cardiovascular events, the optimal VTI end point to measure the effect remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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The optimal measure of microvascular function with velocity time integral for cardiovascular risk prediction

et al. 2012

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Methods Study population and study designThis study included 399 male subjects, a subset of the Firefighters and Their Endothelium (FATE) study cohort. The FATE study protocol has been described previously. 12 Briefly, all subjects were assessed for cardiovascular risk factors through physical examination and blood work. TheThe optimal measure of microvascular function with velocity time integral for cardiovascular risk prediction Vincent Lee, Billie-Jean Martin, Marinda Fung and Todd J Anderson Abstract Recent evidence suggests that microvascular function may be important in cardiovascular risk prediction. One measure of microvascular function is hyperaemic velocity time integral (VTI). We assessed whether the VTI of more than one beat of reactive hyperaemia would provide a stronger correlate to traditional cardiovascular risk factors using a subset of subjects from the Firefighters and Their Endothelium (FATE) study. Vascular function was assessed by measurement of hyperaemic blood velocity with high-resolution ultrasound of the brachial artery. We evaluated three measures in the current analysis: the VTI of the first beat, average VTI of 10 beats, and maximum VTI of 10 beats post-cuff release. A total of 399 male subjects (45.5 ± 10 years) were included in this analysis. Univariate correlations between the three end points and cardiovascular risk factors were calculated, and multivariable regression models constructed. Intra-observer variability was approximately equal for all VTI end points (coefficient of variation: first = 1.6%, average = 1.4%, maximum = 1.4%). Univariate correlations between VTI and cardiovascular risk factors were similar across all three end points. In multivariable analyses, there were no differences in the relationships between cardiovascular risk factors and the various VTI end points (R 2 from 0.090 to 0.102). Age, systolic blood pressure, and BMI were predictors of the three VTI end points (p < 0.05). In conclusion, the first beat of reactive hyperaemia remains the suitable measure of microvascular function.

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Section: Discussionsupporting

confidence: 87%

Section: Ultrasound Image Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The optimal measure of microvascular function with velocity time integral for cardiovascular risk prediction

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“…More recently, there is evidence to suggest that that hyperemic blood flow responses in such vessels hold true prognostic value for predicting future cardiovascular events. 79,80 In the only study to investigate resistance artery remodeling in SCI, individuals with chronic SCI exhibited a 40-60% reduction in SFA-reactive hyperemia compared with AB individuals. 67 This far exceeds values that occur in healthy AB individuals who undergo acute 81 or chronic 82 bed rest.…”

Section: Resistance Arteries Structural Adaptationsmentioning

confidence: 99%

Peripheral vascular function in spinal cord injury: a systematic review

et al. 2012

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Background: During the past 20 years, significant advances in patient care have resulted in individuals with spinal cord injury (SCI) living longer than before. As lifespan increases, cardiovascular complications are emerging as the leading cause of mortality in this population, and individuals with SCI develop cardiovascular disease at younger ages than their able-bodied counterparts. To address this increasing clinical challenge, several recent studies investigated the central cardiovascular adaptations that occur following SCI. However, a somewhat less recognized component of cardiovascular dysfunction in this population is the peripheral vascular adaptations that also occur as a result of SCI. Study design: Literature review.Objective: To present a comprehensive overview of changes in arterial structure and function, which occur after SCI. Setting: Canada. Methods: A systematic literature review was conducted to extract studies that incorporated measures of arterial structure or function after SCI in animals or humans. Results: Individuals with SCI exhibit vascular dysfunction below the lesion that is characterized by a reduction in conduit artery diameter and blood flow, increased shear rate and leg vascular resistance, and adrenoceptor hyper-responsiveness. There is also recent alarming evidence for central arterial stiffening in individuals with SCI. Conclusion: Although physical deconditioning is the primary candidate responsible for the maladaptive remodeling of the peripheral vasculature after SCI, there is emerging evidence that blood pressure oscillations, such as those occurring in the large majority of individuals with SCI, also exacerbates vascular dysfunction in this population.

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“…Dysfunction of endothelial cells is also the earliest event in the process of lesion formation and atherosclerosis (7 ). Various human studies have identified that measures of endothelial dysfunction may offer prognostic information with respect to vascular events (2,3,8 ).…”

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confidence: 99%

Evolving Role of Microparticles in the Pathophysiology of Endothelial Dysfunction

2013

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BACKGROUND Endothelial dysfunction is an early event in the development and progression of a wide range of cardiovascular diseases. Various human studies have identified that measures of endothelial dysfunction may offer prognostic information with respect to vascular events. Microparticles (MPs) are a heterogeneous population of small membrane fragments shed from various cell types. The endothelium is one of the primary targets of circulating MPs, and MPs isolated from blood have been considered biomarkers of vascular injury and inflammation. CONTENT This review summarizes current knowledge of the potential functional role of circulating MPs in promoting endothelial dysfunction. Cells exposed to different stimuli such as shear stress, physiological agonists, proapoptotic stimulation, or damage release MPs, which contribute to endothelial dysfunction and the development of cardiovascular diseases. Numerous studies indicate that MPs may trigger endothelial dysfunction by disrupting production of nitric oxide release from vascular endothelial cells and subsequently modifying vascular tone. Circulating MPs affect both proinflammatory and proatherosclerotic processes in endothelial cells. In addition, MPs can promote coagulation and inflammation or alter angiogenesis and apoptosis in endothelial cells. SUMMARY MPs play an important role in promoting endothelial dysfunction and may prove to be true biomarkers of disease state and progression.

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Microvascular Function Predicts Cardiovascular Events in Primary Prevention

Abstract: Background-Biomarkers of atherosclerosis may refine clinical decision making in individuals at risk of cardiovascular disease. The purpose of the study was to determine the prognostic significance of endothelial function and other vascular markers in apparently healthy men.

Cited by 339 publications

References 37 publications

The optimal measure of microvascular function with velocity time integral for cardiovascular risk prediction

The optimal measure of microvascular function with velocity time integral for cardiovascular risk prediction

Peripheral vascular function in spinal cord injury: a systematic review

Evolving Role of Microparticles in the Pathophysiology of Endothelial Dysfunction

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