Peripheral Endothelial Function and Cardiovascular Events in High‐Risk Patients

Abstract

BackgroundEndothelial dysfunction is a key component of vascular vulnerability. Reactive hyperemia index (RHI), as assessed by the peripheral arterial tonometry, can noninvasively evaluate endothelial function. This study was designed to determine the additional prognostic value of endothelial function to the Synergy Between PCI With Taxus and Cardiac Surgery Score (SYNTAXsc) and the Framingham Risk Score (FRS) in predicting cardiovascular events in high‐risk patients.Methods and ResultsWe undertook a two‐center prospective study in 528 stable patients at high‐risk for cardiovascular events from the years 2006–2011. The RHI was measured before coronary angiography and coronary complexity was assessed by SYNTAXsc. After optimal therapies including coronary revascularization, there was follow‐up with patients until August 2012. Cardiovascular events consist of cardiovascular death, myocardial infarction, unstable angina, ischemic stroke, coronary revascularization, heart failure‐induced hospitalization, aortic disease, and peripheral arterial disease. During 1468 person‐years of follow‐up, 105 patients developed cardiovascular events. Multivariate Cox proportional hazards analysis identified B‐type natriuretic peptide (BNP), SYNTAXsc, and RHI as independent cardiovascular event predictors (hazard ratio [95% confidence interval]: natural logarithm of BNP per 0.1: 1.019 [1.002 to 1.037]; P=0.023, SYNTAXsc per tertile: 2.426 [1.825 to 3.225]; P<0.0001, RHI per 0.1: 0.761 [0.673 to 0.859]; P<0.0001). When RHI was added to the FRS, BNP, and SYNTAXsc, net reclassification index was significantly improved (27.5%; P<0.0001), with a significant increase in the C‐statistic (from 0.728 [0.679 to 0.778] to 0.766 [0.726 to 0.806]; P=0.031).ConclusionsAdvanced endothelial dysfunction significantly correlated with near future cardiovascular events in high‐risk patients. This physiological vascular measurement improved risk discrimination when added to the FRS, BNP, and SYNTAXsc.Clinical Trial RegistrationURL: clinicaltrials.gov (http://www.clinicaltrials.gov). Unique identifier: NCT00737945.

Age‐Dependent Predictive Value of Endothelial Dysfunction for Arrhythmia Recurrence Following Pulmonary Vein Isolation

“…This method has been validated and described previously in other populations16, 17, 18, 19, 20 and in patients with AF 21. After a 5‐minute baseline measurement, the blood pressure cuff on the test arm was inflated to 60 mm Hg above baseline systolic blood pressure or a maximum of 200 mm Hg for 5 minutes.…”

Secondary Prevention Strategy of Cardiovascular Disease Using Endothelial Function Testing

“…72 In a study of 442 patients with CAD, peripheral endothelial dysfunction, as assessed by RH-PAT, predicted the risk of CV events independently of traditional risk factors and coronary plaque complexity as assessed by the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Score. 64 angiography (79% had CAD), 53 FMD, which was performed on the day after angiography, had significant predictive value for CV events. Similarly, another study of 528 patients with chest pain (84% had CAD) demonstrated that RH-PAT before coronary angiography predicted future CV events over a mean follow-up of 34 months.…”

“…Similarly, another study of 528 patients with chest pain (84% had CAD) demonstrated that RH-PAT before coronary angiography predicted future CV events over a mean follow-up of 34 months. 64 Interestingly, the prognostic value of RH-PAT was independent of coronary atherosclerotic plaque. Endothelial dysfunction itself can cause myocardial ischemia, even in the absence of relevant coronary stenosis.…”

Endothelial function assessed by peripheral arterial tonometry is not related to cardiovascular risk score in healthy subjects

“…In a cohort of high-risk individuals, of whom 83.7% had CAD, Matsuzawa et al found no statistically significant correlation between RHI values and Framingham risk score (FRS) [30]. Lind demonstrated that RHI had no significant relation to the FRS in a population-based cohort of 50-year-old individuals [20].…”