Predictive Value of Limb Artery Indices and Endothelial Functional Tests for the Degree of Coronary Artery Stenosis in a Diabetic Population

Abstract

Objective To investigate the correlation between limb artery indices (brachial-ankle pulse wave velocity and ankle-brachial index), endothelial function index (FMD value), and the degree of coronary artery stenosis in diabetic patients and analyze their values in predicting the degree of coronary artery stenosis. Methods The study included 151 patients with type 2 diabetes mellitus and suspected coronary atherosclerotic heart disease. The patients were divided into “coronary atherosclerotic heart disease” (N=94) and “non-coronary atherosclerotic heart disease” (N=57) groups based on the coronary angiographic findings. Within the coronary atherosclerotic heart disease group, the patients were further divided into “low stenosis” (N=47) and “high stenosis” (N=47) subgroups according to their Gensini score. Indicators such as brachial-ankle pulse wave velocity, ankle-brachial index, and FMD value were measured and correlated with the degree of coronary artery stenosis. Logistic regression models were constructed and receiver operating characteristic curves plotted to assess the predictive ability of limb artery and endothelial functional indices for the degree of coronary artery stenosis. Results In a diabetic population, FMD value ( P =0.003), ankle-brachial index ( P =0.004), and brachial-ankle pulse wave velocity ( P =0.003) were different in patients with and without coronary atherosclerotic heart disease. In the population with both diabetes mellitus and coronary atherosclerotic heart disease, the ankle-brachial index and FMD value were both independently associated with the degree of coronary artery stenosis ( P =0.003). The area under the receiver operating characteristic curve plotted from the combined coefficients of ankle-brachial index and FMD value was 0.773, which is predictive of coronary artery stenosis in diabetic patients. Conclusion Ankle-brachial index and FMD value are indicative of the degree of coronary artery stenosis in diabetic patients, and predictive efficacy can be improved by combining the two tests.

A nomogram based on endothelial function and conventional risk factors predicts coronary artery disease in hypertensives

“…In our study, the analysis of 1752 EH patients found that FMD was an independent predictive factor for CAD in EH patients; compared with EH patients with FMD > 7.1%, FMD ≤ 7.1% could increase the weight of 100 points in the nomogram and contributed the most to CAD risk. Wang et al [ 26 ] also found similar results through the study of 151 diabetic patients; FMD was independently associated with CAD, and could predict the degree of coronary artery stenosis alone or in combination with ankle brachial index. At present, the cut-off value of endothelial dysfunction defined by FMD is controversial.…”

“…This study found that smokers with EH were 1.47 times more likely to develop CAD than non-smokers, suggesting that quitting smoking is of great significance for the prevention and treatment of CAD. Abdominal obesity and diabetes mellitus are related to metabolic diseases [ 18 ], and also act as important risk factors for ASCVD [ 26 ]. Our result demonstrated that for EH patients, CAD risk increased by nearly 20% for every 10 cm increase in waist circumference, and EH patients were 2.31 times more likely to develop CAD than those without diabetes mellitus.…”