Prognostic Value of Systemic Endothelial Dysfunction in Patients With Acute Coronary Syndromes

Abstract

Background-Endothelial vasodilator dysfunction may serve as a marker integrating the vascular risk of an individual; however, whether systemic vasodilator function predicts disease progression and cardiovascular event rates in patients with manifest acute coronary syndromes (ACS) is unknown. Methods and Results-In 198 patients with angiographically documented ACS, forearm blood flow (FBF) responses to acetylcholine (ACH; 10 to 50 g/min) and sodium nitroprusside (SNP; 2 to 8 g/min) were measured by venous occlusion plethysmography before hospital discharge within 5 days of an episode of an ACS. Cardiovascular events (cardiovascular death, myocardial infarction, and ischemic stroke) served as outcome variables over a mean follow-up period of 47.7Ϯ15.1 months. Patients who experienced cardiovascular events during follow-up (nϭ31) had a significantly reduced vasodilator response to ACH (PϽ0.05) and SNP (PϽ0.05). By multivariate analysis, vasodilator response to ACH and elevated troponin T serum levels were the only significant (PϽ0.05) independent predictors of a poor prognosis, even after adjustment for traditional cardiovascular risk factors, concurrent medication, invasive treatment strategy, and C-reactive protein serum levels. Recovery of endothelium-dependent vasoreactivity as assessed by repeated FBF assessment 8 weeks after the index measurement after the ACS predicted further event-free survival in a subset of 78 patients. Conclusions-Systemic endothelium-dependent vasoreactivity predicts recurrence of instability and cardiovascular event rates in patients with ACS. Furthermore, the recovery of systemic endothelial function is associated with event-free survival. Assessment of systemic vasoreactivity, measured by a minimally invasive test, provides important prognostic information in addition to that derived from traditional risk factor assessment in patients with ACS.

Low Homoarginine Levels in the Prognosis of Patients With Acute Chest Pain

“…Although median homoarginine concentrations were not significantly different between ACS and NCCP patients, the predictive value of low homoarginine on incident MACE—in the overall study population as well as in the subsample of ACS patients—was evident. It is generally accepted that atherosclerosis plays a pivotal role in pathogenesis of ACS 7, 8. In line with this, Valtonen et al.…”

“…Onset of an acute coronary syndrome (ACS) is related to plaque instability and subsequent inflammation, coronary thrombosis, and/or vasospasms. The link between endothelial dysfunction and ACS is thus not direct, but peripheral endothelial function testing predicts cardiovascular outcome in ACS, and subsequent normalization of endothelial function in these patients lowers event rates 7, 8…”

Endothelial Function Assessed by Automatic Measurement of Enclosed Zone Flow‐Mediated Vasodilation Using an Oscillometric Method Is an Independent Predictor of Cardiovascular Events

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The endothelial cell in health and disease: its function, dysfunction, measurement and therapy

“…59 Despite these limitations, venous occlusion plethysmography predicted cardiovascular events. 47,48,50,54 Pulse waveform analysis/peripheral arterial applanation tonometry Applanation tonometry was originally designed to measure intraocular pressure, but has been adapted to measure arterial pulse (pressure) waveforms. The tonometer, a device resembling a short pencil, is positioned over the radial artery maximal pulsation to minimally flatten the arterial wall.…”