ABSTRACT
BACKGROUND: Although flow-mediated vasodilation (FMD) of brachial artery and carotid intima-media thickness (IMT) are important surrogate markers in the process of atherosclerosis, information about relationship between both markers is insufficient. In the present study, we assessed extensively the relationship in patients with coronary artery disease (CAD). METHODS: The values of brachial FMD and carotid ultrasonography findings in 159 patients (67±8 years, 130 males) with angiographically verified CAD were retrospectively analyzed. RESULTS: In all patients, mean carotid IMT tended to be correlated with FMD, although the correlation was not statistically significant (R=-0.149, P=0.061). Maximum IMT was not correlated with the FMD (R=0.053, P=0.508). In addition, carotid artery diameter was significantly correlated with the FMD (R=0.290, P=0.0002). Prevalence of high IMT value (≥1.0 mm) was higher in the abnormal FMD group (4%>; N.=67), compared with the normal FMD group (≥7%; N.=24; P<0.05). Carotid artery diameter was larger in abnormal FMD group, compared with both groups of normal FMD (P<0.01) and borderline FMD (4-7%; N.=68) (P<0.01). In all patients, receiver operating characteristics analysis demonstrated that cut-off value of FMD to predict the prevalence of ischemic stroke was 3.7% (AUC=0.735, P<0.001). The cut-off value of maximum IMT was 1.9 mm, but was not significant (AUC=0.522, P=0.829). CONCLUSIONS: Brachial FMD and carotid IMT would be different in clinical significance as a surrogate marker for pathophysiology of atherosclerotic disease.
Subject(s)
Carotid Intima-Media Thickness , Coronary Artery Disease , Brachial Artery/diagnostic imaging , Carotid Arteries/diagnostic imaging , Coronary Artery Disease/diagnostic imaging , Dilatation , Endothelium, Vascular/diagnostic imaging , Humans , Male , Retrospective Studies , Tunica Media , Ultrasonography , VasodilationABSTRACT
BACKGROUND: Flow-mediated dilation (FMD) and reactive hyperemia-peripheral arterial tonometry (RH-PAT) are both established modalities to assess vascular endothelial function. However, clinical significance of FMD and RH-PAT may be different because these methods measure vascular function in different vessels (conduit arteries and resistance vessels). METHODS: To elucidate differences in the clinical significance of FMD and RH-PAT, a simultaneous determination of FMD was performed and reactive hyperemia index (RHI) measured by RH-PAT in 131 consecutive patients who underwent coronary angiography for suspicion of coronary artery disease (CAD). RESULTS: There was no significant correlation between FMD and RHI in patients overall. When patients were divided into four groups: FMD ≥ 6%/RHI ≥ 1.67 group, FMD ≥ 6%/RHI < 1.67 group, FMD < 6%/RHI ≥ 1.67 group and FMD < 6%/RHI < 1.67 group, the highest incidence of multivessel CAD was seen in the FMD < 6%/RHI < 1.67 group (52%). Multiple logistic regression analysis showed that a prevalence of both FMD < 6% and RHI < 1.67 was an independent predictor of multivessel CAD (odds ratio: 4.160, 95% confidence interval: 1.505-11.500, p = 0.006). RHI was negatively correlated with the baseline vessel diameter (R = -0.268, p = 0.0065) and maximum vessel diameter (R = -0.266, p = 0.0069) in patients with FMD < 6%, whereas these correlations were absent in patients with FMD ≥ 6%. CONCLUSIONS: Present results suggest that noninvasive assessment of vascular endothelial functions provide pathophysiological information on both conduit arteries and resistance vessels in patients with CAD.