Peripheral Endothelial Dysfunction Predicts Severity of Coronary Artery Disease

Int Heart J. 2019 Apr 10. doi: 10.1536/ihj.18-531. [Epub ahead of print]

Impaired Flow-Mediated Dilation and Severity and Vulnerability of Culprit Plaque in Patients with Coronary Artery Disease.

Nemoto T1, Minami Y2, Yamaoka-Tojo M3, Sato T1, Muramatsu Y1, Kakizaki R1, Fujiyoshi K1, Hashimoto T1, Meguro K2, Shimohama T2, Tojo T2, Ako J2.

Author information

1
Kitasato University Graduate School of Medical Sciences.
2
Department of Cardiovascular Medicine, Kitasato University School of Medicine.
3
Department of Rehabilitation, Kitasato University School of Allied Health Sciences.

Abstract

The association between endothelial function, evaluated using flow-mediated dilatation (FMD), and the severity of coronary artery disease remains to be elucidated.A total of 245 consecutive patients with stable angina were prospectively enrolled. FMD was evaluated in the brachial artery before percutaneous coronary intervention. Patients were divided into 2 groups according to the FMD value (lower FMD group [FMD < 2.0], n = 82; higher FMD group [FMD ≥ 2.0], n = 163). The severity of coronary artery disease was evaluated using findings of angiography and optical coherence tomography, and compared between the 2 groups.The prevalence of left main (LM) disease was significantly higher in the lower FMD group than in the higher FMD group (8.5% versus 2.5%, P = 0.046), although the prevalence of multivessel disease was comparable between the groups. Lower FMD was independently associated with a higher prevalence of LM disease (odds ratio, 3.89; 95% confidence interval, 1.12-15.5; P = 0.033). A general linear model with multiple variables revealed that the minimal lumen area (MLA) in the culprit lesion was significantly smaller in patients with lower FMD than in those with higher FMD (regression coefficient b, -0.249 mm2; 95% confidence interval, -0.479–0.018 mm2; P = 0.035). The prevalence of vulnerable plaque characteristics was comparable between the 2 groups.Patients with lower FMD had a higher incidence of LM disease and a smaller MLA in the culprit lesion. FMD may be a useful, noninvasive indicator for identifying patients with severe coronary artery disease.

KEYWORDS:

Endothelial dysfunction; Optical coherence tomography; Vulnerable plaque

Clinical implication: Ultrasound assessment of FMD in the brachial arteries is a sensitive and noninvasive method of evaluating endothelium-dependent vasomotion, which reflects systemic endothelial function. A recent metaanalysis has demonstrated that FMD has a prognostic potential in predicting future cardiac events and that the pooled relative ratio of cardiovascular events and all-cause mortality per 1% increase in brachial FMD was 0.90 (0.88-0.92) after adjusting for potential confounders. Thus, FMD evaluation is widely used for the risk stratification of patients with conventional risk factors of atherosclerosis in daily clinical practice. In addition to this prognostic utility of FMD for future cardiac events, several previous studies and the present study suggested the potential utility of FMD in identifying patients with severe coronary artery disease. In particular, the application of very low FMD as a cutoff could discriminate patients requiring prompt pharmacological intervention or revascularization


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