|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2001; 38:1843-1849 © 2001 by the American College of Cardiology Foundation |
a Department of Medicine/Division of Cardiology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts, USA
Manuscript received May 9, 2001; revised manuscript received August 6, 2001, accepted August 24, 2001.
* Reprint requests and correspondence: Dr. Richard H. Karas, Molecular Cardiology Research Institute, New England Medical Center, 750 Washington Street, Box 80, Boston, Massachusetts 02111 USA.
rkaras{at}lifespan.org
OBJECTIVES
We studied whether assessment of endothelium-dependent vasomotion (EDV) with brachial artery ultrasound (BAUS) imaging predicts the presence or absence of coronary artery disease (CAD) as defined by exercise myocardial perfusion imaging (ExMPI).
BACKGROUND
Abnormalities in EDV can be detected in arteries before the development of overt atherosclerosis, and its presence may predict poor long-term prognosis. Brachial artery ultrasound during reactive hyperemia is a noninvasive method of assessing peripheral EDV.
METHODS
Clinically-indicated ExMPI along with BAUS were performed in 94 subjects (43 women, 51 men). Coronary artery disease was defined by myocardial ischemia or infarction on single photon emission computed tomography images. Flow-mediated dilation (FMD) after upper arm occlusion was defined as the percent change in arterial diameter during reactive hyperemia relative to the baseline.
RESULTS
Subjects with CAD by ExMPI (n = 23) had a lower FMD (6.3 ± 0.7%) than those without CAD by ExMPI (n = 71) (10.5 ± 0.6%; p = 0.0004). Flow-mediated dilation was highly predictive for CAD with an odds ratio of 1.32 for each percent decrease in FMD (p = 0.001). Based on a receiver-operator analysis, an FMD of 10% was used as a cut-point for further analysis. Twenty-one of 23 subjects who were positive for ExMPI had an FMD <10% (sensitivity 91%), whereas only two of 40 subjects with an FMD 
10% were ExMPI-positive (negative predictive value: 95%). There was a correlation between the number of cardiac risk factors and FMD. Individuals with an FMD <10% exercised for a shorter duration than those with an FMD 10% (456 ± 24 vs. 544 ± 31 s, respectively; p = 0.02).
CONCLUSIONS
Assessment of EDV with BAUS has a high sensitivity and an excellent negative predictive value for CAD and, thus, has the potential for use as a screening tool to exclude CAD in low-risk subjects. Further standardization of BAUS is required, however, before specific cut-points for excluding CAD can be established.
| ||||||||||||||||||||
This article has been cited by other articles:
|
|
 |
|
  S. K. Nishiyama, D. W. Wray, and R. S. Richardson Sex and limb-specific ischemic reperfusion and vascular reactivity Am J Physiol Heart Circ Physiol, September 1, 2008; 295(3): H1100 - H1108. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. D. Patel and R. R. Arora Review: Endothelial dysfunction: A potential tool in gender related cardiovascular disease Therapeutic Advances in Cardiovascular Disease, April 1, 2008; 2(2): 89 - 100. [Abstract] [PDF]
|
|
|
|
 |
|
 V. Stangl, V. Witzel, G. Baumann, and K. Stangl Current diagnostic concepts to detect coronary artery disease in women Eur. Heart J., March 2, 2008; 29(6): 707 - 717. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Schnabel and S. Blankenberg Oxidative Stress in Cardiovascular Disease: Successful Translation From Bench to Bedside? Circulation, September 18, 2007; 116(12): 1338 - 1340. [Full Text] [PDF]
|
|
|
|
 |
|
 N. R Matthan, S. M Jalbert, L. M Ausman, J. T Kuvin, R. H Karas, and A. H Lichtenstein Effect of soy protein from differently processed products on cardiovascular disease risk factors and vascular endothelial function in hypercholesterolemic subjects Am. J. Clinical Nutrition, April 1, 2007; 85(4): 960 - 966. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Rozanski, H. Gransar, N. D. Wong, L. J. Shaw, R. Miranda-Peats, D. Polk, S. W. Hayes, J. D. Friedman, and D. S. Berman Clinical Outcomes After Both Coronary Calcium Scanning and Exercise Myocardial Perfusion Scintigraphy J. Am. Coll. Cardiol., March 27, 2007; 49(12): 1352 - 1361. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. T. Kuvin, A. Mammen, P. Mooney, A. A. Alsheikh-Ali, and R. H. Karas Assessment of peripheral vascular endothelial function in the ambulatory setting Vascular Medicine, February 1, 2007; 12(1): 13 - 16. [Abstract] [PDF]
|
|
|
|
 |
|
 S. Chaiamnuay, J. J. Allison, and J. R. Curtis Risks versus benefits of cyclooxygenase-2-selective nonsteroidal antiinflammatory drugs. Am. J. Health Syst. Pharm., October 1, 2006; 63(19): 1837 - 1851. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J.M. Broadley, A. Korszun, E. Abdelaal, V. Moskvina, J. Deanfield, C. J.H. Jones, and M. P. Frenneaux Metyrapone Improves Endothelial Dysfunction in Patients With Treated Depression J. Am. Coll. Cardiol., July 4, 2006; 48(1): 170 - 175. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Chello, C. Goffredo, G. Patti, D. Candura, R. Melfi, S. Mastrobuoni, G. Di Sciascio, and E. Covino Effects of atorvastatin on arterial endothelial function in coronary bypass surgery Eur. J. Cardiothorac. Surg., December 1, 2005; 28(6): 805 - 810. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Pellegrino, G. Storto, P. P. Filardi, A. R. Sorrentino, A. Silvestro, M. Petretta, G. Brevetti, M. Chiariello, M. Salvatore, and A. Cuocolo Relationship Between Brachial Artery Flow-Mediated Dilation and Coronary Flow Reserve in Patients with Peripheral Artery Disease J. Nucl. Med., December 1, 2005; 46(12): 1997 - 2002. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. O Brubakk, D Duplancic, Z Valic, I Palada, A Obad, D Bakovic, U Wisloff, and Z Dujic A single air dive reduces arterial endothelial function in man J. Physiol., August 1, 2005; 566(3): 901 - 906. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. T Moe, H. Hoven, E. V Hetland, O. Rognmo, and S. A Slordahl Endothelial function in highly endurance-trained and sedentary, healthy young women Vascular Medicine, May 1, 2005; 10(2): 97 - 102. [Abstract] [PDF]
|
|
|
|
|
|
D. J Green, A. Maiorana, G. O'Driscoll, and R. Taylor Effect of exercise training on endothelium-derived nitric oxide function in humans J. Physiol., November 15, 2004; 561(1): 1 - 25. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. Paradossi, E. Ciofini, A. Clerico, N. Botto, A. Biagini, and M. G. Colombo Endothelial Function and Carotid Intima-Media Thickness in Young Healthy Subjects Among Endothelial Nitric Oxide Synthase Glu298->Asp and T-786->C Polymorphisms Stroke, June 1, 2004; 35(6): 1305 - 1309. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. P. Faxon, V. Fuster, P. Libby, J. A. Beckman, W. R. Hiatt, R. W. Thompson, J. N. Topper, B. H. Annex, J. H. Rundback, R. P. Fabunmi, et al. Atherosclerotic Vascular Disease Conference: Writing Group III: Pathophysiology Circulation, June 1, 2004; 109(21): 2617 - 2625. [Full Text] [PDF]
|
|
|
|
|
|
J. T. Kuvin and R. H. Karas Clinical Utility of Endothelial Function Testing: Ready for Prime Time? Circulation, July 1, 2003; 107(25): 3243 - 3247. [Full Text] [PDF]
|
|
|
|
|
|
P. Khairy, S. Rinfret, J.-C. Tardif, R. Marchand, S. Shapiro, J. Brophy, and J. Dupuis Absence of Association Between Infectious Agents and Endothelial Function in Healthy Young Men Circulation, April 22, 2003; 107(15): 1966 - 1971. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Maas, E. Schwedhelm, J. Albsmeier, and R. H Boger The pathophysiology of erectile dysfunction related to endothelial dysfunction and mediators of vascular function Vascular Medicine, August 1, 2002; 7(3): 213 - 225. [Abstract] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
