Peripheral vascular endothelial function testing as a noninvasive indicator of coronary artery disease
Jeffrey T. Kuvin, MD, FACCa,
Ayan R. Patel, MD, FACCa,
Kathleen A. Sliney, RNa,
Natesa G. Pandian, MD, FACCa,
William M. Rand, PhDa,
James E. Udelson, MD, FACCa and
Richard H. Karas, MD, PhD, FACC*,a
a Department of Medicine/Division of Cardiology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts, USA
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Figure 1 Endothelium-dependent and independent vasomotion. Flow-mediated dilation of the brachial artery during reactive hyperemia (endothelium-dependent vasomotion) in subjects with negative exercise myocardial perfusion imaging (ExMPI) is significantly higher than it is in subjects with positive ExMPI. Nitroglycerin-mediated dilation of the brachial artery (endothelium-independent vasomotion) is essentially unchanged between groups. Values are expressed as mean ± standard error. *p = 0.0004.
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Figure 2 A receiver operator characteristics curve is shown examining the ability of flow-mediated dilation (FMD) to predict coronary artery disease defined by exercise myocardial perfusion imaging. An FMD of 10% (arrow) was chosen as a cut-point for further analysis based on the high sensitivity and negative predictive value. The area under the curve was 0.75 (p = 0.001).
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Figure 3 Flow diagram detailing the 94 subjects undergoing exercise myocardial perfusion imaging. Subjects were divided based on a flow-mediated dilation (FMD) cut-point of 10%. Of the 54 subjects with an FMD <10%, 21 had positive exercise myocardial perfusion imaging (ExMPI), while 33 had no evidence of coronary artery disease (CAD). The sensitivity of an FMD <10% for CAD was 91%. Two of the 40 subjects with an FMD  10% had CAD by ExMPI resulting in a negative predictive value of 95%.
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