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The prognostic importance of endothelial dysfunction and carotid atheromaburden in patients with coronary artery disease

Sammy Y. Chan, MD, FRCP(C)^*, G. B. John Mancini, MD, FRCP(C), FACC^*,*, Lisa Kuramoto, BSc, Michael Schulzer, MD, PhD, Jiri Frohlich, MD, FRCP(C) and Andrew Ignaszewski, MD, FRCP(C)^*

^* Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
Department of Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada

View larger version (13K): [in a new window]   Figure 1 Box plots (median and 25th to 75th interquartile range) of brachial artery endothelial function variables between subjects with and without vascular events. Peak flow-mediated dilation (FMD) and FMD/nitroglycerin-mediated dilation (NMD) ratio were significantly lower in subjects with events compared with subjects without events. There was no difference in NMD between subjects with and without events.

View larger version (16K): [in a new window]   Figure 2 Event-free survival curves for tertiles of flow-mediated dilation (FMD)/nitroglycerin-mediated dilation (NMD) ratio. There is a graded response between FMD/NMD ratio tertiles and risk of adverse vascular events. Lower FMD/NMD ratio is associated with higher risk of adverse events.

View larger version (17K): [in a new window]   Figure 3 Event-free survival curves for tertiles of carotid plaque area. There is a graded response between carotid plaque area tertiles and risk of adverse vascular events. Higher carotid plaque areas are associated with increased risk of adverse events.

View larger version (14K): [in a new window]   Figure 4 Interaction between plaque burden and endothelial function in prediction of future adverse vascular events. Patients with high flow-mediated dilation (FMD)/nitroglycerin-mediated dilation (NMD) (0.34) had low event rates irrespective of the plaque area. The highest event rate was seen in patients with a high plaque burden (6.59 mm2) and low FMD/NMD (<0.34) (p < 0.05).