Abstract 9317: Combined Assessment of Flow-Mediated Dilatation of the Brachial Artery and Brachial-Ankle Pulse Wave Velocity Has an Additive Value on Prediction of Future Cardiovascular Events in Patients with Chronic Coronary Artery Disease

Abstract

Flow-mediated dilatation (FMD) of the brachial artery can assess systemic endothelial dysfunction that is an early phase of atherosclerosis. The brachial-ankle pulse wave velocity (PWV) reflects systemic arterial stiffness. Both are widely used as noninvasive methods for assessment of systemic atherosclerosis. This study examined the hypothesis that the combined assessment of FMD and PWV may have an additive effect on the prediction of cardiovascular (CV) events in patients with chronic coronary artery disease (CAD). Methods and Results: FMD and PWV were measured in 625 consecutive patients with chronic CAD. All study patients were prospectively followed up for < 8.5 years or until occurrence of one of the following CV events: cardiac death, non-fatal myocardial infarction (MI), heart failure requiring hospitalization, recurrent or refractory unstable angina pectoris (uAP) requiring coronary revascularization and ischemic stroke. During a mean follow-up of 71 ± 26 months, 79 events occurred (14 cardiac death, 19 MI, 10 heart failure, 31 uAP, 5 stroke). FMD value was not significantly correlated with PWV value, although there was a tendency to have an inverse correlation (r = - 0.11, p = 0.14). Patients with a CV event had lower FMD and higher PWV than those without a CV event (FMD: 3.56 ± 0.28% vs. 5.11± 0.56%, p < 0.01. PWV: 1757 ± 36 cm/sec vs. 1645 ± 38 cm/sec, p = 0.01). In a multivariate Cox hazards analysis, low FMD (< 4.3%, 50 th percentile of study patients) and high PWV (≥ 1660 cm/sec, 50 th percentile of study patients) were significant predictors of CV events (HR;1.58 and 1.66, 95% CI 1.01 - 2.48 and 1.05 - 2.61, respectively, both p < 0.05) that were independent of age, LDL-C levels, hypertension, smoking and diabetes. When outcomes were stratified according to low FMD and high PWV in combination or alone, the combination of low FMD and high PWV was the strongest predictor of CV events, followed by low FMD alone or high PWV alone on the basis of the c -statistic (area under the ROC curve; 0.75, 0.60 and 0.63, respectively). Conclusions: Combined assessment of FMD and PWV has an additive value on the prediction of future cardiovascular events in patients with CAD. This combined assessment may be useful for risk stratification in patients with CAD.