Abstract
BackgroundLimited brachial artery (BA) flow-mediated dilation during brachial artery reactivity testing (BART) has been linked to increased cardiovascular risk. We report on the phenomenon of BA constriction (BAC) following hyperemia.ObjectivesTo determine whether BAC predicts adverse CV outcomes and/or mortality in the women’s ischemic Syndrome Evaluation Study (WISE). Further, as a secondary objective we sought to determine the risk factors associated with BAC.MethodsWe performed BART on 377 women with chest pain referred for coronary angiography and followed for a median of 9.5 years. Forearm ischemia was induced with 4 minutes occlusion by a cuff placed distal to the BA and inflated to 40mm Hg > systolic pressure. BAC was defined as >4.8% artery constriction following release of the cuff. The main outcome was major adverse events (MACE) including all-cause mortality, non-fatal MI, non-fatal stroke, or hospitalization for heart failure.ResultsBA diameter change ranged from -20.6% to +44.9%, and 41 (11%) women experienced BAC. Obstructive CAD and traditional CAD risk factors were not predictive of BAC. Overall, 39% of women with BAC experienced MACE vs. 22% without BAC (p=0.004). In multivariate Cox proportional hazards regression, BAC was a significant independent predictor of MACE (p=0.018) when adjusting for obstructive CAD and traditional risk factors.ConclusionsBAC predicts almost double the risk for major adverse events compared to patients without BAC. This risk was not accounted for by CAD or traditional risk factors. The novel risk marker of BAC requires further investigation in women.
Highlights
Brachial artery reactivity testing (BART) for measurement of flow-mediated dilation (FMD) has been widely used in clinical research as a non-invasive measure of endothelial function
Inadequate dilation following hyperemia signals endothelial dysfunction and has been linked to cardiovascular (CV) risk factors and conditions associated with atherosclerosis; inadequate peripheral FMD response has been associated with coronary endothelial dysfunction [1,2,3]
We previously reported on resting brachial artery diameter and FMD in 377 women with chest pain from the Women’s Ischemic Syndrome Evaluation Study (WISE) who underwent coronary angiography and risk factor assessment [4]
Summary
Brachial artery reactivity testing (BART) for measurement of flow-mediated dilation (FMD) has been widely used in clinical research as a non-invasive measure of endothelial function. We previously reported on resting brachial artery diameter and FMD in 377 women with chest pain from the Women’s Ischemic Syndrome Evaluation Study (WISE) who underwent coronary angiography and risk factor assessment [4]. It is generally assumed that release of the blood pressure cuff should result in an increase in the brachial artery diameter, constriction has been encountered in prior studies. This phenomenon has been largely ignored [3,5,6] or attributed to blunted endothelial function [7,8]. The novel risk marker of BAC requires further investigation in women
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
