Endothelial dysfunction, carotid artery plaque burden, and conventional exercise-induced myocardial ischemia as predictors of coronary artery disease prognosis

Bonpei Takase,Akira Kurita,Masayuki Ishihara,Akimi Uehata,Yoshihiro Matsushima

doi:10.1186/1476-7120-6-61

Abstract

BackgroundWhile both flow-mediated vasodilation (FMD) in the brachial artery (BA), which measures endothelium-dependent vasodilatation, and intima-media thickness (IMT) in the carotid artery are correlated with the prognosis of coronary artery disease (CAD), it is not clear which modality is a better predictor of CAD. Furthermore, it has not been fully determined whether either of these modalities is superior to conventional ST-segment depression on exercise stress electrocardiogram (ECG) as a predictor. Thus, the goal of the present study was to compare the predictive value of FMD, IMT, and stress ECG for CAD prognosis.Methods and ResultsA total of 103 consecutive patients (62 ± 9 years old, 79 men) with clinically suspected CAD had FMD and nitroglycerin-induced dilation (NTG-D) in the BA, carotid artery IMT measurement using high-resolution ultrasound, and exercise treadmill testing. The 73 CAD patients and 30 normal coronary patients were followed for 50 ± 15 months. Fifteen patients had coronary events during this period (1 cardiac death, 2 non-fatal myocardial infarctions, 3 acute heart failures, and 9 unstable anginas). On Kaplan-Meier analysis, only FMD and stress ECG were significant predictors for cardiac events.ConclusionBrachial endothelial function as reflected by FMD and conventional exercise stress testing has comparable prognostic value, whereas carotid artery plaque burden appears to be less powerful for predicting future cardiac events.

Highlights

While both flow-mediated vasodilation (FMD) in the brachial artery (BA), which measures endothelium-dependent vasodilatation, and intima-media thickness (IMT) in the carotid artery are correlated with the prognosis of coronary artery disease (CAD), it is not clear which modality is a better predictor of CAD
Data are expressed as the mean ± SD and numbers in parenthesis expresses percentage of prevalence; CAD group, patients with significant coronary artery disease; NCAD group, patients with non-significant coronary artery stenosis; HDL, high density lipoprotein; Hypertension, blood pressure ≥ 160/95 mmHg; Diabetes mellitus, fasting blood sugar ≥ 126 mg/dl; Hyperlipidemia, total cholesterol ≥ 230 mg/dl; ACE-I or ARB, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers; No, numbers; * P < 0.05 vs. NCAD group
Among CAD group, 26 patients were performed elective percutaneous coronary intervention and these percutaneous coronary interventions were not included as cardiac events

Summary

Introduction

While both flow-mediated vasodilation (FMD) in the brachial artery (BA), which measures endothelium-dependent vasodilatation, and intima-media thickness (IMT) in the carotid artery are correlated with the prognosis of coronary artery disease (CAD), it is not clear which modality is a better predictor of CAD. It has not been fully determined whether either of these modalities is superior to conventional ST-segment depression on exercise stress electrocardiogram (ECG) as a predictor. Exercise stress testing is used as a conventional diagnostic modality but is used as a prognostic tool to predict adverse outcomes in patients with known CAD[12]. There are few studies that have directly compared the relatively new diagnostic modalities (FMD and/or IMT) with conventional exercise stress testing

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