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Hypertension. 2016 May;67(5):1045-52. doi: 10.1161/HYPERTENSIONAHA.115.06839. Epub 2016 Mar 14.

Combination of Flow-Mediated Vasodilation and Nitroglycerine-Induced Vasodilation Is More Effective for Prediction of Cardiovascular Events.

Author information

1
From the Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine (M.K., Y.A., A.N., Y.H.), Global Career Design Center (M.K.), Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences (T. Maruhashi., Y.I., T. Matsumoto., A.I., N.O., S.K., S.M., T.H., Y.K.), and Department of Gastroenterology and Metabolism, Institute of Biomedical and Health Sciences, Graduate School of Biomedical and Health Sciences (K.C.), Hiroshima University, Hiroshima, Japan; Center for Integrated Medical Research (E.H.) and Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research (K.N., Y.H.), Hiroshima University Hospital, Hiroshima, Japan; and Department of Physical Therapy, Hiroshima International University, Hiroshima, Japan (C.G.).
2
From the Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine (M.K., Y.A., A.N., Y.H.), Global Career Design Center (M.K.), Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences (T. Maruhashi., Y.I., T. Matsumoto., A.I., N.O., S.K., S.M., T.H., Y.K.), and Department of Gastroenterology and Metabolism, Institute of Biomedical and Health Sciences, Graduate School of Biomedical and Health Sciences (K.C.), Hiroshima University, Hiroshima, Japan; Center for Integrated Medical Research (E.H.) and Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research (K.N., Y.H.), Hiroshima University Hospital, Hiroshima, Japan; and Department of Physical Therapy, Hiroshima International University, Hiroshima, Japan (C.G.). yhigashi@hiroshima-u.ac.jp.

Abstract

Measurement of nitroglycerine-induced vasodilation has been performed to differentiate endothelium-dependent vasodilation from endothelium-independent vasodilation as a control test for flow-mediated vasodilation (FMD). Recently, nitroglycerine-induced vasodilation per se has been reported to be a useful marker of the grade of atherosclerosis. The present study aimed to evaluate the prognostic value of FMD combined with nitroglycerine-induced vasodilation for future cardiovascular events. We measured FMD and nitroglycerine-induced vasodilation in 402 subjects, including patients with cardiovascular diseases. During a median follow-up period of 32.3 months, 38 first major cardiovascular events (death from cardiovascular causes, acute myocardial infarction, stroke, and coronary revascularization) occurred. Receiver-operator characteristic curve analysis revealed that FMD alone and nitroglycerine-induced vasodilation alone can predict cardiovascular events with areas under the curve of 0.671 (cutoff 3.3%) and 0.692 (cutoff 11.6%), respectively. FMD combined with nitroglycerine-induced vasodilation predicts cardiovascular events with an area under the curve of 0.701. After adjustment for age, sex, and cardiovascular risk factors, above cutoff FMD (≥3.3%) and below cutoff nitroglycerine-induced vasodilation (<11.6%; hazard ratio, 5.55; 95% confidence interval, 1.61-25.46;P=0.006) and below cutoff FMD (<3.3%) and below cutoff nitroglycerine-induced vasodilation (<11.6%; hazard ratio, 7.20; 95% confidence interval, 2.37-31.36;P<0.001) remained strong independent indicator of cardiovascular events. These findings suggest that the combination of FMD and nitroglycerine-induced vasodilation measurements can more accurately predict cardiovascular events compared with FMD alone.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: UMIN000001167.

KEYWORDS:

atherosclerosis; biomarkers; cardiovascular diseases; endothelium; myocardial infarction

[Indexed for MEDLINE]

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