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J Am Heart Assoc. 2018 Jul 12;7(14). pii: e008588. doi: 10.1161/JAHA.118.008588.

Endothelial Dysfunction, Increased Arterial Stiffness, and Cardiovascular Risk Prediction in Patients With Coronary Artery Disease: FMD-J (Flow-Mediated Dilation Japan) Study A.

Author information

1
Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
2
Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
3
Department of Gastroenterology and Metabolism, Biomedical Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
4
Division of Regeneration and Medicine, Hiroshima University Hospital, Hiroshima, Japan.
5
Hiroshima International University, Hiroshima, Japan.
6
Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
7
Division of Biomedical Engineering, National Defense Medical College Research Institute, Tokorozawa, Japan.
8
Cardiovascular Medicine, University of Leicester, United Kingdom.
9
Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan.
10
Department of Clinical Pharmacology and Therapeutics, University of the Ryukyu School of Medicine, Okinawa, Japan.
11
Clinical Research Support Center, Faculty of Medicine, The University of Tokyo, Japan.
12
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan.
13
Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
14
Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan.
15
Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan.
16
Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (DNHMED), Yamagata University School of Medicine, Yamagata, Japan.
17
Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
18
Department of Medical Education and Population-Based Medicine, Postgraduate School of Medicine, Wakayama Medical University, Wakayama, Japan.
19
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
20
Department of General Medicine, Shimane University Faculty of Medicine, Izumo, Japan.
21
Department of Cardiovascular and Renal Medicine, Saga University, Saga, Japan.
22
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
23
The Third Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan.
24
Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
25
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
26
Faculty of Fukuoka Medical Technology, Teikyo University, Omuta, Japan.
27
Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan yhigashi@hiroshima-u.ac.jp.

Abstract

BACKGROUND:

The usefulness of vascular function tests for management of patients with a history of coronary artery disease is not fully known.

METHODS AND RESULTS:

We measured flow-mediated vasodilation (FMD) and brachial-ankle pulse wave velocity (baPWV) in 462 patients with coronary artery disease for assessment of the predictive value of FMD and baPWV for future cardiovascular events in a prospective multicenter observational study. The first primary outcome was coronary events, and the second primary outcome was a composite of coronary events, stroke, heart failure, and sudden death. During a median follow-up period of 49.2 months, the first primary outcome occurred in 56 patients and the second primary outcome occurred in 66 patients. FMD above the cutoff value of 7.1%, derived from receiver-operator curve analyses for the first and second primary outcomes, was significantly associated with lower risk of the first (hazard ratio, 0.27; 95% confidence interval, 0.06-0.74; P=0.008) and second (hazard ratio, 0.32; 95% confidence interval, 0.09-0.79; P=0.01) primary outcomes. baPWV above the cutoff value of 1731 cm/s was significantly associated with higher risk of the first (hazard ratio, 1.86; 95% confidence interval, 1.01-3.44; P=0.04) and second (hazard ratio, 2.19; 95% confidence interval, 1.23-3.90; P=0.008) primary outcomes. Among 4 groups stratified according to the combination of cutoff values of FMD and baPWV, stepwise increases in the calculated risk ratio for the first and second primary outcomes were observed.

CONCLUSIONS:

In patients with coronary artery disease, both FMD and baPWV were significant predictors of cardiovascular events. The combination of FMD and baPWV provided further cardiovascular risk stratification.

CLINICAL TRIAL REGISTRATION:

URL: www.umin.ac.jp. Unique identifier: UMIN000012950.

KEYWORDS:

arterial stiffness; coronary artery disease; endothelial function; flow‐induced dilation; pulse wave velocity

PMID:
30005558
PMCID:
PMC6064856
DOI:
10.1161/JAHA.118.008588
[Indexed for MEDLINE]
Free PMC Article

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