title: Noninvasive determination of endothelium-mediated vasodilation as a screening test for coronary artery disease: pilot study to assess the predictive value in comparison with angina pectoris, exercise electrocardiography, and myocardial perfusion imaging.
abstract: BACKGROUND
  Peripheral endothelial dysfunction (ED) quantified by the determination of flow-mediated dilation (FMD%) of the brachial artery with the use of high-resolution ultrasound is an early marker of atherosclerosis. Although a positive correlation with coronary artery disease (CAD) has been reported, the unanswered clinical question is the validity of FMD% as a screening test in patients with clinical suspicion of CAD. Thus the aim of this study was to determine the predictive value of FMD% compared with angina pectoris, exercise electrocardiography, and myocardial perfusion imaging.
  
  
  RESULTS
  In this pilot study, we measured ED in 122 patients scheduled for coronary angiography by using high-resolution ultrasound (13 MHz). We defined ED as FMD% </=4.5%. The presence of CAD was defined as angiographically detectable atherosclerotic vessel alterations of any degree. Exercise electrocardiography and myocardial perfusion imaging had been performed on an outpatient basis. Statistical analysis was conducted by analysis of variance and Mantel-Haenszel chi-square test. Patients with CAD (n = 101) had a significantly lower FMD% than patients without CAD (n = 21; 3.7% +/- 4.1% vs 7.01% +/- 3.5%, P <.001). A sensitivity of 71%, a specificity of 81% with a positive predictive value of 0.95 (72 of 76), and a negative predictive value of 0.41 (17 of 46) was calculated. In comparison to angina pectoris (sensitivity 95%, specificity 47.6%), exercise electrocardiography (sensitivity 82.4%, specificity 57.1%) and myocardial perfusion imaging (sensitivity in our study group 100%) had the best specificity, and a high sensitivity for FMD% was found.
  
  
  CONCLUSIONS
  The determination of ED was found to be a sensitive and specific screening test to predict the presence of CAD. Because this is a noninvasive, nonradioactive, and cost-effective approach, it warrants further evaluation to determine its value in daily clinical practice as an additional screening test in the diagnosis of CAD.
authors.affiliation: Department of Medicine, Division of Cardiology, University of Tuebingen, Germany. Dr.Schroeder@t-online.de
authors.forename: S
authors.initials: S
authors.lastname: Schroeder
authors.forename: M D
authors.initials: MD
authors.lastname: Enderle
authors.forename: R
authors.initials: R
authors.lastname: Ossen
authors.forename: C
authors.initials: C
authors.lastname: Meisner
authors.forename: A
authors.initials: A
authors.lastname: Baumbach
authors.forename: M
authors.initials: M
authors.lastname: Pfohl
authors.forename: C
authors.initials: C
authors.lastname: Herdeg
authors.forename: M
authors.initials: M
authors.lastname: Oberhoff
authors.forename: H U
authors.initials: HU
authors.lastname: Haering
authors.forename: K R
authors.initials: KR
authors.lastname: Karsch
mesh_terms: D000787:Angina Pectoris / Q000175:diagnosis; D001916:Brachial Artery / Q000000981:diagnostic imaging; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology; D004562:Electrocardiography; D004730:Endothelium, Vascular / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods; D014664:Vasodilation / Q000502:physiology*