title: [Brachial artery flow-mediated dilation in healthy men, men with risk factors, and men with acute myocardial infarction. Importance of occlusion-cuff position].
abstract: OBJECTIVE
  Flow-mediated dilation (FMD) is endothelium-dependent and can be assessed by ultrasound in the brachial artery. We sought to determine the most suitable position for the occlusion cuff for the study of FMD in three groups of adult men.
  
  
  METHODS
  We included 160 subjects, mean age 58.5 7.8 years: 40 healthy subjects, 80 with cardiovascular risk factors, and 40 patients with AMI. In a subgroup of 60 subjects, the first 10, 30, and 20 of each group, respectively, FMD was evaluated twice, after upper arm occlusion and forearm occlusion to induce hyperemia.
  
  
  RESULTS
  In the initial substudy, the FMD after upper arm occlusion was 7.6 2.4% in healthy subjects, 5.1 2.2% in men with risk factors (p < 0.0001), and 3.5 2.2% in AMI patients (p < 0.041, with respect to the risk-factor group). FMD after forearm occlusion was 4.6 1.5%, 2.3 2.1% (p < 0.006), and 2.2 1.9%, respectively, with no significant statistical differences between the risk-factor and AMI groups. Only upper arm occlusion was performed in the remaining participants, as planned, because it provided the most accurate information. Overall, the FMD was, respectively, 7.8 3.1%, 5 2.6% (p < 0.0001) and 3.3 3% (p < 0.004, with respect to the risk-factor group). FMD was directly related to HDL cholesterol and inversely related to resting diameter and number of risk factors.
  
  
  CONCLUSIONS
  The best approach to studying FMD is proximal occlusion since it allows for a better stratification of the with endothelial dysfunction. With this technique, a worsening of endothelial function in acute myocardial infarction can be demonstrated.
authors.affiliation: Servicios de Cardiología, Hospital Arnau de Vilanova, Lleida, Spain.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Dalli
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Segarra
authors.forename: Jorge
authors.initials: J
authors.lastname: Ruvira
authors.forename: Esther
authors.initials: E
authors.lastname: Esteban
authors.forename: Abraham
authors.initials: A
authors.lastname: Cabrera
authors.forename: Ramón
authors.initials: R
authors.lastname: Lliso
authors.forename: Esther
authors.initials: E
authors.lastname: López
authors.forename: Enric
authors.initials: E
authors.lastname: Llopis
authors.forename: José F
authors.initials: JF
authors.lastname: Sotillo
mesh_terms: D000368:Aged; D001916:Brachial Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology*; D012039:Regional Blood Flow; D012307:Risk Factors; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods