Noninvasive tests for arterial structure, function, and compliance: do they identify risk or diagnose disease?
BACKGROUND
Brachial artery reactivity (BAR), carotid intima-media thickness (IMT), and applanation tonometry for evaluation of total arterial compliance may provide information about preclinical vascular disease. We sought to determine whether these tests could be used to identify patients with coronary artery disease (CAD) without being influenced by their ability to identify those at risk for CAD developing.


METHODS
We studied 100 patients and compared 3 groups: 35 patients with known CAD; 34 patients with symptoms and risk factors but no CAD identified by stress echocardiography (risk group); and 31 control subjects. BAR and IMT were measured using standard methods, and total arterial compliance was calculated by the pulse-pressure method from simultaneous radial applanation tonometry and pulsed wave Doppler of the left ventricular outflow. Ischemia was identified as a new or worsening wall-motion abnormality induced by stress.


RESULTS
In a comparison between the control subjects and patients either at risk for developing CAD or with CAD, the predictors of risk for CAD were: age (P =.01); smoking history (P =.002); hypercholesterolemia (P =.002); and hypertension (P =.004) (model R = 0.82; P =.0001). The independent predictors of CAD were: IMT (P =.001); BAR (P =.04); sex (P =.005); and hypertension (P =.005) (model R = 0.80; P =.0001).


CONCLUSIONS
IMT, BAR, and traditional cardiovascular risk factors appear to identify patients at risk for CAD developing. However, only IMT was significantly different between patients at risk for developing CAD and those with overt CAD.
Haluska
Brian A
BA
University Department of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Queensland 4012, Australia. bhaluska@soms.uq.edu.au
Fathi
Robert
R
Jeffriess
Leanne
L
Leano
Rodel
R
Carlier
Stephane G
SG
Marwick
Thomas H
TH
D000368:Aged; D001916:Brachial Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D018617:Ultrasonography, Doppler, Pulsed; D014655:Vascular Resistance / Q000502:physiology*