Brachial arterial flow mediated dilation in acute ischemic stroke.
OBJECTIVE
Brachial arterial flow-mediated dilation (FMD) reflects endothelium-dependent vasodilation function. FMD is diminished in patients with endothelial dysfunction (ED). Our aim was to investigate the relationship between FMD and outcome for patients with acute ischemic stroke.


METHODS
We measured FMD in 120 consecutive patients (58.3% male, median age 73 years) with acute ischemic stroke within the first 48 h of onset of the stroke, using high-resolution ultrasonography. FMD was calculated as the relationship between basal diameter of the brachial artery before (d(1)) and after (d(2)) transient vascular occlusion (300 mmHg for 4 min) was measured using a sphygmomanometer (FMD = d(2) - d(1)/d(1) x 100). Poor outcome was defined as modified Rankin Scale at 3 months >2. FMD was categorized according to ROC analysis and we defined ED as FMD < or = 4.5%.


RESULTS
Thirty-three patients (27.5%) had ED. Median % FMD was 9.12 (7.48). FMD negatively correlated to stroke severity (P = 0.045). Median FMD was significantly lower [4.5 (2.3, 10.3) vs. 9.4 (5.6, 15.1), P = 0.003] for patients with poor outcome (n = 38). The adjusted odds ratio of poor outcome for FMD < or = 4.5% was 3.03 (95% CI, 1.09-27.3).


CONCLUSIONS
Impaired FMD in patients with acute ischemic stroke is associated with poor outcome.
Santos-García
D
D
Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain. diegosangar@yahoo.es
Blanco
M
M
Serena
J
J
Arias
S
S
Millán
M
M
Rodríguez-Yáñez
M
M
Leira
R
R
Dávalos
A
A
Castillo
J
J
D000208:Acute Disease; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D001916:Brachial Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002545:Brain Ischemia / Q000175:diagnosis* / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D042783:Endothelial Cells / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D012039:Regional Blood Flow / Q000502:physiology; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology*; D014463:Ultrasonography; D014664:Vasodilation / Q000502:physiology