title: Impaired brachial flow-mediated dilation is a predictor of a new-onset vascular event after stroke.
abstract: OBJECTIVE
  Brachial arterial flow-mediated dilation (FMD) is associated with an increased risk of vascular events. Our aim was to investigate the relationship between FMD measured in the acute phase of ischemic stroke and a new major adverse vascular event in a consecutive cohort of patients followed up for 48 months after an acute first-ever stroke.
  
  
  METHODS
  We measured FMD in 120 consecutive patients with acute ischemic stroke using high-resolution ultrasonography. FMD was calculated as the relationship between the basal diameter of the brachial artery before and after transient vascular occlusion. Intima-media thickness, extracranial carotid atherosclerosis, stroke severity National Institute of Health Stroke Scale, and modified Rankin Scale at 3 months were also evaluated. A vascular event was defined as any of the following: vascular disease (VD) death, nonfatal myocardial infarction (MI), nonfatal recurrent stroke (RS), claudication or peripheral arterial thrombosis (PVD), angioplasty or cardiac bypass graft surgery.
  
  
  RESULTS
  There were 34 new major adverse vascular events in 32 of 120 patients (26.7%): 21 (61.8%) RS, 5 (14.7%) VD death, 5 (14.7%) MI, and 3 (8.8%) PVD. The presence of carotid artery plaque (81.3 vs. 46%; p < 0.0001), atrial fibrillation (37.5 vs. 14.8%; p = 0.007) and FMD (5.30 ± 7.48 vs. 10.54 ± 7.02; p = 0.001) were associated with new-onset vascular events. FMD ≤4.5% was an independent predictor of new-onset vascular events (hazards ratio 3.48; 95% confidence interval 1.26-9.63; p = 0.01).
  
  
  CONCLUSIONS
  FMD is an independent predictor for a new-onset vascular event after first-ever ischemic stroke.
authors.affiliation: Stroke Unit, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, c/Travesa da Choupana s/n, Santiago de Compostela, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Santos-García
authors.forename: Miguel
authors.initials: M
authors.lastname: Blanco
authors.forename: Joaquín
authors.initials: J
authors.lastname: Serena
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez-Yáñez
authors.forename: Rogelio
authors.initials: R
authors.lastname: Leira
authors.forename: José
authors.initials: J
authors.lastname: Castillo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016893:Carotid Stenosis / Q000150:complications / Q000503:physiopathology; D015331:Cohort Studies; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D013927:Thrombosis / Q000453:epidemiology*; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography; D014652:Vascular Diseases / Q000453:epidemiology*