title: Comparison of brachial artery wall thickness versus endothelial function to predict late cardiovascular events in patients undergoing elective coronary angiography.
abstract: An increased brachial artery intima media thickness (BA-IMT) has been shown to be of prognostic value. Conflicting prognostic data have been reported for brachial artery flow-mediated vasodilation (BA-FMD), and the longest evaluated follow-up period to date is 5.5 years. We sought to investigate the very late prognostic value of BA-IMT and BA-FMD in 396 consecutive patients (age 54 ± 9 years) admitted for invasive evaluation of chest pain. BA-IMT and BA-FMD were measured using high-resolution ultrasonography. The patients were divided according to the median BA-IMT (0.37 mm) and median BA-FMD (7.6%). After a mean follow-up of 141 ± 12 months, cardiovascular events were documented. More cardiovascular events were found in patients with an increased BA-IMT (50 vs 78 events, p = 0.003). When the groups were compared according to the median BA-FMD, no differences in the number of events were documented (70 vs 75 events, p = 0.60). On multivariate Cox regression analysis, including age, number of risk factors, BA diameter, presence of coronary artery disease, BA-FMD, and BA-IMT, only the presence of coronary artery disease and BA-IMT remained significantly associated with outcome. In conclusion, BA-IMT, but not BA-FMD, predicted cardiovascular events and cardiovascular death with ≤12 years of follow-up in patients undergoing an invasive evaluation of chest pain. Our results represent, by far, the longest follow-up of BA-IMT and peripheral endothelial function testing compared with previously reported data.
authors.affiliation: University Clinic for Internal Medicine III, Cardiology, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Alois
authors.initials: A
authors.lastname: Suessenbacher
authors.forename: Jakob
authors.initials: J
authors.lastname: Dörler
authors.forename: Johannes
authors.initials: J
authors.lastname: Wunder
authors.forename: Fabian
authors.initials: F
authors.lastname: Hohenwarter
authors.forename: Hannes F
authors.initials: HF
authors.lastname: Alber
authors.forename: Otmar
authors.initials: O
authors.lastname: Pachinger
authors.forename: Matthias
authors.initials: M
authors.lastname: Frick
mesh_terms: D001916:Brachial Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017023:Coronary Angiography; D018450:Disease Progression; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D014664:Vasodilation / Q000502:physiology*