title: Predictive value of brachial reactive hyperemia and flow-mediated dilation in stable coronary artery disease.
abstract: BACKGROUND
  The purpose of this study was to determine the predictive value of a single measurement of reactive hyperemia (RH) and brachial flow-mediated dilation (FMD) in patients with established stable coronary artery disease (CAD).
  
  
  METHODS
  RH and brachial artery FMD were ultrasonographically measured in 325 patients with stable CAD. Patients were followed for cerebro-cardiovascular events. The median follow-up was 3.7 years (range 0.01-5.7 years).
  
  
  RESULTS
  Sixty-seven patients (20.6%) had an cerebro-cardiovascular event. Patients with subsequent events had lower FMD (4.9 ± 3.3% versus 6.3 ± 3.5%, p = 0.003), higher brachial artery resting diameter (5.1 ± 0.7 mm versus 4.8 ± 0.7 mm, p = 0.002) and lower NMD (11.2 ± 5.1% versus 12.8 ± 5.4%, p = 0.02), while the mean hyperemic flow velocity and shear stress did not differ from patients without cerebro-cardiovascular events. Cox proportional hazard model adjusted for sex, age, BMI, and traditional cardiovascular risk factors revealed a hazard ratio of 0.84 for lower FMD (p = 0.01).
  
  
  CONCLUSIONS
  We conclude that single spot measurements of peak RH do not provide long-term prognostic information, but evaluation of conduit artery FMD predicts long-term cerebro-cardiovascular events in patients with stable CAD. The prognostic value of FMD is incremental to traditional cardiovascular risk factors and may therefore be of clinical importance.
authors.affiliation: Department of Medicine II, University Medical Center Mainz, Germany.
authors.forename: Mir Abolfazl
authors.initials: MA
authors.lastname: Ostad
authors.affiliation: Department of Medicine II, University Medical Center Mainz, Germany Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany.
authors.forename: Philipp S
authors.initials: PS
authors.lastname: Wild
authors.affiliation: Department of Medicine II, University Medical Center Mainz, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Schnorbus
authors.affiliation: Department of Medicine II, University Medical Center Mainz, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schulz
authors.affiliation: Department of Medicine II, University Medical Center Mainz, Germany Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Munzel
authors.affiliation: Kardiologische Praxis Dr. Tauchert, PD Dr. Warnholtz, Griesheim, Germany.
authors.forename: Ascan
authors.initials: A
authors.lastname: Warnholtz
mesh_terms: D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000473:pathology*; D003324:Coronary Artery Disease; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors
keywords: Endothelium; coronary artery disease; flow-mediated dilation; reactive hyperemia; shear stress