title: Volume elastic modulus of the brachial artery and coronary artery stenosis in patients with suspected stable coronary artery disease.
abstract: This study aimed to examine the association between the non-invasive measurement of the brachial artery volume elastic modulus (V E), an index of arterial stiffness, and the presence of coronary artery stenosis in patients with suspected stable coronary artery disease (CAD). A total of 135 patients with suspected stable CAD (87 men, mean age, 64 ± 12 years) underwent oscillometric measurement of the brachial artery to obtain V E. Coronary angiography was thereafter carried out to diagnose CAD, defined as having ≥75 % stenosis in the epicardial coronary arteries. V E was significantly higher in patients with CAD (1.94 ± 0.34 mmHg/%) than in those without CAD (1.71 ± 0.35 mmHg/%, P < 0.001). In multiple logistic regression analysis, V E was an independent predictor for the presence of CAD (odds ratio 1.19 per 0.1 mmHg/% increase, 95 % CI 1.04-1.51) even after adjusting for multiple potential confounders including the Framingham risk score (FRS). The area under the curve of the receiver operating characteristic curve analysis for discriminating CAD increased significantly after the addition of V E to the FRS (from 0.75 to 0.81, P = 0.034). The category-free net reclassification improvement and the integrated discrimination improvement by adding V E to the FRS were 0.476 (95 % CI 0.146-0.806) and 0.086 (95 % CI 0.041-0.132), respectively. In conclusion, the brachial V E was significantly associated with the presence of coronary artery stenosis. The additional measurement of V E to the FRS improved the ability to identify patients with coronary artery stenosis among those with suspected stable CAD.
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan. rmuna@nms.ac.jp.
authors.forename: Ryo
authors.initials: R
authors.lastname: Munakata
authors.affiliation: Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo City, 113-8602, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Otsuka
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Saori
authors.initials: S
authors.lastname: Uchiyama
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Shimura
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Kurihara
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Nakahisa
authors.initials: N
authors.lastname: Kimata
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Inami
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Murakami
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohba
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Takano
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Chikao
authors.initials: C
authors.lastname: Ibuki
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Seino
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo City, 113-8602, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001916:Brachial Artery / Q000503:physiopathology*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000503:physiopathology*; D055119:Elastic Modulus; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009991:Oscillometry; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D059289:Vascular Stiffness
keywords: Brachial artery stiffness; Coronary artery disease; Framingham risk score; Oscillometric measurement; Risk prediction