Worse brachial-radial flow-mediated slowing response was significantly correlated with markers of worse left ventricular diastolic function, including lower E peak velocity and E/A ratio (p<0.01).
Cross-Sectional (n=420)
Is macrovascular reactivity assessed by brachial-radial flow-mediated slowing associated with left ventricular diastolic function?
Brachial-radial flow-mediated slowing is associated with echocardiographic markers of left ventricular relaxation, suggesting its potential as a practical, non-invasive tool for early detection of ventricular-vascular mismatch.
p-value: p=<0.01
Objective: Endothelial dysfunction is an early sign of cardiovascular (CV) disease and closely linked to left ventricular (LV) diastolic function through shared mechanisms such as nitric oxide imbalance. While flow-mediated dilation is the gold standard for assessing endothelial function, its complexity limits daily clinical use. Flow-mediated slowing (FMS), a non-invasive user-friendly technique measuring transient changes in brachial-radial pulse wave velocity (PWV) during reactive hyperemia, may offer a practical alternative. This study investigates the association between FMS and LV diastolic function, to evaluate FMS as a clinically applicable marker of macrovascular reactivity and, in extent, endothelial health. Design and method: A cross-sectional analysis was performed of 420 adults with and without CV risk factors from the FLEMENGHO and PRIORITY cohort. Brachial-radial FMS was assessed using the Vicorder® device as the relative change in brachial-radial PWV following five minutes of brachial cuff occlusion. FMS was quantified as the relative PWV change at each 30-second interval and categorized as (ab)normal peak based on age-specific reference cutoffs and as (ab)normal trajectory. LV diastolic function was evaluated using echocardiography. Associations were examined using correlation analysis and multivariable regression modelling. Results: Among 420 adults (mean age 61.7±10.5 years; 44.5% women), 319 had at least one CV risk factor, while 101 were apparently healthy. Less decline in brachial-radial PWV within the first 180 seconds post-occlusion, indicating worse FMS response, was significantly correlated with lower E peak velocity, E/A ratio, and E’ peak velocity, markers of worse LV diastolic function (p<0.01) (Figure 1). No significant correlations were found with E/E’ ratio or A peak velocity. The inverse associations with E peak velocity, E/A ratio and E’ peak velocity remained significant after multivariable adjustment (p<0.05) (Table 1). Categorically, an abnormally low peak was associated with significantly lower E peak velocity (p<0.01). Conclusions: Worse macrovascular reactivity, assessed by brachial-radial FMS was associated with worse LV diastolic function, particularly LV relaxation. These findings align with the documented physiological coupling between endothelial health and myocardial relaxation. Overall, these results support the potential use of FMS as a practical, non-invasive tool for early detection of ventricular-vascular mismatches.
Renier et al. (Fri,) conducted a cross-sectional in Cardiovascular risk factors (n=420). Brachial-radial flow-mediated slowing (FMS) vs. Normal FMS response was evaluated on Left ventricular diastolic function (E peak velocity, E/A ratio, and E' peak velocity) (p=<0.01). Worse brachial-radial flow-mediated slowing response was significantly correlated with markers of worse left ventricular diastolic function, including lower E peak velocity and E/A ratio (p<0.01).