Higher brachial flow-mediated dilatation (RR 0.90 per 1% increase) and peripheral arterial tonometry (RR 0.85 per 0.1 increase) independently predict lower risk of cardiovascular events and mortality.
Meta-Analysis (n=15,191)
Does non-invasive endothelial function testing using brachial FMD or PAT predict future cardiovascular events and all-cause mortality?
Non-invasive endothelial function testing with brachial FMD and PAT independently predicts cardiovascular events and all-cause mortality, supporting their potential utility in clinical risk stratification.
Relative Risk: 0.9 (95% CI 0.88–0.92)
OBJECTIVES: We performed a systematic review and meta-analysis to understand the role of flow-mediated dilatation (FMD) of the brachial artery (BA) and peripheral arterial tonometry (PAT) in predicting adverse events, including cardiovascular (CV) events and all-cause mortality. BACKGROUND: FMD of the BA and PAT are non-invasive measures of endothelial function. Impairment of endothelial function is associated with increased CV events. While FMD is the more widely used and studied technique, PAT offers several advantages. The purpose of this systematic review and meta-analysis is to determine whether brachial FMD and PAT are independent risk factors for future CV events and mortality. METHODS: Multiple electronic databases were searched for articles relating FMD or PAT to CV events. Data were extracted on study characteristics, study quality, and study outcomes. Relative risks (RRs) from individual studies were combined and a pooled multivariate RR was calculated. RESULTS: Thirty-six studies for FMD were included in the systematic review, of which 32 studies consisting of 15, 191 individuals were meta-analysed. The pooled RR of CV events and all-cause mortality per 1% increase in brachial FMD, adjusting for potential confounders, was 0.90 (0.88-0.92). In contrast, only three studies evaluated the prognostic value of PAT for CV events, and the pooled RR per 0.1 increase in reactive hyperaemia index was 0.85 (0.78-0.93). CONCLUSION: Brachial FMD and PAT are independent predictors of CV events and all-cause mortality. Further research to evaluate the prognostic utility of PAT is necessary to compare it with FMD as a non-invasive endothelial function test in clinical practice.
Xu et al. (Tue,) conducted a meta-analysis in Cardiovascular events and all-cause mortality (n=15,191). Flow-mediated dilatation (FMD) and peripheral arterial tonometry (PAT) was evaluated on Cardiovascular events and all-cause mortality (RR 0.90, 95% CI 0.88-0.92). Higher brachial flow-mediated dilatation (RR 0.90 per 1% increase) and peripheral arterial tonometry (RR 0.85 per 0.1 increase) independently predict lower risk of cardiovascular events and mortality.