Prognostic value of flow-mediated dilation and computed tomography angiography findings for determining cardiovascular risk in patients with subclinical atherosclerosis

Background Flow-mediated dilation (FMD) tests endothelial function, and computed tomography angiography (CTA) estimates the extent of coronary atherosclerosis and plaque vulnerability. This study aimed to examine the prognostic value of combining FMD and CTA in patients with no history of atherosclerotic disease. Methods The study retrospectively examined patients who underwent CTA and FMD within 3 months between 2012 and 2020. Patients with a history of cardio-cerebrovascular disease or significant stenoses on CTA were excluded. The study endpoint was defined as major cardiac and cerebrovascular events (MACCE): a composite of cardio-cerebrovascular death, acute coronary syndrome, fatal arrhythmia, ischaemic and haemorrhagic stroke, and late revascularisation of the coronary or carotid arteries 6 months after CTA. Finally, the patients were stratified into four groups based on the following factors: FMD <6.0%, per cent atheroma volume (PAV) ≥21.0%, and the presence of high-risk plaques (HRPs). Results During a mean follow-up of 4.7 years, MACCE occurred in 19 of 154 patients (mean age: 61.0±12.9 years, 89 males). FMD, PAV, and HRPs were independent predictors of MACCE after adjusting for age, sex, and hypertension. Compared with the patients with 0 points, hazard ratios of those with 1, 2, and 3 points were 2.76 (P=0.322), 9.89 (P=0.004), and 28.43 (P<0.001), respectively. Adding FMD, PAV, and HRPs to the baseline model, including age, sex, and hypertension, improved the C-index (0.712–0.831, P=0.023). Conclusions Although FMD and CTA findings are useful for predicting cardiovascular events, their combination synergises their prognostic abilities.