Why the study?
Does an improvement in brachial artery flow-mediated dilation (FMD ≥ 3%) predict a reduction in cardiovascular events in patients with coronary artery disease?
Does an improvement in brachial artery flow-mediated dilation (FMD ≥ 3%) predict a reduction in cardiovascular events in patients with coronary artery disease?
Serial measurement of brachial artery flow-mediated dilation ('delta-FMD') may be a better prognostic indicator for cardiovascular events than a single baseline measurement in patients with coronary artery disease.
FMD improvement was associated with fewer events in CAD; hypothesis-generating for serial monitoring and requires prospective validation before clinical use.
The aim of this pilot study was to test the prognostic value of serial measurements of peripheral endothelial function, assessed by brachial artery flow-mediated dilation (FMD), in patients with angiographically proven coronary artery disease. In 68 patients, FMD was measured on the day after coronary angiography and again after a mean of 14 +/- 12 months. Patients were divided into two groups: absolute improvement in FMD > or = 3% (FMD-improver = FMD-i) and < 3% (FMD-non-improver = FMD-ni). After a mean follow-up of 44 +/- 12 months, cardiovascular events were recorded. Baseline characteristics were similar between groups, except the number of risk factors which was smaller in FMD-i (1.6 +/- 0.7 vs 2.1 +/- 0.9, p < 0.02). Cardiovascular events were more frequent in FMD-ni (9 vs 1 event; p < 0.05). In Kaplan-Meier analysis, a trend towards a better outcome in patients with improved FMD was found using the log-rank test (p = 0.08). The single baseline FMD showed no relationship with late cardiovascular events. Thus, 'delta-FMD' may be more closely related to prognosis than a single FMD measurement.
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Suessenbacher et al. (2006) studied this question.
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