Endothelial dysfunction, increased arterial stiffness, and cardiovascular risk prediction in patients with coronary artery disease: FMD-J (flow-mediated dilation Japan) study A

Tatsuya Maruhashi, Junko Soga, Noritaka Fujimura, Naomi Idei, Shinsuke Mikami, Yumiko Iwamoto, Akimichi Iwamoto, Masato Kajikawa, Takeshi Matsumoto, Nozomu Oda, Shinji Kishimoto, Shogo Matsui, Haruki Hashimoto, Yoshiki Aibara, Farina Mohamad Yusoff, Takayuki Hidaka, Yasuki Kihara, Kazuaki Chayama, Kensuke Noma, Ayumu NakashimaChikara Goto, Hirofumi Tomiyama, Bonpei Takase, Takahide Kohro, Toru Suzuki, Tomoko Ishizu, Shinichiro Ueda, Tsutomu Yamazaki, Tomoo Furumoto, Kazuomi Kario, Teruo Inoue, Shinji Koba, Kentaro Watanabe, Yasuhiko Takemoto, Takuzo Hano, Masataka Sata, Yutaka Ishibashi, Koichi Node, Koji Maemura, Yusuke Ohya, Taiji Furukawa, Hiroshi Ito, Hisao Ikeda, Akira Yamashina, Yukihito Higashi

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Abstract

Background—The usefulness of vascular function tests for management of patients with a history of coronary artery disease is not fully known. Methods and Results—We measured flow-mediated vasodilation (FMD) and brachial–ankle pulse wave velocity (baPWV) in 462 patients with coronary artery disease for assessment of the predictive value of FMD and baPWV for future cardiovascular events in a prospective multicenter observational study. The first primary outcome was coronary events, and the second primary outcome was a composite of coronary events, stroke, heart failure, and sudden death. During a median follow-up period of 49.2 months, the first primary outcome occurred in 56 patients and the second primary outcome occurred in 66 patients. FMD above the cutoff value of 7.1%, derived from receiver-operator curve analyses for the first and second primary outcomes, was significantly associated with lower risk of the first (hazard ratio, 0.27; 95% confidence interval, 0.06–0.74; P=0.008) and second (hazard ratio, 0.32; 95% confidence interval, 0.09–0.79; P=0.01) primary outcomes. baPWV above the cutoff value of 1731 cm/s was significantly associated with higher risk of the first (hazard ratio, 1.86; 95% confidence interval, 1.01–3.44; P=0.04) and second (hazard ratio, 2.19; 95% confidence interval, 1.23–3.90; P=0.008) primary outcomes. Among 4 groups stratified according to the combination of cutoff values of FMD and baPWV, stepwise increases in the calculated risk ratio for the first and second primary outcomes were observed. Conclusions—In patients with coronary artery disease, both FMD and baPWV were significant predictors of cardiovascular events. The combination of FMD and baPWV provided further cardiovascular risk stratification. Clinical Trial Registration—URL: www.umin.ac.jp. Unique identifier: UMIN000012950.

Original languageEnglish
Article numbere008588
JournalJournal of the American Heart Association
Volume7
Issue number14
DOIs
Publication statusPublished - Jul 1 2018

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Keywords

  • Arterial stiffness
  • Coronary artery disease
  • Endothelial function
  • Flow-induced dilation
  • Pulse wave velocity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Maruhashi, T., Soga, J., Fujimura, N., Idei, N., Mikami, S., Iwamoto, Y., Iwamoto, A., Kajikawa, M., Matsumoto, T., Oda, N., Kishimoto, S., Matsui, S., Hashimoto, H., Aibara, Y., Yusoff, F. M., Hidaka, T., Kihara, Y., Chayama, K., Noma, K., ... Higashi, Y. (2018). Endothelial dysfunction, increased arterial stiffness, and cardiovascular risk prediction in patients with coronary artery disease: FMD-J (flow-mediated dilation Japan) study A. Journal of the American Heart Association, 7(14), [e008588]. https://doi.org/10.1161/JAHA.118.008588