open access

Vol 27, No 1 (2020)
Original articles — Clinical cardiology
Published online: 2018-08-14
Get Citation

The comparison of endothelial function between conduit artery and microvasculature in patients with coronary artery disease

Emi Tajima, Masashi Sakuma, Seiko Tokoi, Hisae Matsumoto, Fumiya Saito, Ryo Watanabe, Shigeru Toyoda, Shichiro Abe, Teruo Inoue
DOI: 10.5603/CJ.a2018.0077
·
Pubmed: 30155869
·
Cardiol J 2020;27(1):38-46.

open access

Vol 27, No 1 (2020)
Original articles — Clinical cardiology
Published online: 2018-08-14

Abstract

Background: Flow-mediated dilation (FMD) and reactive hyperemia-peripheral arterial tonometry (RH-PAT) are both established modalities to assess vascular endothelial function. However, clinical significance of FMD and RH-PAT may be different because these methods measure vascular function in different vessels (conduit arteries and resistance vessels).

Methods: To elucidate differences in the clinical significance of FMD and RH-PAT, a simultaneous determination of FMD was performed and reactive hyperemia index (RHI) measured by RH-PAT in 131 consecutive patients who underwent coronary angiography for suspicion of coronary artery disease (CAD).

Results: There was no significant correlation between FMD and RHI in patients overall. When patients were divided into four groups: FMD 6%/RHI 1.67 group, FMD 6%/RHI < 1.67 group, FMD < 6%/RHI 1.67 group and FMD < 6%/RHI < 1.67 group, the highest incidence of multivessel CAD was seen in the FMD < 6%/RHI < 1.67 group (52%). Multiple logistic regression analysis showed that a prevalence of both FMD < 6% and RHI < 1.67 was an independent predictor of multivessel CAD (odds ratio: 4.160, 95% confidence interval: 1.505–11.500, p = 0.006). RHI was negatively correlated with the baseline vessel diameter (R = –0.268, p = 0.0065) and maximum vessel diameter (R = –0.266, p = 0.0069) in patients with FMD < 6%, whereas these correlations were absent in patients with FMD 6%.

Conclusions: Present results suggest that noninvasive assessment of vascular endothelial functions provide pathophysiological information on both conduit arteries and resistance vessels in patients with CAD.

Abstract

Background: Flow-mediated dilation (FMD) and reactive hyperemia-peripheral arterial tonometry (RH-PAT) are both established modalities to assess vascular endothelial function. However, clinical significance of FMD and RH-PAT may be different because these methods measure vascular function in different vessels (conduit arteries and resistance vessels).

Methods: To elucidate differences in the clinical significance of FMD and RH-PAT, a simultaneous determination of FMD was performed and reactive hyperemia index (RHI) measured by RH-PAT in 131 consecutive patients who underwent coronary angiography for suspicion of coronary artery disease (CAD).

Results: There was no significant correlation between FMD and RHI in patients overall. When patients were divided into four groups: FMD 6%/RHI 1.67 group, FMD 6%/RHI < 1.67 group, FMD < 6%/RHI 1.67 group and FMD < 6%/RHI < 1.67 group, the highest incidence of multivessel CAD was seen in the FMD < 6%/RHI < 1.67 group (52%). Multiple logistic regression analysis showed that a prevalence of both FMD < 6% and RHI < 1.67 was an independent predictor of multivessel CAD (odds ratio: 4.160, 95% confidence interval: 1.505–11.500, p = 0.006). RHI was negatively correlated with the baseline vessel diameter (R = –0.268, p = 0.0065) and maximum vessel diameter (R = –0.266, p = 0.0069) in patients with FMD < 6%, whereas these correlations were absent in patients with FMD 6%.

Conclusions: Present results suggest that noninvasive assessment of vascular endothelial functions provide pathophysiological information on both conduit arteries and resistance vessels in patients with CAD.

Get Citation

Keywords

flow mediated-dilation, reactive hyperemia-peripheral arterial tonometry, reactive hyperemia index, vascular endothelial function, coronary artery disease

About this article
Title

The comparison of endothelial function between conduit artery and microvasculature in patients with coronary artery disease

Journal

Cardiology Journal

Issue

Vol 27, No 1 (2020)

Pages

38-46

Published online

2018-08-14

DOI

10.5603/CJ.a2018.0077

Pubmed

30155869

Bibliographic record

Cardiol J 2020;27(1):38-46.

Keywords

flow mediated-dilation
reactive hyperemia-peripheral arterial tonometry
reactive hyperemia index
vascular endothelial function
coronary artery disease

Authors

Emi Tajima
Masashi Sakuma
Seiko Tokoi
Hisae Matsumoto
Fumiya Saito
Ryo Watanabe
Shigeru Toyoda
Shichiro Abe
Teruo Inoue

References (24)
  1. Lerman A, Zeiher AM. Endothelial function: cardiac events. Circulation. 2005; 111(3): 363–368.
  2. Flammer AJ, Anderson T, Celermajer DS, et al. The assessment of endothelial function: from research into clinical practice. Circulation. 2012; 126(6): 753–767.
  3. Anderson TJ, Uehata A, Gerhard MD, et al. Close relation of endothelial function in the human coronary and peripheral circulations. J Am Coll Cardiol. 1995; 26(5): 1235–1241.
  4. Celermajer DS, Sorensen KE, Gooch VM, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992; 340(8828): 1111–1115.
  5. Joannides R, Haefeli WE, Linder L, et al. Nitric oxide is responsible for flow-dependent dilatation of human peripheral conduit arteries in vivo. Circulation. 1995; 91(5): 1314–1319.
  6. Anderson TJ, Uehata A, Gerhard MD, et al. Close relation of endothelial function in the human coronary and peripheral circulations. J Am Coll Cardiol. 1995; 26(5): 1235–1241.
  7. Green DJ, Jones H, Thijssen D, et al. Flow-mediated dilation and cardiovascular event prediction: does nitric oxide matter? Hypertension. 2011; 57(3): 363–369.
  8. Matsubara J, Sugiyama S, Akiyama E, et al. Dipeptidyl peptidase-4 inhibitor, sitagliptin, improves endothelial dysfunction in association with its anti-inflammatory effects in patients with coronary artery disease and uncontrolled diabetes. Circ J. 2013; 77(5): 1337–1344.
  9. Inoue T, Matsuoka H, Higashi Y, et al. Flow-mediated vasodilation as a diagnostic modality for vascular failure. Hypertens Res. 2008; 31(12): 2105–2113.
  10. Hamburg NM, Palmisano J, Larson MG, et al. Relation of brachial and digital measures of vascular function in the community: the Framingham heart study. Hypertension. 2011; 57(3): 390–396.
  11. Nohria A, Gerhard-Herman M, Creager MA, et al. Role of nitric oxide in the regulation of digital pulse volume amplitude in humans. J Appl Physiol (1985). 2006; 101(2): 545–548.
  12. Vanhoutte PM, Mombouli JV. Vascular endothelium: vasoactive mediators. Prog Cardiovasc Dis. 1996; 39(3): 229–238.
  13. Rubinshtein R, Kuvin JT, Soffler M, et al. Assessment of endothelial function by non-invasive peripheral arterial tonometry predicts late cardiovascular adverse events. Eur Heart J. 2010; 31(9): 1142–1148.
  14. Tomiyama H, Yoshida M, Higashi Y, et al. Autonomic nervous activation triggered during induction of reactive hyperemia exerts a greater influence on the measured reactive hyperemia index by peripheral arterial tonometry than on flow-mediated vasodilatation of the brachial artery in patients with hypertension. Hypertens Res. 2014; 37(10): 914–918.
  15. Matsuo S, Imai E, Horio M, et al. Collaborators developing the Japanese equation for estimated GFR. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009; 53(6): 982–992.
  16. Vogel RA. Measurement of endothelial function by brachial artery flow-mediated vasodilation. Am J Cardiol. 2001; 88(2A): 31E–34E.
  17. Bonetti PO, Pumper GM, Higano ST, et al. Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia. J Am Coll Cardiol. 2004; 44(11): 2137–2141.
  18. Dhindsa M, Sommerlad SM, DeVan AE, et al. Interrelationships among noninvasive measures of postischemic macro- and microvascular reactivity. J Appl Physiol (1985). 2008; 105(2): 427–432.
  19. Hamburg NM, Palmisano J, Larson MG, et al. Relation of brachial and digital measures of vascular function in the community: the Framingham heart study. Hypertension. 2011; 57(3): 390–396.
  20. Schnabel RB, Schulz A, Wild PS, et al. Noninvasive vascular function measurement in the community: cross-sectional relations and comparison of methods. Circ Cardiovasc Imaging. 2011; 4(4): 371–380.
  21. Hamburg NM, Keyes MJ, Larson MG, et al. Cross-sectional relations of digital vascular function to cardiovascular risk factors in the Framingham Heart Study. Circulation. 2008; 117(19): 2467–2474.
  22. Woo JS, Jang WS, Kim HS, et al. Comparison of peripheral arterial tonometry and flow-mediated vasodilation for assessment of the severity and complexity of coronary artery disease. Coron Artery Dis. 2014; 25(5): 421–426.
  23. Schiffrin EL. Beyond blood pressure: the endothelium and atherosclerosis progression. Am J Hypertens. 2002; 15(10 Pt 2): 115S–122S.
  24. Tong XK, Nicolakakis N, Kocharyan A, et al. Vascular remodeling versus amyloid beta-induced oxidative stress in the cerebrovascular dysfunctions associated with Alzheimer's disease. J Neurosci. 2005; 25(48): 11165–11174.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl