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(Circulation. 2002;106:653.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
From the Cardiology Branch (J.P.J.H., W.H.S., G.Z., R.M., A.P., K.R.A.N., A.A.Q.), Office of Biostatistics Research (M.A.W.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
Correspondence to Arshed A. Quyyumi, MD, Professor of Medicine (Cardiology), Emory University Hospital, Suite F606, 1364 Clifton Rd NE, Atlanta, GA 30322. E-mail aquyyum{at}emory.edu
Background Whether patients at increased risk can be identified from a relatively low-risk population by coronary vascular function testing remains unknown. We investigated the relationship between coronary endothelial function and the occurrence of acute unpredictable cardiovascular events (cardiovascular death, myocardial infarction, stroke, and unstable angina) in patients with and without coronary atherosclerosis (CAD).
Methods and Results We measured the change in coronary vascular resistance (
CVR) and epicardial diameter with intracoronary acetylcholine (ACh, 15 µg/min) to test endothelium-dependent function and sodium nitroprusside (20 µg/min) and adenosine (2.2 mg/min) to test endothelium-independent vascular function in 308 patients undergoing cardiac catheterization (132 with and 176 without CAD). Patients underwent clinical follow-up for a mean of 46±3 months. Acute vascular events occurred in 35 patients. After multivariate analysis that included CAD and conventional risk factors for atherosclerosis,
CVR with ACh (P=0.02) and epicardial constriction with ACh (P=0.003), together with increasing age, CAD, and body mass index, were independent predictors of adverse events. Thus, patients in the tertile with the best microvascular responses with ACh and those with epicardial dilation with ACh had improved survival by Kaplan-Meier analyses in the total population, as did those in the subset without CAD. Similar improvement in survival was also observed when all adverse events, including revascularization, were considered. Endothelium-independent responses were not predictive of outcome.
Conclusions Epicardial and microvascular coronary endothelial dysfunction independently predict acute cardiovascular events in patients with and without CAD, providing both functional and prognostic information that complements angiographic and risk factor assessment.
Key Words: atherosclerosis coronary disease endothelium prognosis infarction
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H. Zhang, A. Zhang, D.E. Kohan, R.D. Nelson, F.J. Gonzales, T. Yang, C. Schmidt-Lucke, L. Rossig, S. Fichtlscherer, M. Vasa, et al. Edema and Congestive Heart Failure from Thiazolidone Insulin Sensitizers--Excess Sodium Reabsoption in the Collecting Duct: Collecting Duct-Specific Deletion of Peroxisome Proliferator-Activated Receptor {gamma} Blocks Thiazolidinedione-Induced Fluid Retention. Proc Nat Acad Sci U S A 102: 9406-9411, 2005 J. Am. Soc. Nephrol., November 1, 2005; 16(11): 3139 - 3142. [Full Text] [PDF] |
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K. E Pyke and M. E Tschakovsky The relationship between shear stress and flow-mediated dilatation: implications for the assessment of endothelial function J. Physiol., October 15, 2005; 568(2): 357 - 369. [Abstract] [Full Text] [PDF] |
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S. M. Wildhirt, C. Schulze, N. Conrad, R. Bauernschmitt, R. Lange, and W. von Scheidt Persistently increased systemic, but not cardiac-specific, adhesion molecule expression and coronary endothelial dysfunction in human cardiac allografts J. Thorac. Cardiovasc. Surg., October 1, 2005; 130(4): 1175 - 1175. [Abstract] [Full Text] [PDF] |
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M. Schwaiger, S. Ziegler, and S. G. Nekolla PET/CT: Challenge for Nuclear Cardiology J. Nucl. Med., October 1, 2005; 46(10): 1664 - 1678. [Abstract] [Full Text] [PDF] |
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J P J Halcox and J E Deanfield Childhood origins of endothelial dysfunction Heart, October 1, 2005; 91(10): 1272 - 1274. [Full Text] [PDF] |
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J A Vita Endothelial function and clinical outcome Heart, October 1, 2005; 91(10): 1278 - 1279. [Full Text] [PDF] |
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N. P. Johnson and K. L. Gould Clinical Evaluation of a New Concept: Resting Myocardial Perfusion Heterogeneity Quantified by Markovian Analysis of PET Identifies Coronary Microvascular Dysfunction and Early Atherosclerosis in 1,034 Subjects J. Nucl. Med., September 1, 2005; 46(9): 1427 - 1437. [Abstract] [Full Text] [PDF] |
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E. Oechslin, W. Kiowski, R. Schindler, A. Bernheim, B. Julius, and H. P. Brunner-La Rocca Systemic Endothelial Dysfunction in Adults With Cyanotic Congenital Heart Disease Circulation, August 23, 2005; 112(8): 1106 - 1112. [Abstract] [Full Text] [PDF] |
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Y. Neishi, S. Mochizuki, T. Miyasaka, T. Kawamoto, T. Kume, R. Sukmawan, M. Tsukiji, Y. Ogasawara, F. Kajiya, T. Akasaka, et al. Evaluation of bioavailability of nitric oxide in coronary circulation by direct measurement of plasma nitric oxide concentration PNAS, August 9, 2005; 102(32): 11456 - 11461. [Abstract] [Full Text] [PDF] |
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P.-H. Huang, L.-C. Chen, H.-B. Leu, P. Y.-A. Ding, J.-W. Chen, T.-C. Wu, and S.-J. Lin Enhanced Coronary Calcification Determined by Electron Beam CT Is Strongly Related to Endothelial Dysfunction in Patients With Suspected Coronary Artery Disease Chest, August 1, 2005; 128(2): 810 - 815. [Abstract] [Full Text] [PDF] |
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P. Thanyasiri, D. S. Celermajer, and M. R. Adams Endothelial dysfunction occurs in peripheral circulation patients with acute and stable coronary artery disease Am J Physiol Heart Circ Physiol, August 1, 2005; 289(2): H513 - H517. [Abstract] [Full Text] [PDF] |
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D. Wu, L. Liu, M. Meydani, and S. N. Meydani Vitamin E Increases Production of Vasodilator Prostanoids in Human Aortic Endothelial Cells through Opposing Effects on Cyclooxygenase-2 and Phospholipase A2 J. Nutr., August 1, 2005; 135(8): 1847 - 1853. [Abstract] [Full Text] [PDF] |
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A.A. Lteif, K. Han, and K.J. Mather Obesity, Insulin Resistance, and the Metabolic Syndrome: Determinants of Endothelial Dysfunction in Whites and Blacks Circulation, July 5, 2005; 112(1): 32 - 38. [Abstract] [Full Text] [PDF] |
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I. A. Arenas, S. J. Armstrong, Y. Xu, and S. T. Davidge Chronic Tumor Necrosis Factor-{alpha} Inhibition Enhances NO Modulation of Vascular Function in Estrogen-Deficient Rats Hypertension, July 1, 2005; 46(1): 76 - 81. [Abstract] [Full Text] [PDF] |
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D. R. Witte, J. Westerink, E. J. de Koning, Y. van der Graaf, D. E. Grobbee, and M. L. Bots Is the Association Between Flow-Mediated Dilation and Cardiovascular Risk Limited to Low-Risk Populations? J. Am. Coll. Cardiol., June 21, 2005; 45(12): 1987 - 1993. [Abstract] [Full Text] [PDF] |
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