Abstract 15249: Loss of Early Vasodilator Response at the Brachial Artery Predicts the Presence of Critical Coronary Stenoses
Cardiovascular diseases (CVD) are the leading cause of mortality and morbidity in Western Countries. Coronary artery disease is the etiology underlying the most prevalent clinical manifestations of CVD. Atherosclerosis is often diagnosed only at late stages, when it manifests in clinically overt forms. Coronary angiography often does not show critical stenoses. We recently showed that the latency of flow mediated dilation (FMD) correlates with the presence of carotid atherosclerosis and the individual cardiovascular risk. Hence, we aimed at evaluating whether the latency of the vasodilator response at the brachial artery could predict the presence of critical coronary stenoses. We evaluated FMD in 74 consecutive patients, before performing coronary angiography for clinical indication at our hospital. Patients were classified in early (ED), late (LD) and no dilators (ND), based on the latency of the vasodilator response. Briefly, ED showed maximal dilation at 60s after ischemic stimulus, and LD over 60s. Very interestingly, lost of early vasodilator response showed a much better diagnostic performance than maximal FMD for the prediction of critical (>70%) coronary stenoses. In fact, classification match of loss of early vasodilator response with coronary angiography was twice as good as with FMD max (72% vs 39%, p=0.002). Using this approach, the number of false negative results was quite low at 4/74 (0.5%), yielding a 89% specificity. Furthermore, ischemia extension - measured by means of the Gensini score - was progressively larger with longer latency (4.5±13.5 in ED, 17.5±27.1 in LD, 39.7±55.0 in ND; p<0.02). In conclusion, using the lost of early vasodilator response as a diagnostic cutpoint allowed to confidently rule out the presence of critical coronary stenoses be means of a simple non-invasive examination. In our cohort, this could have avoided a useless exposition of patients to the potential complications of an invasive coronary angiography in 42% of cases. Once confirmed in larger studies, measurement of latency in vasodilator response could largely improve the selection of patients to refer for coronary angiography, reducing useless patients’ exposition to a potentially harmful diagnostic procedure and healthcare costs.
Author Disclosures: S. De Rosa: None. C. Irace: None. G. Ambrosio: None. C. Carallo: None. C. Covello: None. C. Tripolino: None. C. Gareri: None. E. Abramo: None. C. Indolfi: None. A. Gnasso: None.
- © 2015 by American Heart Association, Inc.