Division of Cardiovascular Medicine, Oregon Health and Science University, UHN62, Portland, OR 97239, USA.
Int J Cardiovasc Imaging. 2010 Aug;26(6):631-40. doi: 10.1007/s10554-010-9616-1. Epub 2010 Mar 26.
We conducted a meta-analysis of observational studies which examined the association between flow-mediated dilatation (FMD) of brachial artery, a noninvasive measure of endothelial function, and future cardiovascular events.
Electronic databases were searched using a predefined search strategy. Data was independently abstracted on study characteristics, study quality, and outcomes by two reviewers. The multivariate relative risks, adjusted for confounding factors, were calculated from individual studies and then pooled using random-effects models. Statistical heterogeneity was evaluated using I2 statistics. Subgroup analyses and meta-regression analyses were conducted to assess the robustness of the meta-analysis. Publication bias was examined with funnel plot analysis and Egger's test.
Four population-based cohort studies and ten convenience-cohort studies, involving 5,547 participants, were included in the meta-analysis. The pooled relative risks of cardiovascular events per 1% increase in brachial FMD, adjusted for confounding risk factors, was 0.87 (95% CI, 0.83- 0.91). The significant associations between brachial FMD and cardiovascular events were consistent among all subgroups evaluated, suggesting the robustness of the meta-analysis. However, the presence of heterogeneity in study quality, the remaining confounding factors, and publication bias in the available literature prevent a definitive evaluation of the additional predictive value of brachial FMD beyond traditional cardiovascular risk factors.
The meta-analysis of heterogeneous studies with moderate methodological quality suggested that impairment of brachial FMD is significantly associated with future cardiovascular events. Further prospective randomized trials are warranted to confirm the efficacy of the usage of brachial FMD in the management of cardiovascular diseases.
我们对观察性研究进行了荟萃分析，这些研究检查了肱动脉血流介导的扩张（FMD）与未来心血管事件之间的关系，肱动脉血流介导的扩张是内皮功能的一种非侵入性测量方法。
使用预先确定的搜索策略对电子数据库进行了搜索。两位评审员独立对研究特征、研究质量和结果进行了摘录。使用随机效应模型从个体研究中计算出调整混杂因素后的多变量相对风险，并进行汇总。使用 I2 统计量评估统计异质性。进行亚组分析和荟萃回归分析，以评估荟萃分析的稳健性。使用漏斗图分析和 Egger 检验检查发表偏倚。
荟萃分析纳入了四项基于人群的队列研究和十项便利队列研究，共涉及 5547 名参与者。调整混杂风险因素后，肱动脉 FMD 每增加 1%，心血管事件的相对风险为 0.87（95%CI，0.83-0.91）。在所有评估的亚组中，肱动脉 FMD 与心血管事件之间的显著关联均保持一致，表明荟萃分析的稳健性。然而，可用文献中研究质量、剩余混杂因素和发表偏倚的异质性限制了对肱动脉 FMD 超越传统心血管危险因素的额外预测价值的明确评估。
荟萃分析具有中等方法学质量的异质性研究表明，肱动脉 FMD 受损与未来心血管事件显著相关。需要进一步的前瞻性随机试验来证实肱动脉 FMD 在心血管疾病管理中的使用的疗效。
