Stroke Unit, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, c/Travesa da Choupana s/n, Santiago de Compostela, Spain.
Cerebrovasc Dis. 2011;32(2):155-62. doi: 10.1159/000328651. Epub 2011 Jul 22.
Brachial arterial flow-mediated dilation (FMD) is associated with an increased risk of vascular events. Our aim was to investigate the relationship between FMD measured in the acute phase of ischemic stroke and a new major adverse vascular event in a consecutive cohort of patients followed up for 48 months after an acute first-ever stroke.
We measured FMD in 120 consecutive patients with acute ischemic stroke using high-resolution ultrasonography. FMD was calculated as the relationship between the basal diameter of the brachial artery before and after transient vascular occlusion. Intima-media thickness, extracranial carotid atherosclerosis, stroke severity National Institute of Health Stroke Scale, and modified Rankin Scale at 3 months were also evaluated. A vascular event was defined as any of the following: vascular disease (VD) death, nonfatal myocardial infarction (MI), nonfatal recurrent stroke (RS), claudication or peripheral arterial thrombosis (PVD), angioplasty or cardiac bypass graft surgery.
There were 34 new major adverse vascular events in 32 of 120 patients (26.7%): 21 (61.8%) RS, 5 (14.7%) VD death, 5 (14.7%) MI, and 3 (8.8%) PVD. The presence of carotid artery plaque (81.3 vs. 46%; p < 0.0001), atrial fibrillation (37.5 vs. 14.8%; p = 0.007) and FMD (5.30 ± 7.48 vs. 10.54 ± 7.02; p = 0.001) were associated with new-onset vascular events. FMD ≤4.5% was an independent predictor of new-onset vascular events (hazards ratio 3.48; 95% confidence interval 1.26-9.63; p = 0.01).
FMD is an independent predictor for a new-onset vascular event after first-ever ischemic stroke.
肱动脉血流介导的扩张（FMD）与血管事件风险增加有关。我们的目的是在首次急性缺血性卒中后随访 48 个月的连续队列患者中，研究急性期中 FMD 与新发主要不良血管事件之间的关系。
我们使用高分辨率超声测量了 120 例连续急性缺血性卒中患者的 FMD。FMD 通过测量短暂血管闭塞前后肱动脉基础直径的关系来计算。还评估了内-中膜厚度、颅外颈动脉粥样硬化、卒中严重程度国立卫生研究院卒中量表（NIHSS）和 3 个月时改良 Rankin 量表。血管事件定义为以下任何一种情况：血管疾病（VD）死亡、非致命性心肌梗死（MI）、非致命性复发性卒中（RS）、跛行或外周动脉血栓形成（PVD）、血管成形术或心脏旁路移植术。
在 120 例患者中的 32 例（26.7%）中出现了 34 例新发主要不良血管事件：21 例（61.8%）RS、5 例（14.7%）VD 死亡、5 例（14.7%）MI 和 3 例（8.8%）PVD。颈动脉斑块（81.3% vs. 46%；p<0.0001）、心房颤动（37.5% vs. 14.8%；p=0.007）和 FMD（5.30±7.48 vs. 10.54±7.02；p=0.001）与新发血管事件相关。FMD≤4.5%是新发血管事件的独立预测因子（危险比 3.48；95%置信区间 1.26-9.63；p=0.01）。
FMD 是首次缺血性卒中后新发血管事件的独立预测因子。
