Los Angeles Biomed Research Institute at Harbor UCLA, Torrance, CA, USA.
University of Arizona College of Medicine, Phoenix, AZ, USA.
Atherosclerosis. 2020 Jun;302:15-19. doi: 10.1016/j.atherosclerosis.2020.04.009. Epub 2020 Apr 22.
Endothelial dysfunction and atherosclerosis are linked by multiple mechanisms. Brachial artery flow-mediated dilation (FMD) rate is used to evaluate endothelial function and has been independently associated with adverse cardiac outcomes. The relationship between brachial artery FMD rate and severity of subclinical atherosclerosis by coronary computed tomography angiography (CCTA) is not understood. We hypothesized that brachial FMD is inversely associated with burden of subclinical atherosclerosis measured by CCTA.
This is a retrospective study of 100 participants with intermediate cardiac risk and atypical symptoms to examine association between brachial artery FMD rate and surrogate markers of severity of subclinical atherosclerosis on CCTA. Multivariate linear regression analysis was used to understand the relationship between brachial artery FMD rate and markers of plaque burden on CCTA including coronary artery calcium (CAC) score, segment involvement score (SIS; total number of segments with any plaque), segment stenosis score (SSS, sum of maximal stenosis score per segment), and total plaque score (TPS, the sum of all segments plaque burden).
52 participants (42%) were female. Mean age of the cohort was 59.3 ± 10.4 years. After adjusting for traditional risk factors, brachial artery FMD rate was inversely associated with higher CAC, TPS, SIS and SSS (p < 0.05 for all). FMD <4.5 predicted the presence of CAC >0 and ≤ 100 most effectively, with a sensitivity of 62.2% and a specificity of 66.7%, respectively (area under the curve (AUC) of 0.5729, p = 0.0302). FMD <2.7 predicted the presence of CAC >100 most effectively, with a sensitivity of 34% and a specificity of 83% respectively (AUC of 0.6226, p = 0.0095).
Brachial FMD is independently associated with the presence and extent of subclinical atherosclerosis on CCTA. Our findings provide more detailed evidence that mechanistically, FMD, a surrogate marker of systemic endothelial dysfunction is a correlate of atherosclerotic burden, assessed by CCTA and CAC.
内皮功能障碍和动脉粥样硬化通过多种机制相关联。肱动脉血流介导的扩张（FMD）率用于评估内皮功能，并且与不良心脏结局独立相关。通过冠状动脉计算机断层血管造影术（CCTA）评估的肱动脉 FMD 率与亚临床动脉粥样硬化严重程度之间的关系尚不清楚。我们假设肱动脉 FMD 与通过 CCTA 测量的亚临床动脉粥样硬化负担呈负相关。
这是一项针对 100 名具有中等心脏风险和非典型症状的参与者的回顾性研究，旨在检查肱动脉 FMD 率与 CCTA 上亚临床动脉粥样硬化严重程度的替代标志物之间的关系。多元线性回归分析用于理解肱动脉 FMD 率与 CCTA 上斑块负担的标志物之间的关系，包括冠状动脉钙（CAC）评分、节段受累评分（SIS；任何斑块的总节段数）、节段狭窄评分（SSS，每节段最大狭窄评分之和）和总斑块评分（TPS，所有节段斑块负担之和）。
52 名参与者（42%）为女性。队列的平均年龄为 59.3±10.4 岁。在调整了传统危险因素后，肱动脉 FMD 率与更高的 CAC、TPS、SIS 和 SSS 呈负相关（所有 p<0.05）。FMD<4.5 最有效地预测 CAC>0 且≤100 的存在，其敏感性为 62.2%，特异性为 66.7%（曲线下面积（AUC）为 0.5729，p=0.0302）。FMD<2.7 最有效地预测 CAC>100 的存在，其敏感性为 34%，特异性为 83%（AUC 为 0.6226，p=0.0095）。
肱动脉 FMD 与 CCTA 上亚临床动脉粥样硬化的存在和程度独立相关。我们的研究结果提供了更详细的证据，表明机制上，作为全身内皮功能障碍的替代标志物的 FMD 与通过 CCTA 和 CAC 评估的动脉粥样硬化负担相关。
