Prognostic value of flow-mediated dilatation following myocardial infarction

• Published in: International journal of cardiology Vol. 132; no. 1; pp. 45 - 50
• Main Authors: Guazzi, Marco, Reina, Giuseppe, Gripari, Paola, Tumminello, Gabriele, Vicenzi, Marco, Arena, Ross
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 06-02-2009; Elsevier
• Subjects: Aged; Biological and medical sciences; Brachial artery; Brachial Artery - diagnostic imaging; Brachial Artery - physiopathology; Cardiology. Vascular system; Cardiovascular; Chi-Square Distribution; Confidence Intervals; Coronary heart disease; Echocardiography; Endothelium, Vascular - diagnostic imaging; Endothelium, Vascular - physiopathology; Female; Heart; Humans; Hyperemia - diagnostic imaging; Hyperemia - etiology; Hyperemia - physiopathology; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocarditis. Cardiomyopathies; Prognosis; Prospective Studies; Regional Blood Flow; Risk Factors; ROC Curve; Stroke Volume; Survival Analysis; Ultrasound; Ventricular Function, Left; Ultrasound; Risk factors; Brachial artery; Sonography; Myocardial infarction; Prognosis; Dilatation; Risk factor; Cardiovascular disease; Cardiology; Coronary heart disease; Myocardial disease
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2007.10.036

Abstract Background Risk stratification for subsequent cardiovascular events following a myocardial infarction (MI) is an important area of research. Previous findings indicate flow-mediated dilatation (FMD) may be a valuable prognostic indicator. This study investigates the prognostic value of FMD in patients suffering an uncomplicated MI. Methods One hundred and seventy nine post-MI patients [110male/69 female, mean age: 64.8 ± 10.0 years, ejection fraction: 51.9 ± 12.2%] were included in this analysis. Ultrasound images of the brachial artery were used to determine FMD following reactive hyperemia. Subjects were tracked for subsequent cardiovascular events [myocardial infarction, heart failure, additional interventions (percutaneous coronary intervention, coronary artery bypass)] following data collection via medical chart review. Results There were 45 subsequent cardiovascular events during a mean tracking period of 13.7 (± 9.5) months. Receiver operating characteristic (ROC) curve analysis revealed a diagnosis of diabetes (ROC area: 0.67, p = 0.001, 95% confidence interval: 0.58–0.77) and percent change in arterial diameter (ROC area: 0.63, p = 0.01, 95% confidence interval: 0.53–0.73, optimal threshold: ≤/> 4.5%) were prognostically significant. Kaplan–Meier analysis revealed the event-free survival rate for subjects without diabetes and an arterial diameter change > 4.5%, without diabetes and percent change in arterial diameter ≤ 4.5%, with diabetes and percent change in arterial diameter > 4.5% and with diabetes and percent change in arterial diameter ≤ 4.5% was 88.7%, 78.4%, 67.7% and 38.5%, respectively (Log-rank: 24.9, p < 0.0001). Conclusions Non-invasive FMD is a potential risk factor after MI and may add information to conventional risk stratification. This will need to be tested in further studies.