Endothelial Function Assessed by Automatic Measurement of Enclosed Zone Flow‐Mediated Vasodilation Using an Oscillometric Method Is an Independent Predictor of Cardiovascular Events

Abstract

BackgroundA new device for automatic measurement of flow‐mediated vasodilation (FMD) using an oscillometric method has been developed to solve technical problems of conventional FMD measurement. This device measures enclosed zone FMD (ezFMD). The purpose of this study was to evaluate the prognostic value of endothelial function assessed by ezFMD for future cardiovascular events.Methods and ResultsWe measured ezFMD in 272 participants who underwent health‐screening examinations. First, we investigated cross‐sectional associations between ezFMD and cardiovascular risk factors, and then we assessed the associations between ezFMD and first major cardiovascular events (death from cardiovascular causes, stroke, and coronary revascularization). Univariate regression analysis revealed that ezFMD was significantly correlated with age, triglycerides, glucose, smoking pack‐years, estimated glomerular filtration rate, high‐sensitivity C‐reactive protein, and Framingham risk score. During a median follow‐up period of 36.1 months (interquartile range 18.8–40.1 months), 12 participants died (6 from cardiovascular causes), 3 had stroke, 8 had coronary revascularization, and 10 were hospitalized for heart failure. There was no episode of acute coronary syndrome during the study period. Participants were divided into tertiles (low, intermediate, and high) based on ezFMD. Kaplan–Meier curves for first major cardiovascular events among the 3 groups were significantly different (P=0.004). After adjustment for cardiovascular risk factors, the low group was significantly associated with an increased risk of first major cardiovascular events compared with the high group (hazard ratio 6.47; 95% CI 1.09–125.55; P=0.038).ConclusionsThese findings suggest that endothelial function assessed by ezFMD may be useful as a surrogate marker of future cardiovascular events.Clinical Trial Registration URL: https://upload.umin.ac.jp. Unique identifier: UMIN000004902.

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“…Measurements of flow-mediated vasodilation (FMD), which is an index of endothelium-dependent vasodilation, have frequently been utilized to evaluate endothelial function 3–6 . Endothelial dysfunction is an independent predictor of vascular events 7–10 . Type 2 diabetes is associated with endothelial dysfunction and is a risk factor for systemic atherosclerosis and cardiovascular events 11–14 .…”

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“…In a clinical setting, assessment of endothelial function using an established method is important. Methods that have been used for the assessment of endothelial function in humans include the measurement of endothelium-dependent vasodilation induced by intra-arterial infusion of a vasoactive agent by using coronary angiography, a Doppler flow guide wire [65,75], or plethysmography [25,66]; measurement of flow-mediated vasodilation (FMD) using ultrasonography [69,70,71]; measurement of reactive hyperemia index (RHI) using RH-peripheral arterial tonometry [72]; and measurement of enclosed zone FMD (ezFMD) using an oscillometric method [76]. At present, measurement of vascular responses to intra-arterial infusion of NO agonists and NO antagonists in the coronary and brachial arteries is the gold standard for the assessment of endothelial function.…”