Clinical significance of flow-mediated dilation, brachial intima-media thickness and pulse wave velocity in patients with and without coronary artery disease.

BACKGROUND Little is known about the interrelationships among brachial flow-mediated vasodilatation (bFMD), brachial-ankle pulse wave velocity (baPWV) and brachial intima-media thickness (bIMT) in patients with and without coronary artery disease (CAD). METHODS AND RESULTS Two-hundred consecutive patients with stable angina pectoris (SAP) were enrolled as the CAD group and 50 age-, sex- and body mass index-matched patients without CAD were selected as the non-CAD group. bFMD, diastolic blood pressure (DBP) and high-density lipoprotein cholesterol (HDL-C) in the CAD group were significantly lower. The CAD group showed significantly higher levels of hemoglobin A(1c)(HbA(1c)) and low-density lipoprotein cholesterol (LDL-C), but not baPWV. CAD was independently associated with bFMD, DBP, HbA(1c) and HDL-C. bFMD and HDL-C significantly decreased and LDL-C increased as the number of diseased vessels with significant stenosis increased. The number of diseased vessels was independently associated with bFMD and HDL-C. In addition, bFMD, bIMT, the time constant of the shear rate and the time constant of the flow rate as assessed by a new program, Trend Plus(®), were associated with the presence of CAD. Among these parameters, the presence of CAD was independently associated with bIMT as well as bFMD. CONCLUSIONS bFMD was a better predictor of the severity of CAD than either baPWV or coronary risk factors in patients with SAP. In addition, bIMT may be a critical predictor of CAD.