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Prognostic Value of Coronary Vascular Endothelial Dysfunction
Abstract
Background — Whether patients at increased risk can be identified from a relatively low-risk population by coronary vascular function testing remains unknown. We investigated the relationship between coronary endothelial function and the occurrence of acute unpredictable cardiovascular events (cardiovascular death, myocardial infarction, stroke, and unstable angina) in patients with and without coronary atherosclerosis (CAD). Methods and Results — We measured the change in coronary vascular resistance (ΔCVR) and epicardial diameter with intracoronary acetylcholine (ACh, 15 μg/min) to test endothelium-dependent function and sodium nitroprusside (20 μg/min) and adenosine (2.2 mg/min) to test endothelium-independent vascular function in 308 patients undergoing cardiac catheterization (132 with and 176 without CAD). Patients underwent clinical follow-up for a mean of 46±3 months. Acute vascular events occurred in 35 patients. After multivariate analysis that included CAD and conventional risk factors for atherosclerosis, ΔCVR with ACh ( P =0.02) and epicardial constriction with ACh ( P =0.003), together with increasing age, CAD, and body mass index, were independent predictors of adverse events. Thus, patients in the tertile with the best microvascular responses with ACh and those with epicardial dilation with ACh had improved survival by Kaplan-Meier analyses in the total population, as did those in the subset without CAD. Similar improvement in survival was also observed when all adverse events, including revascularization, were considered. Endothelium-independent responses were not predictive of outcome. Conclusions — Epicardial and microvascular coronary endothelial dysfunction independently predict acute cardiovascular events in patients with and without CAD, providing both functional and prognostic information that complements angiographic and risk factor assessment.
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“Endothelial dysfunction occurs early in the pathogenesis of atherosclerosis, and predicts future cardiovascular events.”
From The Vasculature in Prediabetes (2018) · cites this paper as [32]
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Matsuzawa, Y., Guddeti, R. R., Kwon, T., Lerman, L. O., & Lerman, A. (2015) · Circulation Journal · doi:10.1253/circj.cj-15-0068 · Cited by 45
Endothelial Dysfunction and Coronary Artery Disease
Veerasamy, M., Bagnall, A. J., Neely, D., Allen, J., Sinclair, H., & Kunadian, V. (2014) · Cardiology in Review · doi:10.1097/crd.0000000000000047 · Cited by 45
Çimen, T., Efe, T. H., Akyel, A., Sunman, H., Algül, E., Şahan, H. F., Erden, G., Özdemir, Ş., Alay, E. F., Doğan, M., et al. (2016) · Angiology · doi:10.1177/0003319715625827 · Cited by 45
“Email: drtolgacim@hotmail.com is the main cause of MVA.13,14 Among the other contenders are smooth muscle dysfunction, inappropriate sympathetic tone, microvascular atherosclerosis, and inflammation.15 Although the cause of endothelial dysfunction in MVA is not well known, chronic inflammation can induce vascular dysf…”
BackgroundReriani, M., Sara, J. D. S., Flammer, A. J., Gulati, R., Li, J., Rihal, C. S., Lennon, R. J., Lerman, L. O., & Lerman, A. (2016) · Coronary Artery Disease · doi:10.1097/mca.0000000000000347 · Cited by 46
Wang, W., Zhou, X., Kwong, J. S., Li, L., Li, Y., & Sun, X. (2017) · Scientific Reports · doi:10.1038/s41598-017-01965-0 · Cited by 48
Takase, B., Hamabe, A., Satomura, K., Akima, T., Uehata, A., Matsui, T., Ohsuzu, F., Ishihara, M., & Kurita, A. (2005) · Circulation Journal · doi:10.1253/circj.70.49 · Cited by 45
Sirolimus accelerates senescence of endothelial progenitor cells through telomerase inactivation
Imanishi, T., Kobayashi, K., Kuki, S., Takahashi, C., & Akasaka, T. (2006) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2005.12.031 · Cited by 45
Vallbracht, K. B., Schwimmbeck, P. L., Kühl, U., Seeberg, B., & Schultheiß, H. (2004) · Circulation · doi:10.1161/01.cir.0000146891.31481.cf · Cited by 45
Neishi, Y., Mochizuki, S., Miyasaka, T., Kawamoto, T., Kume, T., Sukmawan, R., Tsukiji, M., Ogasawara, Y., Kajiya, F., Akasaka, T., et al. (2005) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0501392102 · Cited by 45
Perticone, F., Maio, R., Tassone, J. E., Perticone, M., Pascale, A., Sciacqua, A., & Sesti, G. (2012) · International Journal of Cardiology · doi:10.1016/j.ijcard.2011.12.065 · Cited by 44
“On the other hand, previously published findings have demonstrated that endothelial dysfunction, in both coronary [18–21] and forearm [22] vasculature, is an independent prognostic factor for future clinical events.”
ResultBavry, A., Handberg, E., Huo, T., Lerman, A., Quyyumi, A., Shufelt, C., Sharaf, B. L., Merz, C., Cooper-DeHoff, R., Sopko, G., et al. (2014) · American Heart Journal · doi:10.1016/j.ahj.2014.01.017 · Cited by 44
Self-citationLeft ventricular hypertrophy and endothelial dysfunction in chronic kidney disease
Poulikakos, D. J., Ross, L. E., Mayoral, A. R., Cole, D., ANDOH, J., Chitalia, N., Sharma, R., Kaski, J. C., & Banerjee, D. (2013) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jet120 · Cited by 44
“Moreover, in the general population, ED has been shown to be an independent predictorof adverseoutcomes.(24) Endothelial function is highly abnormal in patients with CKD and worsens with decreasing kidney function.”
BackgroundCoronary physiology assessment in the catheterization laboratory
Díez‐Delhoyo, F., Gutiérrez, E., Loughlin, G., y, R. S.-R., Vázquez-Álvarez, M. E., Sarnago‐Cebada, F., Angulo‐Llanos, R., Plasencia, A. C., Elı́zaga, J., & Díaz, F. F. A. (2015) · World Journal of Cardiology · doi:10.4330/wjc.v7.i9.525 · Cited by 44
Bar, A., Kieronska‐Rudek, A., Proniewski, B., Suraj, J., Czamara, K., Marczyk, B., Matyjaszczyk‐Gwarda, K., Jasztal, A., Kuś, E., Majka, Z., et al. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.120.016929 · Cited by 45
Ruotsalainen, E., Vauhkonen, I., Salmenniemi, U., Pihlajamäki, J., Punnonen, K. R. A., Kainulainen, S., Jalkanen, S., Salmi, M., & Laakso, M. (2007) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2007.04.021 · Cited by 44
“[5] Halcox JP, Schenke WH, Zalos G, et al.”
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Toyota, E., Matsunaga, T., & Chilian, W. M. (2004) · Molecular and Cellular Biochemistry · doi:10.1023/b:mcbi.0000044372.65864.18 · Cited by 44
“Endothelial dysfunction is observed in patients with ischemic heart disease [54]; moreover, deficits in endothelial function are observed during many of the risk factors for ischemic heart disease, e.”
BackgroundCardiac Rehabilitation and Endothelial Function
Lanza, G. A., Golino, M., Villano, A., Lanza, O., Lamendola, P., Fusco, A., & Leggio, M. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9082487 · Cited by 43
Dimitroulas, T., Sandoo, A., & Kitas, G. D. (2012) · International Journal of Molecular Sciences · doi:10.3390/ijms131012315 · Cited by 46
“common in asymptomatic individuals with CVD risk factors [16] and they convey prognostic significance regarding the occurrence of CVD events [17].”
BackgroundLazdam, M., Davis, E., Lewandowski, A. J., Worton, S. A., Kenworthy, Y., Kelly, B., & Leeson, P. (2011) · Journal of Pregnancy · doi:10.1155/2012/704146 · Cited by 45
“Peripheral dysfunction of the vascular endothelium has been demonstrated to correlate with increased risk of clinical events [54] and all cause mortality [55] and associates with many traditional cardiovascular risk factors including hypertension, diabetes mellitus, insulin resistance, hypercholesterolemia, and smokin…”
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“[5] have evidenced dilation of epicardial arteries and higher flow response of coronary microcirculation to acetylcholine in their subgroup of patients at risk for coronary artherosclerosis but without coronary artery disease.”
BackgroundPeripheral Microvascular Function Reflects Coronary Vascular Function
AlBadri, A., Kim, J. H., Liu, C., Mehta, P. K., & Quyyumi, A. A. (2019) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.119.312378 · Cited by 43
“We also performed comparisons of single doses of these agonists, based on prior experience.(20) It is possible that a doseresponse curve with multiple doses of each agonist would have provided better correlations than observed with a single dose.”
MethodSelf-citationLee, J., Shirodaria, C. C., Jackson, C., Robson, M. D., Antoniades, C. A., Francis, J. M., Wiesmann, F., Channon, K. M., Neubauer, S., & Choudhury, R. P. (2007) · Diabetes and Vascular Disease Research · doi:10.3132/dvdr.2007.005 · Cited by 43
Hogas, S. M., Voroneanu, L. E., Șerban, D. N., Segall, L., Hogas, M. M., Șerban, I. L., & Covic, A. C. (2010) · Journal of the American Society of Hypertension · doi:10.1016/j.jash.2010.03.008 · Cited by 43
Chen, L., Wang, L., Shu, G., & Li, J. (2021) · Journal of Agricultural and Food Chemistry · doi:10.1021/acs.jafc.1c02117 · Cited by 45
Endothelial function, arterial stiffness and lipid lowering drugs
Τζιόμαλος, Κ., Athyros, V. G., Karagiannis, A. I., & Mikhailidis, D. P. (2007) · Expert Opinion on Therapeutic Targets · doi:10.1517/14728222.11.9.1143 · Cited by 41
“The evaluation of forearm endothelial dysfunction using VOP was predictive of cardiovascular morbidity and mortality in hypertensive patients [40] , in patients with stable CAD [41] or with acute coronary syndromes [42] , as well as in patients with early-stage heart failure [43] .”
BackgroundInfluentialMak, A., LIU, Y., & Ho, R. (2011) · The Journal of Rheumatology · doi:10.3899/jrheum.101182 · Cited by 42
Ramadan, M. M., Mahfouz, E., Gomaa, G. F., El-Diasty, T. A., Alldawi, L., Ikrar, T., Limin, D., Kodama, M., & Aizawa, Y. (2008) · Circulation Journal · doi:10.1253/circj.72.778 · Cited by 41
“The median CACS was higher in males than in females (2 [0–202] vs 1 [0–97.”
Background
Metadata
- Authors
- Halcox, J. P. J., Schenke, W. H., Zalos, G., Mincemoyer, R., Prasad, A., Waclawiw, M. A., Nour, K. R. A., & Quyyumi, A. A.
- Affiliations
- National Institutes of Health (US)
- Venue
- Circulation
- Published
- 2002-08-06
- Volume
- 106
- Issue
- 6
- Pages
- 653-658
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2019338486
- Cited by
- 1,385
- References
- 24
- Citations by year
- 2026: 12 · 2025: 13 · 2024: 25 · 2023: 33 · 2022: 21 · 2021: 33 · 2020: 49 · 2019: 50 · 2018: 56 · 2017: 51 · 2016: 51 · 2015: 70 · 2014: 87 · 2013: 59 · 2012: 70
- FWCI
- 51.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Physiology (medical) › Nitric Oxide and Endothelin Effects
- Keywords
- coronary endothelial dysfunction, coronary artery disease, acetylcholine provocation test, sodium nitroprusside, adenosine, coronary vascular resistance, cardiovascular events, prognosis, myocardial infarction, unstable angina, stroke, cardiovascular mortality, revascularization
- MeSH terms
- Angina, Unstable, Coronary Artery Disease, Coronary Circulation, Coronary Vessels, Endothelium, Vascular, Female, Follow-Up Studies, Humans, Male, Microcirculation, Middle Aged, Myocardial Infarction, Pericardium, Prognosis, Vascular Resistance, Vasodilator Agents, Disease-Free Survival, Stroke
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