Predictive value of reactive hyperemia for cardiovascular events in patients with peripheral arterial disease undergoing vascular surgery

Huang, Alex L., Silver, Annemarie E., Shvenke, Elena, Schopfer, David W., Jahangir, Eiman, Titas, Megan A., Shpilman, Alex, Menzoian, James O., Watkins, Michael T., Raffetto, Joseph D., Gibbons, Gary, Woodson, Jonathan, Shaw, Palma M., Dhadly, Mandeep, Eberhardt, Robert T., Keaney Jr., John F., Gokce, Noyan and Vita, Joseph A. (2007) Predictive value of reactive hyperemia for cardiovascular events in patients with peripheral arterial disease undergoing vascular surgery. Arteriosclerosis, Thrombosis, and Vascular Biology, 27 10: 2113-2119. doi:10.1161/ATVBAHA.107.147322


Author Huang, Alex L.
Silver, Annemarie E.
Shvenke, Elena
Schopfer, David W.
Jahangir, Eiman
Titas, Megan A.
Shpilman, Alex
Menzoian, James O.
Watkins, Michael T.
Raffetto, Joseph D.
Gibbons, Gary
Woodson, Jonathan
Shaw, Palma M.
Dhadly, Mandeep
Eberhardt, Robert T.
Keaney Jr., John F.
Gokce, Noyan
Vita, Joseph A.
Title Predictive value of reactive hyperemia for cardiovascular events in patients with peripheral arterial disease undergoing vascular surgery
Journal name Arteriosclerosis, Thrombosis, and Vascular Biology   Check publisher's open access policy
ISSN 1079-5642
1524-4636
Publication date 2007-10-01
Sub-type Article (original research)
DOI 10.1161/ATVBAHA.107.147322
Open Access Status Not Open Access
Volume 27
Issue 10
Start page 2113
End page 2119
Total pages 7
Place of publication Philadelphia, PA United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
Objective— Reactive hyperemia is the compensatory increase in blood flow that occurs after a period of tissue ischemia, and this response is blunted in patients with cardiovascular risk factors. The predictive value of reactive hyperemia for cardiovascular events in patients with atherosclerosis and the relative importance of reactive hyperemia compared with other measures of vascular function have not been previously studied.

Methods and Results— We prospectively measured reactive hyperemia and brachial artery flow-mediated dilation by ultrasound in 267 patients with peripheral arterial disease referred for vascular surgery (age 66±11 years, 26% female). Median follow-up was 309 days (range 1 to 730 days). Fifty patients (19%) had an event, including cardiac death (15), myocardial infarction (18), unstable angina (8), congestive heart failure (6), and nonhemorrhagic stroke (3). Patients with an event were older and had lower hyperemic flow velocity (75±39 versus 95±50 cm/s, P=0.009). Patients with an event also had lower flow-mediated dilation (4.5±3.0 versus 6.9±4.6%, P<0.001), and when these 2 measures of vascular function were included in the same Cox proportional hazards model, lower hyperemic flow (OR 2.7, 95% CI 1.2 to 5.9, P=0.018) and lower flow-mediated dilation (OR 4.2, 95% CI: 1.8 to 9.8, P=0.001) both predicted cardiovascular events while adjusting for other risk factors.

Conclusions— Thus, lower reactive hyperemia is associated with increased cardiovascular risk in patients with peripheral arterial disease. Furthermore, flow-mediated dilation and reactive hyperemia incrementally relate to cardiovascular risk, although impaired flow-mediated dilation was the stronger predictor in this population. These findings further support the clinical relevance of vascular function measured in the microvasculature and conduit arteries in the upper extremity.
Keyword Endothelium
Cardiovascular risk
Surrogate markers
Reactive hyperemia
Flow-mediated dilation
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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