Predictive value of reactive hyperemia for cardiovascular events in patients with peripheral arterial disease undergoing vascular surgery - PubMed (original) (raw)

. 2007 Oct;27(10):2113-9.

doi: 10.1161/ATVBAHA.107.147322. Epub 2007 Aug 23.

Annemarie E Silver, Elena Shvenke, David W Schopfer, Eiman Jahangir, Megan A Titas, Alex Shpilman, James O Menzoian, Michael T Watkins, Joseph D Raffetto, Gary Gibbons, Jonathan Woodson, Palma M Shaw, Mandeep Dhadly, Robert T Eberhardt, John F Keaney Jr, Noyan Gokce, Joseph A Vita

Affiliations

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

Alex L Huang et al. Arterioscler Thromb Vasc Biol. 2007 Oct.

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.

PubMed Disclaimer

Figures

Figure 1

Figure 1

Kaplan–Meier plots showing survival according to tertile of hyperemic velocity. Overall, survival differed according to tertile of hyperemic velocity by log-rank test (_P_=0.03). By pairwise comparison, the survival curves for the lower (8 to 61 cm/sec, n=89) and middle (63 to 105 cm/sec, n=89) tertiles did not differ (_P_=0.91), but both differed from the highest tertile (105 to 269 cm/sec, n=89) by log-rank test (_P_=0.01 for both).

Figure 2

Figure 2

Kaplan–Meier plots showing survival according to tertile of flow-mediated dilation. Overall, survival differed according to tertile of flow-mediated dilation by log-rank test (P<0.001). By pairwise comparison, the survival curves for the lower (−2.3 to 4.1%, n=89) and middle (4.2 to 7.9%, n=89) tertiles did not differ (_P_=0.34), but both differed from the highest tertile (8.0% to 25%, n=89) by log-rank test (P<0.001 and _P_=0.002, respectively).

Comment in

Similar articles

Cited by

References

    1. Loscalzo J, Vita JA. Ischemia, hyperemia, exercise, and nitric oxide: Complex physiology and complex molecular adaptations. Circulation. 1994;90:2556–2559. - PubMed
    1. Meredith IT, Currie KE, Anderson TJ, Roddy MA, Ganz P, Creager MA. Postischemic vasodilation in human forearm is dependent on endothelium-derived nitric oxide. Am J Physiol. 1996;270:H1435–H1440. - PubMed
    1. Higashi Y, Sasaki S, Nakagawa K, Matsuura H, Kajiyama G, Oshima T. A noninvasive measurement of reactive hyperemia that can be used to assess resistance artery endothelial function in humans. Am J Cardiol. 2001;87:121–125. - PubMed
    1. Mitchell GF, Parise H, Vita JA, Larson MG, Warner E, Keaney JF, Jr, Keyes MJ, Levy D, Vasan RS, Benjamin EJ. Local shear stress and brachial artery flow-mediated dilation: The Framingham Heart Study. Hypertension. 2004;44:134–139. - PubMed
    1. Vita JA, Keaney JF, Jr, Larson MG, Keyes MJ, Massaro JM, Lipinska I, Lehman B, Fan S, Osypiuk E, Wilson PWF, Vasan RS, Mitchell GF, Benjamin EJ. Brachial artery vasodilator function and systemic inflammation in the Framingham Offspring Study. Circulation. 2004;110:3604–3609. - PubMed

Publication types

MeSH terms

Grants and funding

LinkOut - more resources