DOI: http://dx.doi.org/10.18203/2349-3933.ijam20171037

A study of brachial artery flow mediated dilatation and carotid intima media thickness in subjects having risk factors for coronary artery disease

Shweta Sahai, Sumit Sinha

Abstract


Background: Endothelial dysfunction (ED) is an early phenomenon in atherosclerosis and often progresses to structural changes and clinical manifestations. Brachial artery flow mediated dilatation (BAFMD) has recently emerged as a reliable tool for assessment of ED. Carotid artery intima media thickness (CCAIMT) is an established tool for the detection of early structural atherosclerosis. This study was done to assess the reliability of BAFMD as a surrogate marker of atherosclerosis by comparing it to CCAIMT.

Methods: Seventy-one subjects were divided in to Group I (n = 42, patients with overt cardiovascular disease; abnormal resting ECG or history of myocardial infarction/angina or an abnormal coronary angiogram), Group II (n = 17, apparently healthy individuals, with risk factors, but no overt cardiovascular disease) and Group III (n = 12, control, healthy individuals without risk factors). Ischemia induced BAFMD and CCAIMT were studied using ultrasound imaging along with presence of metabolic abnormalities.

Results: Age ranged from 18-70 years with male predominance [42 (49.4%)]. Mean BAFMD in Group I, Group II and Group III was 6.68±3.52%, 7.39±3.62 and 11.65±4.32% respectively. Impaired BAFMD was highest in Group I [31 (73.80%)] compared to other two groups (p = 0.0002). Abnormal CCA-IMT was significantly higher in group I [33 (78.57%)] than in group II [9 (52.94%)] and Group III (3 (25%)] (p = 0.0018).

Conclusions: Both BAFMD and CCAIMT can be used interchangeably as surrogate markers for endothelial dysfunction and atherosclerosis. BAFMD is a reliable tool for prediction of early atherosclerosis.


Keywords


Atherosclerosis, BAFMD, CCAIMT, Coronary artery disease, Endothelial dysfunction

Full Text:

PDF

References


Furchgott RF, Zawadski JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature. 1980;288:373-6.

Palmer RM, Ferrige AG, Monacada S. Nitric oxide release accounts for the biological activity of endothelium - derived relaxing factor. Nature. 1987;327:524-6.

Celermajer DS. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992; 340:1111-5.

Coretti MC, Anderson TJ, Benjamin EJ. Guidelines for the ultrasound assessment of endothelium dependent flow mediated vasodilatation of the brachial artery. A report of the international brachial artery reactivity task force. J Am Coll Cardiol. 2002;39:257-65.

Neunteufl T, Katzenschlager R, Hassan A. Systemic endothelial dysfunction is related to the extent and severity of coronary artery disease. Atherosclerosis.1997;129(1):111-8.

Haskote SS, Joshi SR. Carotid intimomedial thickness - a non - invasive index of vascular health. JAPI. 2008;56.

Scnell GB, Robertson A, Houston D, Malley L, Anderson TJ. Impaired brachial artery endothelial function is not predicted by elevated triglycerides. J Am Coll Cardiol. 1999:33(7):2038-43.

Celermajer DS, Sorensan KE, Georgakopoulos D. Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium- dependent dilation in healthy young adults. Circulation. 1993;88:2149-55.

Dharmalingam M, Deshpande NR, Vidyasagar S. Triglyceride levels and its correlation with Carotid Intima-Media Thickness. Int J Diab Dev Countries. 2004;24:19-22.

Agarwal AK, Gupta PK, Singla S, Garg U, Prasad A, Yadav R. Carotid intimomedial thickness in type 2 diabetic patients and its correlation with coronary risk factors. JAPI. 2008;56:581-6.

Mohan V, Ravikumar R, Shanthi Rani S, Deepa R. Intima medial thickness of the carotid artery in South Indian diabetic and non-diabetic subjects: the Chennai Urban Population Study (CUPS). Diabetologia. 2000;43:494-9.

Ravikumar R, Deepa R, Shanthirani C, Mohan V. Comparison of carotid intima-media thickness, arterial stiffness, and brachial artery flow mediated dilatation in diabetic and non-diabetic subjects (the chennai urban population study cups-9. Am J Cardiol. 2002;90:702-7.

Raymond TY, Todd JA, Francois C. Relationship between carotid artery intima-media thickness and brachial artery flow- mediated dilatation in middle - aged healthy men. J Am Coll Cardiol. 2005;45:1980-6.