Prediction of future cardiovascular outcomes by flow-mediated vasodilatation of brachial artery: a meta-analysis

被引:647
作者
Inaba, Yoichi [1 ]
Chen, Jennifer A. [2 ]
Bergmann, Steven R. [2 ]
机构
[1] Oregon Hlth & Sci Univ, Div Cardiovasc Med, Portland, OR 97239 USA
[2] Beth Israel Deaconess Med Ctr, Div Cardiol, New York, NY 10003 USA
关键词
Endothelium; Imaging; Meta-analysis; Vasodilation; ACUTE CORONARY SYNDROMES; ENDOTHELIAL DYSFUNCTION; PROGNOSTIC VALUE; RISK; DILATION; EVENTS; ADULTS; ATHEROSCLEROSIS; ASSOCIATION; DILATATION;
D O I
10.1007/s10554-010-9616-1
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We conducted a meta-analysis of observational studies which examined the association between flow-mediated dilatation (FMD) of brachial artery, a noninvasive measure of endothelial function, and future cardiovascular events. Electronic databases were searched using a predefined search strategy. Data was independently abstracted on study characteristics, study quality, and outcomes by two reviewers. The multivariate relative risks, adjusted for confounding factors, were calculated from individual studies and then pooled using random-effects models. Statistical heterogeneity was evaluated using I2 statistics. Subgroup analyses and meta-regression analyses were conducted to assess the robustness of the meta-analysis. Publication bias was examined with funnel plot analysis and Egger's test. Four population-based cohort studies and ten convenience-cohort studies, involving 5,547 participants, were included in the meta-analysis. The pooled relative risks of cardiovascular events per 1% increase in brachial FMD, adjusted for confounding risk factors, was 0.87 (95% CI, 0.83- 0.91). The significant associations between brachial FMD and cardiovascular events were consistent among all subgroups evaluated, suggesting the robustness of the meta-analysis. However, the presence of heterogeneity in study quality, the remaining confounding factors, and publication bias in the available literature prevent a definitive evaluation of the additional predictive value of brachial FMD beyond traditional cardiovascular risk factors. The meta-analysis of heterogeneous studies with moderate methodological quality suggested that impairment of brachial FMD is significantly associated with future cardiovascular events. Further prospective randomized trials are warranted to confirm the efficacy of the usage of brachial FMD in the management of cardiovascular diseases.
引用
收藏
页码:631 / 640
页数:10
相关论文
共 34 条
[1]   Endothelial dysfunction and cardiovascular risk prediction in peripheral arterial disease - Additive value of flow-mediated dilation to ankle-brachial pressure index [J].
Brevetti, G ;
Silvestro, A ;
Schiano, V ;
Chiariello, M .
CIRCULATION, 2003, 108 (17) :2093-2098
[2]   NONINVASIVE DETECTION OF ENDOTHELIAL DYSFUNCTION IN CHILDREN AND ADULTS AT RISK OF ATHEROSCLEROSIS [J].
CELERMAJER, DS ;
SORENSEN, KE ;
GOOCH, VM ;
SPIEGELHALTER, DJ ;
MILLER, OI ;
SULLIVAN, ID ;
LLOYD, JK ;
DEANFIELD, JE .
LANCET, 1992, 340 (8828) :1111-1115
[3]   Endothelial function and dysfunction - Testing and clinical relevance [J].
Deanfield, John E. ;
Halcox, Julian P. ;
Rabelink, Ton J. .
CIRCULATION, 2007, 115 (10) :1285-1295
[4]   METAANALYSIS IN CLINICAL-TRIALS [J].
DERSIMONIAN, R ;
LAIRD, N .
CONTROLLED CLINICAL TRIALS, 1986, 7 (03) :177-188
[5]   The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions [J].
Downs, SH ;
Black, N .
JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 1998, 52 (06) :377-384
[6]   Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis [J].
Duval, S ;
Tweedie, R .
BIOMETRICS, 2000, 56 (02) :455-463
[7]   The relative importance of vascular structure and function in predicting cardiovascular events [J].
Fathi, R ;
Haluska, B ;
Isbel, N ;
Short, L ;
Marwick, TH .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 43 (04) :616-623
[8]   Prognostic value of systemic endothelial dysfunction in patients with acute coronary syndromes - Further evidence for the existence of the "vulnerable" patient [J].
Fichtlscherer, S ;
Breuer, S ;
Zeiher, AM .
CIRCULATION, 2004, 110 (14) :1926-1932
[9]   Prognostic value of brachial artery endothelial function and wall thickness [J].
Frick, M ;
Suessenbacher, A ;
Alber, HF ;
Dichtl, W ;
Ulmer, H ;
Pachinger, O ;
Weidinger, F .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2005, 46 (06) :1006-1010
[10]   Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events in patients with peripheral vascular disease [J].
Gokce, N ;
Keaney, JF ;
Hunter, LM ;
Watkins, MT ;
Nedeljkovic, ZS ;
Menzoian, JO ;
Vita, JA .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 41 (10) :1769-1775