[Assessment of endothelial function reliably predicts the existence and the severity of coronary disease].

Background: Endothelial dysfunction has been proven to be a cornerstone of atherosclerosis occurrence, development and progression. However, its use in clinical practice is still unclearly defined.

Aim: To prospectively assess how accurately endothelial function assessment predicts the existence and the extensiveness of significant coronary artery disease.

Methods: Fifty adults (37 men and 13 women, mean age of 59.9 +/- 12.6 years) were randomly included among candidates for a coronary angiography. They previously underwent endothelial function assessment by the Flow-mediated dilation technique (FMD) according to ACC guidelines. The FMD% was expressed as maximal percent change in brachial artery diameter from baseline and the test was considered positive when FMD% was below 5%.

Results: Endothelial function impairment has been diagnosed in 36 patients and at least one significant coronary artery stenosis (>50%) in 38 patients. Endothelial dysfunction predicted significant coronary stenosis with a sensibility and a specificity of 89.5% and 83% respectively; positive predictive and negative predictive values were 94.4% and 71.4% respectively. Statistical correlation has been found between FMD% and the number of significantly diseased coronary vessels (rs = -0.44; p = 0.001). An FMD% less than 8% reliably predicted all multivessel coronary-diseased patients. In multivariate analysis, endothelial dysfunction was the only independent predictive factor of coronary disease (p = 0.02).

Conclusion: Endothelial dysfunction has been proven to be highly correlated to the existence of significant coronary stenosis at coronary angiography (PPV = -94.4%). The severity of endothelial dysfunction assessed by the FMD% has also been significantly correlated to the extensiveness of coronary disease.