Prognostic impact of coronary vasodilator dysfunction on adverse long-termoutcome of coronary heart disease

Background Endothelial vasodilator dysfunction is a characteristic feature of patients at risk for coronary atherosclerosis. Therefore, we prospective ly investigated whether coronary endothelial dysfunction predicts disease p rogression and cardiovascular event rates. Methods and Results: Coronary vasoreactivity was assessed in 147 patients u sing the endothelium-dependent dilator acetylcholine, sympathetic activatio n by cold presser testing, dilator responses to increased blood flow, and d ilation in response to nitroglycerin. Cardiovascular events (cardiovascular death, unstable angina, myocardial infarction, percutaneous transluminal c oronary angioplasty, coronary bypass grafting, ischemic stroke, or peripher al artery revascularization) served as outcome variables over a median foll ow-up period of 7.7 Sears, Patients suffering from cardiovascular events du ring follow-up (n=16) had significantly increased vasoconstrictor responses to acetylcholine infusion (P=0.009) and cold presser testing (P=0.002), as well as significantly blunted vasodilator responses to increased blood flo w (P<0.001) and the intracoronary injection of nitroglycerin (P=0.001). Imp aired endothelial and endothelium-independent coronary vasoreactivity were associated with a significantly higher incidence of cardiovascular events 6 2 Kaplan-Meier analysis, By multivariate analysis, all tests of coronary va soreactivity were significant, independent predictors of a poor prognosis, even after adjustment for traditional cardiovascular risk factors or the pr esence of atherosclerosis itself, Conclusions: Coronary endothelial vasodilator dysfunction predicts long-ter m atherosclerotic disease progression and cardiovascular event rates, Thus, the assessment of coronary endothelial vasoreactivity can pro tide pivotal information as both a diagnostic and prognostic tool in patients at risk f or coronary heart disease.