Predictive Value of Limb Artery Indices and Endothelial Functional Tests for the Degree of Coronary Artery Stenosis in a Diabetic Population

Zihan Wang,1 Ying Chen,1 Shuying Lv,1 Ziyi Sun,1 Xiaoyan Lu,2 Li Huang,2 Lin Li2 1Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 2Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, People’s Republic of ChinaCorrespondence: Lin LiDepartment of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, People’s Republic of ChinaTel +86-18600285198Email lilinxcy@126.comObjective: To investigate the correlation between limb artery indices (brachial-ankle pulse wave velocity and ankle-brachial index), endothelial function index (FMD value), and the degree of coronary artery stenosis in diabetic patients and analyze their values in predicting the degree of coronary artery stenosis.Methods: The study included 151 patients with type 2 diabetes mellitus and suspected coronary atherosclerotic heart disease. The patients were divided into “coronary atherosclerotic heart disease” (N=94) and “non-coronary atherosclerotic heart disease” (N=57) groups based on the coronary angiographic findings. Within the coronary atherosclerotic heart disease group, the patients were further divided into “low stenosis” (N=47) and “high stenosis” (N=47) subgroups according to their Gensini score. Indicators such as brachial-ankle pulse wave velocity, ankle-brachial index, and FMD value were measured and correlated with the degree of coronary artery stenosis. Logistic regression models were constructed and receiver operating characteristic curves plotted to assess the predictive ability of limb artery and endothelial functional indices for the degree of coronary artery stenosis.Results: In a diabetic population, FMD value (P=0.003), ankle-brachial index (P=0.004), and brachial-ankle pulse wave velocity (P=0.003) were different in patients with and without coronary atherosclerotic heart disease. In the population with both diabetes mellitus and coronary atherosclerotic heart disease, the ankle-brachial index and FMD value were both independently associated with the degree of coronary artery stenosis (P=0.003). The area under the receiver operating characteristic curve plotted from the combined coefficients of ankle-brachial index and FMD value was 0.773, which is predictive of coronary artery stenosis in diabetic patients.Conclusion: Ankle-brachial index and FMD value are indicative of the degree of coronary artery stenosis in diabetic patients, and predictive efficacy can be improved by combining the two tests.Keywords: type 2 diabetes mellitus, coronary artery stenosis, limb artery testing, vascular endothelial function, clinical predictive model