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

  • Yoichi Inaba
  • Jennifer A. Chen
  • Steven R. Bergmann
Original Paper

DOI: 10.1007/s10554-010-9616-1

Cite this article as:
Inaba, Y., Chen, J.A. & Bergmann, S.R. Int J Cardiovasc Imaging (2010) 26: 631. doi:10.1007/s10554-010-9616-1



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.


Endothelium Imaging Meta-analysis Vasodilation 



Confidence interval


Flow-mediated dilatation


Standard deviation

Supplementary material

10554_2010_9616_MOESM1_ESM.docx (27 kb)
Supplementary material 1 (DOCX 26 kb)

Copyright information

© Springer Science+Business Media, B.V. 2010

Authors and Affiliations

  • Yoichi Inaba
    • 1
  • Jennifer A. Chen
    • 2
  • Steven R. Bergmann
    • 2
  1. 1.Division of Cardiovascular MedicineOregon Health and Science UniversityPortlandUSA
  2. 2.Division of CardiologyBeth Israel Medical CenterNew YorkUSA

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