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Title: Reliability of measurement of endothelial function across multiple institutions and establishment of reference values in Japanese.
Authors: Tomiyama, H.
Kohro, T.
Higashi, Y.
Takase, B.
Suzuki, Toru
Ishizu, T.
Ueda, S.
Yamazaki, T.
Furumoto, T.
Kario, K.
Inoue, T.
Koba, S.
Watanabe, K.
Takemoto, Y.
Hano, T.
Sata, M.
Ishibashi, Y.
Node, K.
Maemura, K.
Ohya, Y.
Furukawa, T.
Ito, H.
Ikeda, H.
Yamashina, A.
First Published: 5-Aug-2015
Publisher: Elsevier fpr European Atherosclerosis Society, International Atherosclerosis Society, Society of Atherosclerosis Imaging and Prevention
Citation: Atherosclerosis, 2015, 242 (2), pp. 433-442
Abstract: AIMS: For the standardization of flow-mediated vasodilatation (FMD) assessment as a clinical tool, validation of its reliability across multiple institutions and the establishment of normal/reference values based on reliable data from multiple institutions are needed. METHODS AND RESULTS: In Study 1, assessment of FMD (scan recording and analysis) using an ultrasonographic semi-automatic measuring system (sFMD) was conducted at 18 participating institutions (sFMD-INST) (n = 981). All of the brachial arterial scans were also analyzed at a core laboratory (sFMD-COLB). After 111 subjects with inadequate sFMD recordings were excluded (n = 880), the correlation between the sFMD-INST and sFMD-COLB improved from R = 0.725 to R = 0.838 (p < 0.001). In Study 2, based on good-quality sFMD data obtained from 6660 subjects without cardiovascular disease (CVD) and 729 subjects with CVD from 27 institutions, reference values of sFMD are proposed by the Framingham risk score (FRS)-based risk categories and according to gender and age. The receiver-operating characteristic curve analysis revealed a significant power of sFMD values in reference ranges to discriminate between subjects with and without CVD (e.g., area under curve = 0.64 in the FRS-low risk group). CONCLUSIONS: When the analysis was limited to cases with clear sFMD recordings, the reliability of the sFMD assessment (scan and its analysis) conducted in individual institutions appeared to be acceptable. Reference sFMD values (lower cuff occlusion) for the Japanese population are proposed based on reliable data derived from multiple institutions, and the reference values may identify patients without advanced vascular damage.
DOI Link: 10.1016/j.atherosclerosis.2015.08.001
ISSN: 0021-9150
eISSN: 1879-1484
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: © 2015 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (
Description: Supplementary data related to this article can be found at
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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