Brachial Flow-Mediated Vasodilator Responses in Population-Based Research: Methods, Reproducibility and Effects of Age, Gender and Baseline Diameter

Background Brachial artery ultrasound has been proposed as an inexpensive, accurate way to assess cardiovascular risk in populations. However, analysis and interpretation of these data are not uniform. Methods We analysed the relationship between relative and absolute changes in brachial artery diameter in response to flow-mediated dilation and age, gender and baseline diameter among 4040 ultrasound examinations from subjects aged 14 to 98 years. Results Reproducibility studies demonstrated intra- and interreader and intrasubject correlations from 0.67 to 0.84 for repeated measures of per cent change in diameter. Per cent change in diameter after flow stimulus was 3.58 ± 0.10% (mean ± standard deviation). Corresponding values for baseline diameter and absolute change in diameter were 4.43 ± 0.87 mm and 0.15 ± 0.01 mm, respectively. Baseline diameter and its variance were inversely related to per cent change in diameter (P < 0.001). In contrast, absolute change in diameter was more uniform throughout the range of baseline diameters. Baseline diameter was directly related, and per cent change in diameter inversely related, to age (P < 0.001 for all three measures). Time to maximum vasodilator response increased with age (P < 0.001). Women (n=2315) had significantly larger per cent change in diameter than men (n=1725) (P < 0.001). However, after adjustment for age and baseline diameter, per cent and absolute change were 5% smaller in women than men (P < 0.05 for both). In multivariate analysis, age was overwhelmingly the most important determinant of absolute change in diameter (P < 0.001). Conclusions Automated analysis of brachial flow-mediated vasodilator responses is both feasible and reproducible in large-scale clinical and population-based research.