{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:16:15Z","timestamp":1791472575836,"version":"4.3.4"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2013,11,18]]},"abstract":"\n Background<\/jats:title>\n \n Endothelial dysfunction is a key component of vascular vulnerability. Reactive hyperemia index (\n RHI<\/jats:styled-content>\n ), as assessed by the peripheral arterial tonometry, can noninvasively evaluate endothelial function. This study was designed to determine the additional prognostic value of endothelial function to the Synergy Between\n PCI<\/jats:styled-content>\n With Taxus and Cardiac Surgery Score (\n SYNTAX<\/jats:styled-content>\n sc) and the Framingham Risk Score (\n FRS<\/jats:styled-content>\n ) in predicting cardiovascular events in high\u2010risk patients.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We undertook a two\u2010center prospective study in 528 stable patients at high\u2010risk for cardiovascular events from the years 2006\u20132011. The\n RHI<\/jats:styled-content>\n was measured before coronary angiography and coronary complexity was assessed by\n SYNTAX<\/jats:styled-content>\n sc. After optimal therapies including coronary revascularization, there was follow\u2010up with patients until August 2012. Cardiovascular events consist of cardiovascular death, myocardial infarction, unstable angina, ischemic stroke, coronary revascularization, heart failure\u2010induced hospitalization, aortic disease, and peripheral arterial disease. During 1468 person\u2010years of follow\u2010up, 105 patients developed cardiovascular events. Multivariate Cox proportional hazards analysis identified B\u2010type natriuretic peptide (\n BNP<\/jats:styled-content>\n ),\n SYNTAX<\/jats:styled-content>\n sc, and\n RHI<\/jats:styled-content>\n as independent cardiovascular event predictors (hazard ratio [95% confidence interval]: natural logarithm of\n BNP<\/jats:styled-content>\n per 0.1: 1.019 [1.002 to 1.037];\n P<\/jats:italic>\n =0.023,\n SYNTAX<\/jats:styled-content>\n sc per tertile: 2.426 [1.825 to 3.225];\n P<\/jats:italic>\n <0.0001,\n RHI<\/jats:styled-content>\n per 0.1: 0.761 [0.673 to 0.859];\n P<\/jats:italic>\n <0.0001). When\n RHI<\/jats:styled-content>\n was added to the\n FRS<\/jats:styled-content>\n ,\n BNP<\/jats:styled-content>\n , and\n SYNTAX<\/jats:styled-content>\n sc, net reclassification index was significantly improved (27.5%;\n P<\/jats:italic>\n <0.0001), with a significant increase in the C\u2010statistic (from 0.728 [0.679 to 0.778] to 0.766 [0.726 to 0.806];\n P<\/jats:italic>\n =0.031).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Advanced endothelial dysfunction significantly correlated with near future cardiovascular events in high\u2010risk patients. This physiological vascular measurement improved risk discrimination when added to the\n FRS<\/jats:styled-content>\n ,\n BNP<\/jats:styled-content>\n , and\n SYNTAX<\/jats:styled-content>\n sc.\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL<\/jats:styled-content>\n : clinicaltrials.gov (\n http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n ). Unique identifier:\n NCT<\/jats:styled-content>\n 00737945.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.113.000426","type":"journal-article","created":{"date-parts":[[2013,11,25]],"date-time":"2013-11-25T23:03:29Z","timestamp":1385420609000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":148,"title":["Peripheral Endothelial Function and Cardiovascular Events in High\u2010Risk Patients"],"prefix":"10.1161","volume":"2","author":[{"given":"Yasushi","family":"Matsuzawa","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan"},{"name":"Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seigo","family":"Sugiyama","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Sumida","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Sugamura","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshimitsu","family":"Nozaki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Ohba","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichi","family":"Matsubara","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirofumi","family":"Kurokawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichiro","family":"Fujisue","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaaki","family":"Konishi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan"},{"name":"Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiichi","family":"Akiyama","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan"},{"name":"Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Nagayoshi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megumi","family":"Yamamuro","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satomi","family":"Iwashita","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideaki","family":"Jinnouchi","sequence":"additional","affiliation":[{"name":"Jinnouchi Hospital, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masataka","family":"Taguri","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology, Yokohama City University Medical Center, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Morita","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology, Yokohama City University Medical Center, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunihiko","family":"Matsui","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Yamaguchi University Hospital, Yamaguchi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuo","family":"Kimura","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Yokohama City University Medical Center, Yokohama, 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