Retrograde flow and vascular function in the Framingham Heart Study
Hamburg, Naomi Miriam
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Experimental studies link oscillatory flow accompanied by flow reversal to impaired endothelial cell function. The relation of retrograde flow with vascular function and arterial stiffness remains incompletely defined. We measured brachial diastolic flow patterns along with vasodilator function and central and peripheral arterial stiffness in 5708 participants (age 47±13 years, 53% women) of the Framingham Heart Study Offspring and Third Generation cohorts. Brachial artery diastolic flow reversal was present in 35% of participants. In multivariable regression models, the presence of flow reversal was associated with lower flow-mediated dilation and reactive hyperemia (both P<0.0001). The relation of diastolic flow velocity with vasodilator function was nonlinear with a decline in vascular function associated with increasing magnitude of flow reversal. Flow reversal was associated with greater central aortic stiffness, measured by carotid-femoral pulse wave velocity, and conversely with lower muscular artery stiffness, measured by carotid-radial pulse wave velocity (both P<0.0001). In a large, community-based cohort, brachial artery flow reversal is prevalent and relates to impaired vasodilator function and higher aortic stiffness. Our findings support the possibility that retrograde flow may be relevant to vascular dysfunction.
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