Huang W. Significance of flow-mediated dilation in evaluating endothelial dysfunction in vasospastic angina. World J Cardiol 2026; 18(5): 119513 [DOI: 10.4330/wjc.v18.i5.119513]
Corresponding Author of This Article
Wilbert Huang, MD, Senior Research Fellow, Faculty of Medicine, University of Padjadjaran, Jl. Dipatiukur No. 35, Bandung 40416, West Java, Indonesia. wilberthuang67@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
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Opinion Review
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Huang W. Significance of flow-mediated dilation in evaluating endothelial dysfunction in vasospastic angina. World J Cardiol 2026; 18(5): 119513 [DOI: 10.4330/wjc.v18.i5.119513]
World J Cardiol. May 26, 2026; 18(5): 119513 Published online May 26, 2026. doi: 10.4330/wjc.v18.i5.119513
Significance of flow-mediated dilation in evaluating endothelial dysfunction in vasospastic angina
Wilbert Huang
Wilbert Huang, Faculty of Medicine, University of Padjadjaran, Bandung 40416, West Java, Indonesia
Author contributions: Huang W wrote the original draft and contributed to manuscript conceptualization, writing, reviewing, and editing.
AI contribution statement: ChatGPT was used for language polishing. Graphical abstract was generated by AI.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Corresponding author: Wilbert Huang, MD, Senior Research Fellow, Faculty of Medicine, University of Padjadjaran, Jl. Dipatiukur No. 35, Bandung 40416, West Java, Indonesia. wilberthuang67@gmail.com
Received: January 30, 2026 Revised: February 4, 2026 Accepted: March 10, 2026 Published online: May 26, 2026 Processing time: 110 Days and 3.1 Hours
Abstract
A previous retrospective cohort study evaluated flow-mediated dilation (FMD) as a marker of endothelial-dependent vasodilation and nitroglycerin-induced dilation as a marker of endothelial-independent vasodilation in vasospastic angina patients. The study demonstrated that low FMD (< 3.7%) was significantly associated with major adverse cardiovascular events, whereas low nitroglycerin-induced dilation (< 14%) was not. Multivariable Cox proportional hazards modeling was carefully limited to three covariates to avoid overfitting in the setting of a small number of events. Important contributors to endothelial dysfunction, including smoking, chronic kidney disease, and inflammatory status, were acknowledged, and baseline use of endothelial-protective medications did not differ between groups. Despite limitations related to its retrospective design and sample size, the study supports the prognostic value of FMD in vasospastic angina and highlights endothelial dysfunction as a key determinant of adverse outcomes.
Core Tip: This study emphasizes the prognostic importance of endothelial-dependent vasodilation assessed by flow-mediated dilation (FMD) in patients with vasospastic angina. Unlike nitroglycerin-induced dilation, FMD was independently associated with major adverse cardiovascular events, underscoring the pivotal role of endothelial dysfunction rather than vascular smooth muscle impairment. Careful model construction avoided overfitting despite limited events. Given its non-invasive nature, FMD may serve as a valuable risk-stratification and potentially diagnostic tool in vasospastic angina, warranting further prospective validation.
