Evaluating endothelial function in humans: a guide to invasive and non-invasive techniques

• Published in: Heart (British Cardiac Society) Vol. 91; no. 4; pp. 553 - 558
• Main Authors: Tousoulis, D, Antoniades, C, Stefanadis, C
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.04.2005; BMJ; BMJ Publishing Group LTD; Copyright 2005 by Heart
• Subjects: Atherosclerosis; Biological and medical sciences; Blood pressure; Brachial Artery - diagnostic imaging; Brachial Artery - physiopathology; Cardiology. Vascular system; Cardiovascular disease; Coronary Artery Disease - diagnosis; Coronary Artery Disease - physiopathology; Coronary vessels; Education in Heart; endothelial function; Endothelium; Endothelium, Vascular - physiopathology; Flow velocity; Humans; Medical sciences; Nitric oxide; plethysmography; reactive hyperaemia; Risk factors; Smooth muscle; Ultrasonography; Vasodilation; Vasodilator Agents; Human; Technique; Endothelial function; Non invasive method
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/hrt.2003.032847

The vasodilatory effect of acetylcholine or other vasodilators is usually compared with the response to glyceryl trinitrate, an exogenous source of NO leading to endothelium independent dilation of the vessel. 5, 6 Although intracoronary studies are considered to be the gold standard for early detection of endothelial dysfunction in the coronary arteries, they have the disadvantage of being invasive and expensive, with the risks of coronary catheterisation, and cannot be used as a screening test in the general population. 2 w4 Intrabrachial infusion of vasoactive agents It has been shown previously that endothelial function in the coronary arteries is closely related to endothelial function in peripheral arteries such as the brachial artery. 7 Therefore, the technique of intracoronary infusions of vasoactive agents can also be applied in the brachial artery, which is easily accessible and its cannulation has fewer potential dangers and complications. Evaluating endothelial function: key points Endothelial dysfunction is considered to be a major step in atherogenesis Early detection of endothelial dysfunction may identify subjects at high risk for atherosclerosis Endothelial function can be evaluated with invasive or non-invasive techniques, applied directly into the coronary arteries or in peripheral conduit arteries Endothelial dysfunction is an independent prognostic factor in patients with advanced atherosclerosis Asymptomatic subjects with endothelial dysfunction require better control of risk factors CLINICAL IMPLICATIONS Recent data suggest that endothelial function is a useful prognostic marker in coronary artery disease patients.w17 In these patients, it has been reported that endothelial dysfunction is an independent prognostic factor and may predict future events irrespective of the angiographic severity of the disease.w17 Persisting severe endothelial dysfunction in patients with advanced atherosclerosis may require a more aggressive control of risk factors and probably modification of current medication. [...]blunted endothelial function may reflect early atherosclerosis, and should lead to a detailed evaluation (and control) of all the conventional and newer (such as infection/inflammation, homocysteine, etc) risk factors.