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Detection of endothelial dysfunction with brachial artery ultrasound scanning
Michael D Faulx1, Andrew T Wright, Brian D Hoit
1Department of Medicine, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, Ohio 44106-5038, USA.
Insights
Endothelial dysfunction, a precursor to cardiovascular disease, can be assessed noninvasively using brachial artery flow-mediated dilation (FMD). This method shows promise as a clinical screening tool for endothelial function.
Area of Science:
- Vascular Biology
- Cardiovascular Medicine
- Diagnostic Imaging
Background:
- The endothelium plays a critical role in human health, with impaired function linked to cardiovascular disease (CVD).
- Endothelial dysfunction often precedes clinical manifestation of vascular disease and is a potentially modifiable risk factor for CVD.
Purpose of the Study:
- To evaluate the potential of brachial artery flow-mediated dilation (FMD) as a clinical tool for assessing endothelial function.
- To highlight FMD's role in identifying endothelial dysfunction as an early marker for cardiovascular risk.
Main Methods:
- Flow-mediated dilation (FMD) of the brachial artery measured using Doppler ultrasonography.
- Assessment involves evaluating arterial response to transient vascular occlusion to gauge nitric oxide bioavailability.
Main Results:
- Brachial artery FMD is a well-tolerated, noninvasive, and low-risk procedure.
- Impaired FMD correlates with coronary arterial abnormalities and serves as an index of nitric oxide bioavailability.
Conclusions:
- Brachial artery FMD is a promising, widely available screening tool for endothelial dysfunction.
- Despite current limitations in standardization, FMD is poised to become a leading clinical technique for evaluating endothelial disease.
Abstract:
The role of the endothelium in human disease recently has become the focus of intense scientific investigation. Impaired endothelial function is associated with a number of disease states, including cardiovascular disease (CVD) and its major risk factors. Endothelial dysfunction precedes overt vascular disease by years and may itself be a potentially modifiable CVD risk factor. Although no gold standard for the measurement of endothelial function exists, the measurement of flow-mediated dilation (FMD) in the brachial artery, assessed with Doppler ultrasonography, is the most studied method and shows the most promise for clinical application. It is a well-tolerated, noninvasive, and low-risk procedure. Brachial artery FMD after transient vascular occlusion may serve as an index of nitric oxide bioavailability, and its impairment correlates with coronary arterial abnormalities. These factors, with the wide availability of vascular ultrasound scanning in clinical practice, make brachial artery FMD an attractive screening tool for endothelial dysfunction. Present limitations of this procedure include the lack of a consensus definition of normal FMD and the variability among centers in both procedural technique and image analysis. However, these limitations are likely to be overcome with increasing experience and advances in technology, and with further refinements, the measurement of brachial artery FMD will likely become the clinical technique of choice for the evaluation of endothelial disease.