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Updated: Sep 20, 2026
Ultrasound Assessment of Endothelial Function: A Technical Guideline of the Flow-mediated Dilation Test
Published on: April 27, 2016
Relation between conduit vessel stiffness (assessed by tonometry) and endothelial function (assessed by flow-mediated
Anil Nigam1, Gary F Mitchell, Jean Lambert
1Research Center, Montreal Heart Institute, Montreal, Quebec, Canada.
Insights
Arterial stiffness and endothelial dysfunction are linked in coronary artery disease (CAD) patients and those at risk. Increased large artery stiffness may cause or result from endothelial dysfunction, explaining elevated pulse pressure as a cardiovascular risk factor.
Area of Science:
- Cardiovascular Physiology
- Vascular Biology
- Medical Imaging and Diagnostics
Background:
- Endothelial dysfunction and large artery stiffness are prevalent in individuals with coronary artery disease (CAD) risk factors and established CAD.
- These vascular abnormalities may contribute to the development and progression of atherosclerosis.
Purpose of the Study:
- To investigate the relationship between endothelial function and large artery distensibility.
- To compare these parameters in healthy individuals, patients with stable CAD, and those with only CAD risk factors.
Main Methods:
- Endothelium-dependent vasodilation assessed via flow-mediated dilation (FMD) of the brachial artery using high-resolution ultrasound.
- Large artery stiffness evaluated using applanation tonometry.
- Statistical analysis adjusted for age and intergroup differences.
Main Results:
- Percent flow-mediated dilation significantly correlated with multiple measures of arterial stiffness.
- Negative correlations observed with central and peripheral pulse pressure and central systolic pressure.
- Positive correlation found with proximal aortic compliance, indicating stiffer arteries have poorer endothelial function.
Conclusions:
- Arterial stiffness and endothelial function are significantly interrelated in the context of cardiovascular health.
- Increased large conduit vessel stiffness may be a cause or consequence of endothelial dysfunction.
- This relationship may elucidate the role of elevated pulse pressure as an emerging cardiovascular risk factor.
Abstract:
Endothelial dysfunction and large artery stiffness occur in patients with risk factors for coronary artery disease (CAD) and in those with established CAD. We evaluated the relation between endothelial function and conduit vessel distensibility in normal subjects, in patients with documented stable CAD, and in patients demonstrating only risk factors but no overt atherosclerosis. Endothelium-dependent dilatation was evaluated by way of flow-mediated dilatation of the brachial artery using high-resolution ultrasound. Large artery stiffness was assessed using tonometry. After adjusting for age and intergroup differences, percent flow-mediated dilatation showed statistically significant correlations with several measures of stiffness, including central pulse pressure (r = -0.457, p = 0.019), central systolic pressure (r = -0.442, p = 0.024), peripheral pulse pressure (r = -0.393, p = 0.039), peripheral systolic pressure (r = -0.398, p = 0.036), and proximal aortic compliance (r = 0.390, p = 0.049). Measures of arterial stiffness correlate significantly with those of endothelial function. An increase in large conduit vessel stiffness may represent either a cause or consequence of endothelial dysfunction and may explain why elevated pulse pressure is a new cardiovascular risk factor.
