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Updated: Aug 15, 2026
A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
Noninvasive evaluation of endothelial vascular reactivity: should the quest continue?
1Research Centre of the Montreal Heart Institute, Department of Medicine, University of Montreal, Quebec. Jocelyn.dupuis@bellnet.ca
Insights
Endothelial dysfunction, an early sign of atherosclerosis, may predict cardiovascular events. Evaluating endothelial function could improve risk assessment and personalize treatment, but more research is needed.
Area of Science:
- Cardiovascular Research
- Vascular Biology
- Atherosclerosis Pathogenesis
Background:
- Endothelial dysfunction is an early indicator in atherosclerosis development.
- It may reflect cumulative risk factors and predict cardiovascular events.
- Clinical assessment of endothelial function could enhance risk stratification and therapy.
Purpose of the Study:
- To explore the clinical utility of evaluating endothelial function.
- To identify reliable methods for assessing endothelium-dependent vascular reactivity.
- To determine if endothelial function serves as a surrogate for cardiovascular risk.
Main Methods:
- Reactive hyperemia of the forearm is a common method for testing vascular reactivity.
- High-resolution brachial ultrasound and venous impedance plethysmography are used in research.
- Alternative, clinically practical methods for evaluating endothelial function are under development.
Main Results:
- Endothelial dysfunction is a persistent feature throughout atherosclerosis.
- Current research methods (ultrasound, plethysmography) are not ideal for routine clinical practice.
- The clinical value of endothelial function testing requires further validation.
Conclusions:
- Endothelial function assessment holds potential for improved cardiovascular risk prediction.
- Development of practical, validated methods is crucial for clinical integration.
- Large-scale trials are needed to confirm endothelial function as a reliable barometer of cardiovascular risk.
Abstract:
Endothelial dysfunction is an early event in the continuum of the pathogenesis of atherosclerosis that persists throughout the disease process. Endothelial dysfunction may be a valuable marker or barometer of the composite effect of the various predisposing factors, even some yet unknown, on the subsequent risk of cardiovascular events. Accumulating data suggest that clinical evaluation of endothelial function may provide incremental value to current risk stratification and to the tailoring of pharmacological and nonpharmacological therapy. This has prompted many investigators to probe the integrity of endothelium-dependent vascular reactivity in an effort to uncover clinically useful methods of evaluating endothelial function. For practical purposes, reactive hyperemia of the forearm has become the most popular stimulus for testing vascular reactivity, and several methods have been developed to quantify this response and study its determinants. High-resolution brachial ultrasound and venous impedance plethysmography are used extensively in mechanistic studies; however, for practical purposes, it is unlikely that these methods could be used in routine clinical practice. Therefore, some alternatives are being actively developed. The greatest remaining challenge is to find firm evidence that endothelial function can be used as a clinical surrogate of cardiovascular events. Validation of these methods and their evaluation in large-scale trials is needed to determine whether abnormal vascular reactivity is indeed a good barometer of cardiovascular risk.
