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Updated: Aug 11, 2026
Ultrasound Assessment of Endothelial Function: A Technical Guideline of the Flow-mediated Dilation Test
Published on: April 27, 2016
[Endothelial function in high risk cardiovascular patients]
1Szent János Kórház, III. Belosztály, Budapest.
Insights
In advanced atherosclerosis, vascular disease and poor risk stratification, not traditional risk factors, significantly worsen endothelial dysfunction. Further research is needed to confirm clinical relevance.
Area of Science:
- Cardiovascular Medicine
- Atherosclerosis Research
- Endothelial Function Studies
Context:
- Endothelial dysfunction is a key early event in atherogenesis, driven by traditional risk factors.
- The influence of these risk factors on endothelial dysfunction in later stages of atherosclerosis remains less understood.
- This study investigates the determinants of endothelial dysfunction in high-risk patients with established or advanced atherosclerosis.
Purpose:
- To assess brachial artery flow-mediated vasodilation in 293 high-risk patients.
- To determine the relationship between endothelial function and various risk factors and risk stratifications.
- To identify the primary predictors of endothelial dysfunction in the late phase of atherosclerosis.
Summary:
- Mean endothelial function was reduced in the high-risk cohort.
- Vascular disease and unfavorable risk stratification were identified as principal predictors of reduced endothelial function in late-phase atherosclerosis.
- Traditional risk factors like hypertension, smoking, and metabolic alterations did not show a significant role in this advanced stage.
Impact:
- Findings suggest a shift in the primary drivers of endothelial dysfunction from traditional risk factors to existing vascular disease and overall risk burden in advanced atherosclerosis.
- Highlights the importance of considering vascular disease status and risk stratification for managing endothelial dysfunction in later disease stages.
- Underscores the need for further studies to establish the clinical relevance of these findings for patient outcomes.
Introduction:
Endothelial dysfunction is caused by risk factors, which have basic, and initial role in atherogenesis. During further progression it is still not known, whether is and how is endothelial dysfunction influenced by risk factors in the late phase of atherosclerosis and/or what kind of other factors play role in endothelial dysfunction.
Objectives:
Brachial artery flow mediated vasodilation was examined in 293 high risk patients (vascular 2. type diabetes patients/persons with + 2 risk factors). Relationship between endothelial function and risk factors, and risk stratifications were statistically examined to define the principal predictors of endothelial dysfunction.
Methods:
1. Examination of flow mediated vasodilation of brachial artery with ultrasound machine, 2. Risk factors evaluating, 3. Vascular examinations: physical, exercise test, Holter monitoring, CW Doppler, duplex scan 4. Risk stratification (10 year risk of fatal vascular events), 5. Statistical analysis (comparative and cohort).
Results:
1. Mean endothelial function of 293 high risk patients was reduced (105.1%). 2. Vascular disease plays principal role of the endothelial function in late phase atherosclerosis, because significantly decreases the brachial artery vasodilation (104.3% v. 108.3% p < 0.01) and significantly more (p < 0.0009) endothelial dysfunction can be found in patients with vascular disease than without. 3. Bad risk stratification plays principal role too, because there are significantly (p = 0.012) more endothelial dysfunction in high risk patients, than with better risk stratification. 4. Lipid-, glucose-metabolic alterations, hypertension, age and smoking (all: p = NS) have not already any role in endothelial dysfunction in late phase atherosclerosis.
Conclusions:
Role of risk factors in initial atherogenesis is scientific evidence, but the role of these factors can not be proved later, when endothelial dysfunction already evolved. In this phase of atherosclerosis the vascular disease and the bed risk stratification have principal role, because they can cause significant more reduction of already reduced endothelial function. Further studies necessary to determine, whether this statistically proved relationship have, or have not any clinical relevance.
