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Updated: Jul 17, 2026
Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
Endothelial dysfunction precedes atherosclerosis in systemic sclerosis--relevance for prevention of vascular
G Szucs1, O Tímár, Z Szekanecz
13rd Department of Internal Medicine, Rheumatology Division, University of Debrecen, Medical and Health Science Center, Hungary, Móricz Zs krt. 22., H-4004 Debrecen, Hungary.E-mail: szekanecz@iiibel.dote.hu.
Insights
Systemic sclerosis (SSc) patients show impaired endothelium-dependent vasodilation (FMD), but preserved endothelium-independent vasodilation (NMD). Early FMD assessment in SSc may aid diagnosis and treatment.
Area of Science:
- Vascular Medicine
- Rheumatology
- Cardiology
Background:
- Systemic sclerosis (SSc) is characterized by vasculopathy and endothelial dysfunction.
- Endothelial dysfunction contributes to the pathogenesis of SSc.
Purpose of the Study:
- To investigate endothelium-dependent, flow-mediated dilatation (FMD) and endothelium-independent, nitroglycerin-mediated dilatation (NMD) of the brachial artery in SSc patients.
- To assess common carotid intimal-medial thickness (ccIMT) in SSc patients compared to healthy controls.
Main Methods:
- High-resolution ultrasound imaging was used to measure FMD and NMD in the brachial artery.
- Duplex color ultrasound assessed ccIMT in the common carotid arteries.
- 29 SSc patients and 29 healthy controls were included, with similar demographics and cardiovascular risk factors.
Main Results:
- SSc patients exhibited significantly lower FMD compared to controls (4.82% vs. 8.86%, P < 0.001).
- No significant difference in NMD was observed between SSc patients and controls (P > 0.1).
- A trend towards increased ccIMT was noted in SSc patients (0.67 mm vs. 0.57 mm, P = 0.067), correlating with age and disease duration.
Conclusions:
- SSc is associated with impaired endothelium-dependent vasodilation (low FMD).
- Endothelium-independent vasodilation (NMD) remains preserved, suggesting potential for nitroglycerin therapy.
- ccIMT may indicate carotid atherosclerosis in older SSc patients with longer disease duration; FMD assessment could be diagnostically and prognostically valuable.
Objectives:
The pathogenesis of systemic sclerosis (SSc) includes vasculopathy with endothelial dysfunction. The aim of this study was to investigate endothelium-dependent, flow-mediated dilatation (FMD), as well as endothelium-independent, nitroglycerin-mediated dilatation (NMD) of the brachial artery and to assess common carotid intimal-medial thickness (ccIMT) in SSc patients compared with healthy controls.
Methods:
FMD and NMD of the brachial artery were determined using high-resolution ultrasound imaging and the values were expressed as percentage change from baseline in 29 SSc patients and 29 healthy controls. The two groups were very similar regarding sex, age and traditional cardiovascular risk factors. In addition, common carotid arteries were assessed by duplex colour ultrasound, ccIMT determined using high resolution ultrasound and expressed in mm thickness in the same patients and controls. Correlations between FMD, NMD, ccIMT, age and the SSc subtype (diffuse or limited form) were analysed.
Results:
In the 29 SSc patients (mean age: 51.8 yrs), the FMD was significantly lower (4.82 +/- 3.76%) in comparison with the controls (8.86 +/- 3.56%) (P < 0.001). No difference was found in NMD between patients (19.13 +/- 17.68%) and controls (13.13 +/- 10.40%) (P > 0.1). There was a tendency of increased ccIMT in SSc patients (0.67 +/- 0.26 mm) compared with healthy subjects (0.57 +/- 0.09), but this difference was not significant (P = 0.067). A significant, positive correlation between ccIMT and age in SSc (r = 0.470, P = 0.013) was detected, as well as in healthy controls (r = 0.61, P = 0.003), but no correlation was found between FMD and age. In addition, ccIMT, but not FMD and NMD, displayed significant correlation with disease duration (r = 0.472, P = 0.011). NMD displayed significant inverse correlation with the age in SSc patients (r = -0.492, P = 0.012), but not in controls. We did not find any correlation between FMD, NMD, ccIMT and SSc subtype.
Conclusions:
There is an impairment of endothelium-dependent vasodilatation indicated by low FMD in SSc. At the same time, the endothelium-independent dilatation assessed by NMD is still preserved giving an opportunity of nitroglycerine therapy. Carotid atherosclerosis indicated by ccIMT may occur at higher ages and after longer disease duration. Thus, the assessment of FMD in the pre-atherosclerotic stage may have a beneficial diagnostic, prognostic and therapeutic relevance.
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