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A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
Non-invasive vascular function tests: their pathophysiological background and clinical application
Hirofumi Tomiyama1, Akira Yamashina
1Second Department of Internal Medicine, Tokyo Medical University, Japan. tomiyama@tokyo-med.ac.jp
Insights
Assessing arterial wall functions using non-invasive vascular tests like flow-mediated vasodilatation (FMD) and pulse wave velocity (PWV) aids in cardiovascular disease (CVD) risk stratification and management.
Area of Science:
- Cardiovascular Science
- Vascular Biology
Background:
- The arterial wall comprises intima, media, and adventitia, each crucial for systemic circulation.
- Vascular endothelium regulates tone and permeability; the media determines elasticity and blood flow cushioning.
- Dysfunction in these layers leads to organ and vascular damage.
Purpose of the Study:
- To explore the role of non-invasive vascular function tests in assessing arterial health.
- To understand how endothelial dysfunction and arterial stiffness impact cardiovascular disease (CVD).
- To evaluate the combined strategy of risk factors, morphological assessment, and vascular function tests for CVD management.
Main Methods:
- Utilized non-invasive methods including flow-mediated vasodilatation (FMD) for endothelial function.
- Employed pulse wave velocity (PWV) and augmentation index (AI) to assess arterial stiffness.
- Considered carotid ultrasound for morphological assessment of vascular damage.
Main Results:
- Endothelial dysfunction (assessed by FMD) is linked to atherosclerosis development.
- Increased arterial stiffness (assessed by PWV/AI) elevates cardiac afterload and contributes to atherogenesis.
- Vascular dysfunction underlies organ/vascular damage.
Conclusions:
- Combining conventional CVD risk factors with morphological and functional vascular assessments offers a comprehensive strategy.
- Non-invasive vascular function tests are valuable tools for CVD risk stratification.
- Improved assessment strategies can aid in the effective management of CVD and its risk factors.
Abstract:
The arterial wall has 3 layers (ie, the intima, including the endothelium, the media, and the adventitia); each of these layers has individual roles in systemic circulation. The vascular endothelium regulates the vascular tone, hemostasis and/or vascular permeability, and the media is the major determinant of arterial elasticity, which regulates the conduit function (delivery of blood to tissues) and cushioning effect (for generation of continuous blood flow). Failure of these functions results in organ/vascular damage. Several non-invasive methods are currently used to assess vascular dysfunction, including measurement of flow-mediated vasodilatation of the brachial artery induced by reactive hyperemia (FMD), pulse wave velocity (PWV), the augmentation index (AI), and central blood pressure. Endothelial dysfunction, which is assessed by FMD, contributes to the initiation/progression of atherosclerosis. Increased arterial stiffness, which is assessed by the PWV and/or AI, causes increased cardiac afterload, impaired coronary arterial blood supply, atherogenesis and/or microvascular damage. The combination of risk stratification by assessment of conventional risk factors for cardiovascular disease (CVD) with not only a morphological assessment of vascular damage, such as carotid ultrasound examination, but also vascular function tests, may be a useful strategy for the management of CVD and its related risk factors. (Circ J 2010; 74: 24 - 33).
