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Updated: Jun 12, 2026
Ultrasound Assessment of Endothelial Function: A Technical Guideline of the Flow-mediated Dilation Test
Published on: April 27, 2016
Endothelial function as a functional expression of cardiovascular risk factors
Martin K Reriani1, Lilach O Lerman, Amir Lerman
1Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN 55905, USA.
Insights
Traditional cardiovascular risk factors inadequately predict heart events. Endothelial dysfunction, measured by reactive hyperemia peripheral arterial tonometry, may improve cardiovascular risk stratification and patient targeting for therapy.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Biomarkers
Background:
- Traditional cardiovascular risk factors (e.g., Framingham risk score) have limitations in predicting coronary heart disease events in diverse populations.
- Existing models fail to account for genetic predisposition and atheroprotective factors, leading to prediction inaccuracies in 25-50% of cases.
- A need exists for improved methods to integrate overall cardiovascular risk and protective factors for better event prediction.
Purpose of the Study:
- To explore endothelial dysfunction as a key indicator bridging cardiovascular risk factors and atherosclerotic disease.
- To evaluate the potential of endothelial function measurements in predicting cardiovascular events and guiding targeted therapies.
- To assess reactive hyperemia peripheral arterial tonometry as a tool for endothelial function assessment and cardiovascular risk stratification.
Main Methods:
- Systematic reviews of traditional cardiovascular risk factor models.
- Analysis of the role of endothelial dysfunction as an integrated index of cardiovascular risk and protective factors.
- Evaluation of reactive hyperemia peripheral arterial tonometry for endothelial function measurement.
Main Results:
- Traditional cardiovascular risk scores demonstrate limitations in predicting coronary heart disease events.
- Endothelial dysfunction represents a comprehensive measure of both risk and protective factors.
- Reactive hyperemia peripheral arterial tonometry shows promise for assessing endothelial function and cardiovascular risk.
Conclusions:
- Endothelial dysfunction may serve as a crucial link in predicting cardiovascular events.
- Measurements of endothelial function can enhance cardiovascular risk stratification.
- Reactive hyperemia peripheral arterial tonometry offers a potential new tool for clinical assessment and targeted cardiovascular therapy.
Abstract:
Traditional cardiovascular risk (CV) factors based on the Framingham study have been used to estimate the risk of CV events and determine target cholesterol levels for primary prevention. Recently published systematic reviews have, however, demonstrated that the Framingham risk score is limited in certain cohorts and requires adjustment. Indeed, traditional CV risk factors fail to predict the development of coronary heart disease in 25-50% of cases. This underscores the complex interplay between traditional CV risk factors, genetic predisposition and other atheroprotective factors present in individuals of different populations in predicting CV events. Endothelial dysfunction, a functional expression of the inherent atherosclerotic risk representing an integrated index of both the overall CV risk-factor burden and the sum of all vasculoprotective factors in an individual, may serve as the missing link between CV risk factors and atherosclerotic disease. Endothelial function measurements may aid in future prediction of CV events and help identify high-risk patients for targeted therapy as well as provide a primary therapeutic end point for clinical follow-up of these patients. Recently introduced reactive hyperemia peripheral arterial tonometry is emerging as a promising tool in endothelial function measurement and CV risk stratification.
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