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Assessing Collagen and Elastin Pressure-dependent Microarchitectures in Live, Human Resistance Arteries by Label-free Fluorescence Microscopy
Published on: April 9, 2018
Functional and structural alterations of large arteries: methodological issues
Elisabetta Bianchini1, Chiara Giannarelli, Rosa Maria Bruno
1Institute of Clinical Physiology, National Research Council, Pisa, Italy.
Insights
Ultrasound can detect early vascular damage, like increased intima-media thickness and arterial stiffness, to identify patients at high cardiovascular risk. These subclinical markers aid in personalized prevention strategies beyond traditional risk factors.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Preventive Cardiology
Background:
- Classical cardiovascular risk factors (smoking, diabetes, hypercholesterolemia, hypertension) are insufficient for comprehensive risk stratification.
- Subclinical vascular damage, detectable via ultrasound, identifies 'vulnerable' patients for targeted prevention.
- Early atherosclerosis, indicated by increased common carotid intima-media thickness, correlates with coronary and cerebrovascular disease.
Purpose of the Study:
- To review clinical evidence supporting the use of ultrasound-assessed vascular biomarkers for cardiovascular risk stratification.
- To highlight the importance of accurate and reliable methodologies for assessing vascular markers.
- To explore the potential of vascular markers in improving cardiovascular prevention strategies.
Main Methods:
- Review of clinical evidence on ultrasound-based vascular biomarkers.
- Assessment of intima-media thickness of the common carotid artery.
- Evaluation of arterial stiffness and flow-mediated dilation of peripheral arteries.
Main Results:
- Increased common carotid intima-media thickness is a recognized marker of early atherosclerosis.
- Increased arterial stiffness, detected by ultrasound, predicts future cardiovascular events and is a target organ in hypertension.
- Endothelial dysfunction (reduced flow-mediated dilation) is an early vascular abnormality with potential future clinical utility.
Conclusions:
- Ultrasound-assessed vascular biomarkers (intima-media thickness, arterial stiffness, flow-mediated dilation) enhance cardiovascular risk stratification.
- Accurate and robust methodologies are crucial for improving the predictive value of these vascular markers.
- Wider adoption of standardized vascular marker assessment in routine clinical practice can improve cardiovascular prevention.
Abstract:
Ultrasound assessment of vascular biomarkers has been implemented for screening, prevention and improvement of cardiovascular risk stratification beyond classical risk factors including smoking, diabetes, hypercholesterolemia and hypertension. Thus, the presence of vascular damage at the sub-clinical, asymptomatic stages can identify a "vulnerable" patient, and aid in implementing cardiovascular prevention strategies. Increased intima-media thickness of the common carotid artery is a well-known marker of early atherosclerosis, which significantly correlates with the development of coronary or cerebro-vascular disease. More recently, guidelines for cardiovascular prevention in hypertension also introduced other vascular parameters evaluating both mechanical and functional arterial properties of peripheral arteries. Increased arterial stiffness, which can be detected by ultrasound at the common carotid, has been shown to predict future cardiovascular events and it is already considered a subclinical target organ of hypertensive patients. Even earlier vascular abnormalities such as endothelial dysfunction in the peripheral arteries, detected as reduced flow-mediated dilation of the brachial artery by ultrasound, have also been mentioned for their possible clinical use in the future. This manuscript reviews clinical evidence supporting the use of these different vascular markers for cardiovascular risk stratification, focusing on the need for an accurate, robust and reliable methodology for the assessment of vascular markers, which could improve their predictive value and increase their use in routine clinical practice.
