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Updated: May 4, 2026
Ultrasound Assessment of Endothelial Function: A Technical Guideline of the Flow-mediated Dilation Test
Published on: April 27, 2016
[Endothelial function: role, assessment and limits]
C Puissant1, P Abraham2, S Durand3
1Service des explorations fonctionnelles vasculaires, centre hospitalier universitaire, 49933 Angers cedex 9, France.
Insights
Detecting endothelial dysfunction, an early sign of cardiovascular disease, is crucial. This review explores methods for assessing endothelial function, highlighting the need for improved, non-invasive techniques.
Area of Science:
- Cardiovascular Science
- Vascular Biology
- Biomedical Engineering
Context:
- Cardiovascular diseases are a major health concern, with endothelial dysfunction being an early indicator of atherosclerosis.
- The vascular endothelium plays a critical role in cardiovascular homeostasis.
- Assessing endothelial function is vital for understanding and managing cardiovascular health.
Purpose:
- To provide an overview of endothelial function and its importance in cardiovascular health.
- To review current biological and physico-chemical methods for assessing endothelial dysfunction.
- To discuss the clinical applications and limitations of these assessment techniques.
Summary:
- Endothelial dysfunction, characterized by reduced nitric oxide (NO) bioavailability, is a key factor in atherosclerosis development.
- Methods for assessment include biological assays measuring NO metabolites and inflammatory mediators, and physico-chemical techniques like flow-mediated dilation (FMD) and various optical methods.
- These techniques, often combined with provocation tests, offer insights into endothelial function but require further development for clinical reliability.
Impact:
- Highlights the significance of the endothelium as a cardiovascular organ.
- Discusses the potential of studying endothelial dysfunction for developing new therapeutic drugs.
- Emphasizes the need for advancements in non-invasive, reproducible, and cost-effective methods for endothelial dysfunction assessment.
Abstract:
For several years, detecting and preventing cardiovascular diseases have become a major issue. Different methods have been developed to evaluate endothelial function. Endothelial dysfunction is one of the first steps leading to atherosclerosis. This review presents an insight into endothelial function, the interests of its assessment and methods for studying endothelial function. To date, the vascular endothelium must be considered as a specific organ with its own functions that contribute to the homeostasis of the cardiovascular system. Endothelial dysfunction typically corresponds to a decrease of nitric oxide NO bioavailability. Biological or physico-chemical methods may be used to assess dysfunction. Biological methods allow measuring NO metabolites and pro-inflammatory and vasoconstrictor mediators released by the endothelium. The physico-chemical methods include intra-coronary injections, plethysmography, flow-mediated dilation (FMD), digital plethysmography and optical techniques using laser (laser Doppler single-point, laser Doppler imager, laser speckle contrast imaging) that can be coupled with provocation tests (iontophoresis, microdialysis, post-ischemic hyperemia, local heating). The principle of each technique and its use in clinical practice are discussed. Studying endothelial dysfunction is a particularly promising field because of new drugs being developed. Nevertheless, assessment methodology still needs further development to enable reliable, non-invasive, reproducible, and inexpensive ways to analyze endothelial dysfunction.
