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Updated: Mar 21, 2026
A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
Non-invasive endothelial function assessment using digital reactive hyperaemia correlates with three-dimensional
Tomas Kovarnik1, Stepan Jerabek, Zhi Chen
12nd Department of Medicine, Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic. tomas.kovarnik@vfn.cz.
Insights
Endothelial dysfunction is linked to more severe coronary atherosclerosis, including larger plaque burden and higher thin-cap fibroatheroma presence. This finding may aid in identifying individuals at increased cardiovascular risk.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Vascular Biology
Background:
- Endothelial dysfunction (ED) is a precursor to cardiovascular events.
- Intravascular ultrasound (IVUS) and virtual histology (VH) provide detailed coronary artery imaging.
- Understanding the link between ED and atherosclerotic plaque characteristics is crucial for risk stratification.
Purpose of the Study:
- To investigate the association between endothelial dysfunction and coronary atherosclerosis.
- To correlate endothelial function markers with plaque phenotypes identified by IVUS-VH.
Main Methods:
- Endothelial function assessed using the EndoPAT system and reactive hyperemia index (RHI).
- Coronary arteries analyzed with IVUS and VH in 56 patients.
- Plaque phenotypes, including thin-cap fibroatheroma (TCFA), were categorized.
Main Results:
- Patients with ED showed significantly higher plaque burden, smaller lumen area, and increased plaque risk scores.
- A higher number of TCFA frames were observed in patients with ED.
- Positive correlation found between fibrous tissue and RHI; inverse correlation between fibroatheromas/calcified plaques and RHI.
Conclusions:
- Endothelial dysfunction is associated with the severity and specific phenotypes of coronary atherosclerotic lesions.
- These findings suggest ED assessment could help identify individuals at higher risk for cardiovascular events.
Background And Aim:
To study relationships between endothelial dysfunction (ED) and coronary atherosclerosis derived from intravascular ultrasound (IVUS) and virtual histology (VH).
Methods:
Endothelial dysfunction was examined by EndoPAT system (Itamar Medical) in 56 patients who underwent IVUS and VH (Volcano corp.). Reactive hyperaemia index (RHI) < 2 was used for definition of ED. IVUS sequences were divided into 5 mm-long non-overlapping and adjacent vessel segments. Plaque phenotype was determined for each frame and 5 mm vessel segment was labeled according to highest frame score (from 0 for "no lesion" to 5 for "thin cap fibroatheroma; TCFA").
Results:
IVUS-VH data were collected from 41 patients suitable for three-dimensional analysis. Patients with ED exhibited larger plaque burden than those without ED (0.46 ± 0.08 vs. 0.39 ± 0.07, p = 0.014), smaller lumen area (8.59 ± 2.19 vs. 11.90 ± 3.50, p = 0.016), higher plaque risk score (2.82 ± 1.18 vs. 1.84 ± 0.90, p = 0.012), and higher number of TCFA frames (0.36 ± 0.22 vs. 0.22 ± 0.16, p = 0.038). Relative amounts of fibrous tissue correlated positively with RHI (p = 0.034, r = 0.33). The numbers of fibroatheromas and calcified plaques correlated with RHI inversely (r = -0.34, p = 0.031 and r = -0.32, p = 0.044, respectively).
Conclusions:
Endothelial dysfunction correlates with severity and phenotype of coronary lesions and can contribute to non-invasive detection of individuals with higher risk of cardiovascular events.
