Detection of endothelial dysfunction with brachial artery ultrasound scanning

• Published in: The American heart journal 2003-06, Vol.145 (6), p.943-951
• Main Authors: Faulx, Michael D, Wright, Andrew T, Hoit, Brian D
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Blood Flow Velocity - physiology; Brachial Artery - diagnostic imaging; Brachial Artery - physiology; Cardiovascular disease; Cardiovascular system; Cell growth; Coronary Disease - blood; Coronary vessels; Diabetes; Drug dosages; Drug therapy; Endothelium; Endothelium, Vascular - diagnostic imaging; Endothelium, Vascular - physiology; Endothelium, Vascular - physiopathology; Hemorheology; Humans; Hypertension; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Multivariate analysis; Nitric oxide; Nitric Oxide - metabolism; Randomized Controlled Trials as Topic; Regional Blood Flow - physiology; Risk factors; Rodents; Shear stress; Ultrasonic imaging; Ultrasonic investigative techniques; Ultrasonography, Doppler; Vasodilation - physiology
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/S0002-8703(03)00097-8

The role of the endothelium in human disease recently has become the focus of intense scientific investigation. Impaired endothelial function is associated with a number of disease states, including cardiovascular disease (CVD) and its major risk factors. Endothelial dysfunction precedes overt vascular disease by years and may itself be a potentially modifiable CVD risk factor. Although no gold standard for the measurement of endothelial function exists, the measurement of flow-mediated dilation (FMD) in the brachial artery, assessed with Doppler ultrasonography, is the most studied method and shows the most promise for clinical application. It is a well-tolerated, noninvasive, and low-risk procedure. Brachial artery FMD after transient vascular occlusion may serve as an index of nitric oxide bioavailability, and its impairment correlates with coronary arterial abnormalities. These factors, with the wide availability of vascular ultrasound scanning in clinical practice, make brachial artery FMD an attractive screening tool for endothelial dysfunction. Present limitations of this procedure include the lack of a consensus definition of normal FMD and the variability among centers in both procedural technique and image analysis. However, these limitations are likely to be overcome with increasing experience and advances in technology, and with further refinements, the measurement of brachial artery FMD will likely become the clinical technique of choice for the evaluation of endothelial disease.