The endothelium holds a pivotal role in cardiovascular health and disease. Assessment of its function was until recently limited to experimental designs due to its location. The advent of novel techniques has facilitated testing on a more detailed basis, with focus on distinct pathways. This review presents available in-vivo and ex-vivo methods for evaluating endothelial function with special focus on more recent ones. The diagnostic modalities covered include assessment of epicardial and microvascular coronary endothelial function, local vasodilation by venous occlusion plethysmography and flow-mediated dilatation, arterial pulse wave analysis and pulse amplitude tonometry, microvascular blood flow by laser Doppler flowmetry, biochemical markers and bioassays, measurement of endothelial-derived microparticles and progenitor cells, and glycocalyx measurements. Insights and practical information on the theoretical basis, methodological aspects, and clinical application in various disease states are discussed. The ability of these methods to detect endothelial dysfunction before overt cardiovascular disease manifests make them attractive clinical tools for prevention and rehabilitation. METHODS FOR EVALUATING ENDOTHELIAL FUNCTION. A POSITION STATEMENT FROM THE EUROPEAN SOCIETY OF CARDI-OLOGY WORKING GROUP ON PERIPHERAL CIRCULATION. John Venous occlusion plethysmographyVenous occlusion plethysmography (VOP), established more than 100 years ago, is the longest living method for investigating blood flow in humans. Flow-mediated dilatationConduit vessels respond to alterations in blood flow by increasing vessel diameter via an endothelial dependent mechanism. 20,21 The flow-mediated dilatation (FMD)technique measures changes in conduit artery diameter by ultrasound. This response has been shown to reflect local bioactivity of endothelial-derived NO. 22 MethodologyThe brachial artery is most often imaged (online Supplemental Figure 2). FMD studies are performed in a quiet temperature controlled room while subjects are lying supine for >10 min prior to image acquisition. A straight, non-branching segment of the brachial artery above the antecubital fossa is imaged in the longitudinal plane with the ultrasound probe securely fixed using a stereotactic clamp. This permits fine adjustments in the coronal and sagittal planes. A blood pressure cuff is placed 1-2 cm below the antecubital fossa and inflated to supra-systolic pressure. 23 After cuff release, reactive hyperaemia results and is quantified using Doppler. The arterial diameter is recorded at end diastole using electrocardiographic gating during image acquisition, to determine the response of the conduit artery to increase in flow. 24 Changes in the arterial diameter are assessed using commercial digital edge detection software. Pulse wave analysisThe arterial waveform contains important information about the stiffness of the large arteries and amount of wave reflection within the arterial system. 32 Wave reflection occurs at sites of impedance mismatc...

AimsThe aim of the present study was to describe a 10 years single-centre experience in pacing and defibrillating leads removal using an effective and safe modified mechanical dilatation technique.Methods and resultsWe developed a single mechanical dilating sheath extraction technique with multiple venous entry site approaches. We performed a venous entry site approach (VEA) in cases of exposed leads and an alternative transvenous femoral approach (TFA) combined with an internal transjugular approach (ITA) in the presence of very tight binding sites causing failure of VEA extraction or in cases of free-floating leads. We attempted to remove 2062 leads [1825 pacing and 237 implantable cardiac defibrillating (ICD) leads; 1989 exposed at the venous entry site and 73 free-floating] in 1193 consecutive patients. The VEA was effective in 1799 leads, the TFA in 28, and the ITA in 205; in the overall population, we completely removed 2032 leads (98.4%), partially removed 18 (0.9%), and failed to remove 12 leads (0.6%). Major complications were observed in eight patients (0.7%), causing three deaths (0.3%).ConclusionMechanical single sheath extraction technique with multiple venous entry site approaches is effective, safe, and with a good cost effective profile for pacing and ICD leads removal.

The assessment of arterial stiffness, a common feature of ageing, exacerbated by many common disorders such as hypertension, diabetes mellitus, or renal diseases, has become an attractive tool for identifying structural and functional abnormalities of the arteries in the preclinical stages of the atherosclerotic disease. Arterial stiffness has been recognized as an important pathophysiological determinant of systolic blood pressure and pulse pressure increases and therefore the cause of cardiovascular complications, demonstrating also an independent predictive value for cardiovascular events. Although there are many techniques and indices currently available, their large clinical application is limited by a lack of standardization, with important difficulties when one try effectively to measure, quantify, and compare. Moreover, information on the 'heart-vessel coupling disease', in which combined stiffness of both heart and arteries interact to limit cardiovascular performance and its possible implications in different clinical conditions, is still not well known. We overviewed main methods and indices used to estimate arterial stiffness and aimed to provide an insight into the knowledge of the ventricular-arterial coupling from the cardiologist's point of view.

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