Assessment of vascular function: flow-mediated constriction complements the information of flow-mediated dilatation

Gori, Tommaso; Grotti, Simone; Dragoni, Saverio; Lisi, Monica; Stolfo, Giuseppe Di; Sonnati, S; Fineschi, Massimo; Parker, John D.

doi:10.1136/hrt.2009.167213

Cited by 74 publications

(90 citation statements)

References 20 publications

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“…Some authors have described radial artery vasoconstriction during low flow and suggested that this is an additional marker of endothelial function [11][12][13][14][15][16] . However, the low-flowmediated vasoconstriction (L-FMC) seems to be specific to the radial artery because it has not been consistently described for the brachial artery.…”

Section: Ultrasound Study Proceduresmentioning

confidence: 99%

Brachial Low-Flow-Mediated Constriction is Associated with Delayed Brachial Flow-Mediated Dilation

Irace

Tripolino

Scavelli

et al. 2016

JAT

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Aim: Flow-mediated vasodilation (FMD) of the brachial artery measures the ability of the artery to dilate after a forearm ischemia lasting for 5 min. During ischemia, and therefore in conditions of low flow, constriction of the brachial artery (L-FMC) has sometimes been reported. The meaning of L-FMC is still unclear. The aims of our study were to establish the prevalence of subjects with L-FMC, to determine whether the magnitude of L-FMC correlates with magnitude of FMD, and to determine whether L-FMC can be used to predict FMD timing. Methods: A total of 179 outpatients were studied, and the brachial artery diameter was measured every minute during the 5 min forearm ischemia. Subjects who had at least one measurement showing a constriction of 1% during ischemia were defined as constrictors. FMD was evaluated at 50 s, 2 min, and 3 min after cuff release. On the basis of time, the subjects in whom maximal dilation had occurred were divided into Early, Late, or No dilators. Conclusions:The present study reveals that almost 40% of the subjects had brachial artery L-FMC and a more pronounced constriction during ischemia correlated with a lower dilation after ischemia. Finally, the prevalence of subjects showing L-FMC was significantly higher among subjects with delayed or no vasodilation, suggesting that L-FMC may be a marker of endothelial dysfunction.

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Section: Ultrasound Study Proceduresmentioning

confidence: 99%

Brachial Low-Flow-Mediated Constriction is Associated with Delayed Brachial Flow-Mediated Dilation

Irace

Tripolino

Scavelli

et al. 2016

JAT

View full text Add to dashboard Cite

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“…The technique of measuring L-FMC also differs in cuff position; most authors place the pneumatic cuff distal to the side of arterial diameter measurement 29) , while others use the proximal cuff occlusion method 30) . Low-flow-mediated constriction is calculated as the percentage decrease in arterial diameter in the last 30s of cuff occlusion (after 4.5 min of 5 min occlusion) as compared with resting diameter 31) ; however, FMD is determined in the 5 min following cuff deflation.…”

Section: Peripheral Arterial Tonometrymentioning

confidence: 99%

Testing Endothelial Function and its Clinical Relevance

Poredoš¹,

Ježovnik²

2013

JAT

107

109

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Endothelial dysfunction as an integrating index of the risk factor burden and genetic susceptibility is an early marker of atherothrombotic disease. Therefore, tremendous interest exists in its measurement and determination of the clinical utility of the evaluation of endothelial function. Different invasive and non-invasive techniques exist for exploring various aspects of the pathobiology of the endothelium. As endothelial dysfunction is a diffuse-systemic disorder, the peripheral arteries, because of their accessibility, represent the basis for assessment of endothelial dysfunction.

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“…All patients abstained from vasoactive medications on the day of the studies. All patients in the middle-aged adult, smoking, HTN, and HF groups, as well as 27 patients with CAD and 14 healthy volunteers, were included in previous studies testing end points not related to the present study or to time-domain end points of FMD (18,19).…”

Section: Flow-mediated Dilation (Fmd) Is a Noninvasive Techniquementioning

confidence: 99%

Observations of time-based measures of flow-mediated dilation of forearm conduit arteries: implications for the accurate assessment of endothelial function

Liuni

Luca

Lisi

et al. 2010

American Journal of Physiology-Heart and Circulatory Physiology

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dependent flow-mediated dilation (FMD) is measured as the increase in diameter of a conduit artery in response to reactive hyperemia, assessed either at a fixed time point [usually 60-s post-cuff deflation (FMD60)] or as the maximal dilation during a 5-min continuous, ECG-gated, measurement (FMDmax-cont). Preliminary evidence suggests that the time between reactive hyperemia and peak dilation (time to FMDmax) may provide an additional index of endothelial health. We measured FMDmax-cont, FMD60, and time to FMDmax in 30 young healthy volunteers, 22 healthy middle-aged adults, 16 smokers, 23 patients with hypertension, 40 patients with coronary artery disease, and 22 patients with heart failure. As previously reported, FMDmax-cont was similar in healthy cohorts and was significantly blunted in smokers and all patient groups, whereas FMD60 was significantly blunted only in heart failure patients. There was a wide within-group variability between measures of time to FMDmax with no significant difference between normal and patient groups. Intra-arterial infusion of the nitric oxide synthase inhibitor N -monomethyl-L-arginine in eight healthy subjects resulted in a blunting of FMDmax-cont (P Ͻ 0.001) and FMD60 (P ϭ 0.02) but not time to FMDmax. Both FMDmax-cont and FMD60 demonstrated good repeatability in 30 young healthy volunteers studied on two separate occasions (P Ͻ 0.01 for both), whereas time to FMD max varied widely between visits (P ϭ not significant). In conclusion, although time to FMDmax does not appear to be a useful adjunctive measure of endothelial health, the use of continuous diameter measurements provides important data in the study of endothelial function in healthy subjects and patients with cardiovascular disease. endothelium; vascular physiology; flow-mediated dilation; arterial diameter; time to peak dilation FLOW-MEDIATED DILATION (FMD) is a noninvasive technique used to evaluate the function of the vascular endothelium in peripheral conduit arteries. The concept of FMD is based on the observation that the induction of ischemia in a peripheral limb (usually the hand/forearm), followed by rapid deflation of the pneumatic cuff used to induce this ischemia, causes a sudden increase in blood flow (reactive hyperemia) in the conduit artery that provides blood to this territory. The ensuing sudden change in local shear stress causes an endotheliumdependent production of a number of vasoactive substances, including nitric oxide (NO) (5, 7). Since the ability of the vessel to respond to changes in shear stress is dependent on an intact and healthy endothelium, the magnitude of this flowinduced vasodilatory response has been proposed as a surrogate measure of overall endothelial function. Importantly, FMD of the radial artery has been demonstrated to be mediated primarily by NO, such that the response observed can also indicate the degree of NO bioavailability (23), although this concept has been recently challenged (26).Traditionally, FMD is calculated as the dilation induced by reactive hyperemia, exp...

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Assessment of vascular function: flow-mediated constriction complements the information of flow-mediated dilatation

Cited by 74 publications

References 20 publications

Brachial Low-Flow-Mediated Constriction is Associated with Delayed Brachial Flow-Mediated Dilation

Brachial Low-Flow-Mediated Constriction is Associated with Delayed Brachial Flow-Mediated Dilation

Testing Endothelial Function and its Clinical Relevance

Observations of time-based measures of flow-mediated dilation of forearm conduit arteries: implications for the accurate assessment of endothelial function

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