Non-invasive measurement of human endothelium dependent arterial responses: accuracy and reproducibility.
Cardiothoracic Unit, Hospital for Sick Children, London.
OBJECTIVE--To assess a non-invasive test for endothelial dysfunction, an important early event in the atherogenic process. METHODS--Using high resolution ultrasound, the accuracy of detecting small changes in vessel diameter was assessed using phantom "arteries", and the same equipment was then used to measure flow mediated dilatation in the brachial artery of 40 healthy adults aged 22-51 years, studied on four occasions; intervals between scans were 1-2 days, 1-2 weeks, and 2-4 months. RESULTS--Differences between pairs of phantom "arteries" with diameters 0.1-0.2 mm apart were correctly estimated in 162 of 264 cases (61%); no measurement by any of four independent observers was > 0.1 mm in error, and the mean error was 0.04 mm. For in vivo scans, the overall coefficient of variation for flow mediated dilatation was 1.8% (1.6% for women, 1.9% for men, P = 0.18). In 34/40 subjects (85%), all values for flow mediated dilatation were within 2.5% of the overall mean for each subject. A nested analysis of variance showed the expected between patient variability, and also significant day to day variation, but little between weeks or months. Using these data to generate power function analyses, we calculated that for individuals, an improvement in flow mediated dilatation of 4-8% is significantly greater than natural variability. In clinical trials, a mean improvement in flow mediated dilatation of at least 2% would usually be required to detect a treatment benefit, with much larger subject numbers needed for a parallel group compared to a crossover trial design. CONCLUSIONS--Vascular responses to endothelium dependent and independent stimuli in systemic arteries can be studied non-invasively in man. Subjects should be studied on at least two occasions before and after any intervention, to optimise the chance of showing a significant effect from any potentially beneficial therapy.
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(2000). Preserved Forearm Endothelial Responses with Acute Exposure to Progesterone: A Randomized Cross-Over Trial of 17-{beta} Estradiol, Progesterone, and 17-{beta} Estradiol with Progesterone in Healthy Menopausal Women. J. Clin. Endocrinol. Metab.
85: 4644-4649
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Pfeifer, M., Poredos, P., Zizek, B.
(2000). Effect of Growth Hormone (GH) Therapy on Endothelial Function in GH-Deficient Adults. J. Clin. Endocrinol. Metab.
85: 4923-4923
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Ringqvist, A., Caidahl, K., Petersson, A.-S., Wennmalm, A.
(2000). Diurnal variation of flow-mediated vasodilation in healthy premenopausal women. Am. J. Physiol. Heart Circ. Physiol.
279: H2720-H2725
[Abstract] [Full Text] -
Chambers, J. C., Ueland, P. M., Obeid, O. A., Wrigley, J., Refsum, H., Kooner, J. S.
(2000). Improved Vascular Endothelial Function After Oral B Vitamins : An Effect Mediated Through Reduced Concentrations of Free Plasma Homocysteine. Circulation
102: 2479-2483
[Abstract] [Full Text] -
Vogel, R. A., Corretti, M. C., Plotnick, G. D.
(2000). The postprandial effect of components of the mediterranean diet on endothelial function. J Am Coll Cardiol
36: 1455-1460
[Abstract] [Full Text] -
Perregaux, D., Chaudhuri, A., Rao, S., Airen, A., Wilson, M., Sung, B.-H., Dandona, P.
(2000). Brachial Vascular Reactivity in Blacks. Hypertension
36: 866-871
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Woo, K. S., Chook, P., Leong, H. C., Huang, X. S., Celermajer, D. S.
(2000). The impact of heavy passive smoking on arterial endothelial function in modernized Chinese. J Am Coll Cardiol
36: 1228-1232
[Abstract] [Full Text] -
Fard, A., Tuck, C. H., Donis, J. A., Sciacca, R., Di Tullio, M. R., Wu, H. D., Bryant, T. A., Chen, N.-T., Torres-Tamayo, M., Ramasamy, R., Berglund, L., Ginsberg, H. N., Homma, S., Cannon, P. J.
(2000). Acute Elevations of Plasma Asymmetric Dimethylarginine and Impaired Endothelial Function in Response to a High-Fat Meal in Patients With Type 2 Diabetes. Arterioscler. Thromb. Vasc. Bio.
20: 2039-2044
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Yoshida, A., Nakao, S., Kobayashi, M., Kobayashi, H.
(2000). Flow-Mediated Vasodilation and Plasma Fibronectin Levels in Preeclampsia. Hypertension
36: 400-404
[Abstract] [Full Text] -
Thambyrajah, J., Landray, M. J., McGlynn, F. J., Jones, H. J., Wheeler, D. C., Townend, J. N.
(2000). Does Folic Acid Decrease Plasma Homocysteine and Improve Endothelial Function in Patients With Predialysis Renal Failure?. Circulation
102: 871-875
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Mullen, M. J., Wright, D., Donald, A. E., Thorne, S., Thomson, H., Deanfield, J. E.
(2000). Atorvastatin but not L-arginine improves endothelial function in type I diabetes mellitus: a double-blind study. J Am Coll Cardiol
36: 410-416
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Raitakari, O. T., Lai, N., Griffiths, K., McCredie, R., Sullivan, D., Celermajer, D. S.
(2000). Enhanced peripheral vasodilation in humans after a fatty meal. J Am Coll Cardiol
36: 417-422
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Raitakari, O. T., Adams, M. R., McCredie, R. J., Griffiths, K. A., Stocker, R., Celermajer, D. S.
(2000). Oral vitamin C and endothelial function in smokers: short-term improvement, but no sustained beneficial effect. J Am Coll Cardiol
35: 1616-1621
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Mather, K. J., Verma, S., Corenblum, B., Anderson, T. J.
(2000). Normal Endothelial Function Despite Insulin Resistance in Healthy Women with the Polycystic Ovary Syndrome. J. Clin. Endocrinol. Metab.
85: 1851-1856
[Abstract] [Full Text] -
Balletshofer, B. M., Rittig, K., Enderle, M. D., Volk, A., Maerker, E., Jacob, S., Matthaei, S., Rett, K., Haring, H. U.
(2000). Endothelial Dysfunction Is Detectable in Young Normotensive First-Degree Relatives of Subjects With Type 2 Diabetes in Association With Insulin Resistance. Circulation
101: 1780-1784
[Abstract] [Full Text]
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