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      Assessment of flow-mediated dilation in humans: a methodological and physiological guideline

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          Abstract

          Endothelial dysfunction is now considered an important early event in the development of atherosclerosis, which precedes gross morphological signs and clinical symptoms. The assessment of flow-mediated dilation (FMD) was introduced almost 20 years ago as a noninvasive approach to examine vasodilator function in vivo. FMD is widely believed to reflect endothelium-dependent and largely nitric oxide-mediated arterial function and has been used as a surrogate marker of vascular health. This noninvasive technique has been used to compare groups of subjects and to evaluate the impact of interventions within individuals. Despite its widespread adoption, there is considerable variability between studies with respect to the protocols applied, methods of analysis, and interpretation of results. Moreover, differences in methodological approaches have important impacts on the response magnitude, can result in spurious data interpretation, and limit the comparability of outcomes between studies. This review results from a collegial discussion between physiologists with the purpose of developing considered guidelines. The contributors represent several distinct research groups that have independently worked to advance the evidence base for improvement of the technical approaches to FMD measurement and analysis. The outcome is a series of recommendations on the basis of review and critical appraisal of recent physiological studies, pertaining to the most appropriate methods to assess FMD in humans.

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          Most cited references 109

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          The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine.

          Despite its very potent vasodilating action in vivo, acetylcholine (ACh) does not always produce relaxation of isolated preparations of blood vessels in vitro. For example, in the helical strip of the rabbit descending thoracic aorta, the only reported response to ACh has been graded contractions, occurring at concentrations above 0.1 muM and mediated by muscarinic receptors. Recently, we observed that in a ring preparation from the rabbit thoracic aorta, ACh produced marked relaxation at concentrations lower than those required to produce contraction (confirming an earlier report by Jelliffe). In investigating this apparent discrepancy, we discovered that the loss of relaxation of ACh in the case of the strip was the result of unintentional rubbing of its intimal surface against foreign surfaces during its preparation. If care was taken to avoid rubbing of the intimal surface during preparation, the tissue, whether ring, transverse strip or helical strip, always exhibited relaxation to ACh, and the possibility was considered that rubbing of the intimal surface had removed endothelial cells. We demonstrate here that relaxation of isolated preparations of rabbit thoracic aorta and other blood vessels by ACh requires the presence of endothelial cells, and that ACh, acting on muscarinic receptors of these cells, stimulates release of a substance(s) that causes relaxation of the vascular smooth muscle. We propose that this may be one of the principal mechanisms for ACh-induced vasodilation in vivo. Preliminary reports on some aspects of the work have been reported elsewhere.
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            Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging.

             A Poli,  P Oreste,  P Pignoli (1986)
            A study in vitro of specimens of human aortic and common carotid arteries was carried out to determine the feasibility of direct measurement (i.e., not from residual lumen) of arterial wall thickness with B mode real-time imaging. Measurements in vivo by the same technique were also obtained from common carotid arteries of 10 young normal male subjects. Aortic samples were classified as class A (relatively normal) or class B (with one or more atherosclerotic plaques). In all class A and 85% of class B arterial samples a characteristic B mode image composed of two parallel echogenic lines separated by a hypoechoic space was found. The distance between the two lines (B mode image of intimal + medial thickness) was measured and correlated with the thickness of different combinations of tunicae evaluated by gross and microscopic examination. On the basis of these findings and the results of dissection experiments on the intima and adventitia we concluded that results of B mode imaging of intimal + medial thickness did not differ significantly from the intimal + medial thickness measured on pathologic examination. With respect to the accuracy of measurements obtained by B mode imaging as compared with pathologic findings, we found an error of less than 20% for measurements in 77% of normal and pathologic aortic walls. In addition, no significant difference was found between B mode-determined intimal + medial thickness in the common carotid arteries evaluated in vitro and that determined by this method in vivo in young subjects, indicating that B mode imaging represents a useful approach for the measurement of intimal + medial thickness of human arteries in vivo.
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              Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery

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                Author and article information

                Journal
                American Journal of Physiology-Heart and Circulatory Physiology
                American Journal of Physiology-Heart and Circulatory Physiology
                American Physiological Society
                0363-6135
                1522-1539
                January 2011
                January 2011
                : 300
                : 1
                : H2-H12
                Affiliations
                [1 ]Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool;
                [2 ]Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;
                [3 ]Vascular Laboratory, Russells Hall Hospital, Dudley Group Of Hospitals, NHS Foundation Trust, Dudley, United Kingdom;
                [4 ]Cardiovascular Stress Response Laboratory and
                [5 ]Department of Biomedical Sciences, University of Missouri, Columbia, Missouri;
                [6 ]Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Augusta, Georgia;
                [7 ]Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut;
                [8 ]Departments of Medicine and Pharmacology and the Cardiovascular Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin;
                [9 ]Human Vascular Control Laboratory, School of Kinesiology and Health Studies and Department of Physiology, Queen's University, Kingston, Ontario, Canada;
                [10 ]School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia, Australia
                Article
                10.1152/ajpheart.00471.2010
                3023245
                20952670
                © 2011

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