Abstract
There are several non-invasive methods to study endothelial function, but their interrelation and association to cardiovascular risk have not been well evaluated. We studied macrovascular and microvascular endothelial function simultaneously in different vascular beds in relation to cardiovascular mortality risk (Systematic Coronary Risk Evaluation, SCORE) and hypertension induced cardiac organ damage, and their interrelationship. The study investigated 71 hypertensive patients by forearm post-ischemic flow-mediated vasodilation, pulse wave analysis (applanation tonometry) and beta 2-adrenoceptor agonist stimulation for changes in reflection index, skin microvascular reactivity by laser Doppler fluxmetry with iontophoresis and heat-induced hyperaemia, and coronary microvascular function by subendocardial viability ratio (derived from pulse wave analysis). Flow mediated vasodilation related inversely to SCORE (r = 0.34, P = 0.011). Adding microalbuminuria and pulse wave velocity strengthened the associations. Pulse wave reflection changes did not relate to SCORE. Skin microvascular reactivity related inversely to SCORE (peak flux change to sodium nitroprusside r = 0.29, P = 0.033, and to heating r = 0.31, P = 0.018). Subendocardial viability ratio did not relate to SCORE. Endothelial function indices showed no consistent relation to cardiac target organ damage. The agreement between the different methods for evaluating indices of macrovascular and microvascular endothelial function was weak. In conclusion, indices of macrovascular and microvascular endothelial function relate to cardiovascular mortality risk. Their use may improve cardiovascular risk prediction in hypertension. However, methods representing different vascular beds show little interrelationship and are not interchangeable, which may depend on different pathogenetic mechanisms representing different aspects of future cardiovascular risk.Trial registry: NCT02901977
Highlights
Impaired endothelial function can detect early disturbances in vascular function that precede symptomatic atherosclerotic disease
Adding left ventricular (LV) mass index did not improve the multivariable model. This is the first study comparing simultaneous measurements of macrovascular endothelial function by brachial artery vasodilatation induced by post-ischemic flow mediated hyperaemia and pulse wave reflection, skin microvascular function, and coronary microvascular function in hypertensive patients
We show that endothelial dysfunction in macrocirculation and microcirculation is both related to cardiovascular mortality risk
Summary
Impaired endothelial function can detect early disturbances in vascular function that precede symptomatic atherosclerotic disease. Heart and Vessels (2019) 34:484–495 which can be expressed as the change in augmentation index derived from the first reflected wave, or from the relative height of the first diastolic reflective wave [2, 10]. This noninvasive technique assesses endothelial function representing resistance arteries. Disturbed skin microvascular reactivity is associated with coronary heart disease and incident type 2 diabetes [15, 16]. A lower SEVR, representing impaired subendocardial perfusion, is associated with a reduced coronary flow reserve [17, 18] and can predict cardiovascular mortality and end stage renal disease in patients with type 1 diabetes and in chronic kidney disease [19, 20]
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