Artery Flow-mediated Dilation In Patients Research Articles

Brachial artery flow-mediated dilation in patients with systemic sclerosis: an experience from tertiary care center from North India.

Role of flow-mediated dilatation (FMD) testing in the assessment of the macrovascular dysfunction in systemic sclerosis (SS) and correlation of FMD values with disease severity. Twenty-five patients of SS and 25 healthy age-matched controls were recruited. Modified Rodnan skin thickness score (MRSS) was used for skin thickness assessment. FMD values were measured in the brachial artery. FMD values done at baseline before the initiation of treatment were lower in SSc patients (4.044 ± 2.742) compared to the healthy controls (11.076 ± 5.896) (P < 0.05). Comparison of FMD values between patients with limited cutaneous systemic sclerosis (LSSc) and diffuse cutaneous systemic sclerosis (DSSc) showed a trend toward lower in LSSc (3.182 ± 2.482) as compared to DSSc patients (5.111 ± 2.711); however, the difference was not statistically significant. Patients with lung manifestations on high-resolution CT chest showed lower FMD values (2.66 ± 2.23) compared to those without HRCT changes (6.45 ± 2.56) (P < 0.05). We demonstrate that FMD values in SSc patients were lower when compared to healthy controls. Patients with SS having pulmonary manifestations showed a lower value of FMD. Key Points • FMD is a simple non-invasive tool to assess the endothelial function in patients with systemic sclerosis. • Lower values of FMD in systemic sclerosis suggest that the endothelial dysfunction and values can also be correlated with other organ involvement such as lung and skin involvement. So, lower FMD values might be a useful marker for disease severity.

Comparison of the radial and brachial artery flow-mediated dilation in patients with hypertension.

Blood flow-mediated dilation (FMD) is a noninvasive assessment of vascular endothelial function in humans. The study of the FMD in hypertensive (HT) patients is an important factor supporting the recognition of the early mechanisms of cardiovascular pathologies, and also of the pathogenesis related to hypertension. To investigate whether FMD measured on the radial artery (FMD-RA) using high-frequency ultrasounds can be used as an alternative to FMD assessed with the lower frequency system on the brachial artery in patients with HT. The simultaneous measurements of FMD-RA and FMD measurements in the brachial artery (FMD-BA) were performed on 76 HT patients using 20 MHz and 7-12 MHz linear array probes, and were compared to the FMD measured in healthy groups. All quantitative data are presented as mean ± standard deviation (SD); the p-values of the normality and tests for variables comparisons are listed. The agreement of the FMD-RA and FMD-BA in HT patients was assessed with the Bland-Altman method, and using the intraclass correlation coefficient (ICC). In some statistical calculations, the FMD-RA values were rescaled by dividing them by a factor of 2. The mean FMD-RA and FMD-BA in HT patients were 5.16 ±2.18% (95% confidence interval (95% CI): [4.50%, 5.82%]) and 2.13 ±1.12% (95% CI: [1.76%, 2.49%]), respectively. The FMD-RA and FMD-BA values of HT patients were significantly different than those in respective control groups. The p-values of Mann-Whitney-Wilcoxon tests were less than 0.05. The Bland-Altman coefficient for both measurement methods, FMD-RA and FMD-BA, was 3%, and the ICC was 0.69. Our findings show that FMD-RA, supplementary to FMD-BA measurements, can be used to assess endothelial dysfunction in the group of HT patients. In addition, the FMD-RA measurements met the criteria of high concordance with the FMD-BA measurements.

Brachial Artery FMD Responses To Steady-State Moderate-Intensity And High-Intensity Interval Exercise In Mid-Spectrum Chronic Kidney Disease

Brachial artery flow-mediated dilation (FMD) is a nitric oxide-dependent measure of conduit artery endothelial function that is transiently potentiated by moderate-intensity steady-state exercise (SSE) in healthy adults. Whether exercise imparts similar effects in adults with Stage 3 or 4 chronic kidney disease (CKD) has not been reported. Moreover, a comparison of SSE and high-intensity interval exercise (HIIE) may add to clinically-relevant findings for improving vascular function in mid-spectrum CKD. PURPOSE: To determine the influence of SSE and a comparable amount of HIIE on post-exercise brachial artery FMD in patients diagnosed with secondary Stage 3 or 4 CKD. METHODS: Twenty participants (n = 6 men; n = 14 women; age 62.0 + 9.9 yr; weight 80.9 + 16.2 kg; body fat 37.3 + 8.5% of weight; VO2max 19.4 + 4.7 ml/kg/min) completed 30 min of SSE at 65% VO2reserve or HIIE by treadmill walking (90% and 20% of VO2reserve in 3:2 min ratio) in a randomized crossover design. Both exercise conditions averaged ~ 65% VO2reserve. Ultrasound measurements of brachial artery FMD were obtained by the same technician under standardized conditions just before, 1 hr and 24 hrs after exercise. FMD responses were analyzed using 2 (condition) by 3 (sample point) repeated measures ANOVAs. RESULTS: Brachial artery FMD responses were augmented 1 hr after exercise in both exercise conditions (p < 0.005 versus pre-exercise FMD). SSE (pre-exercise = 11.5 + 1.3; 1 hr = 17.2* + 1.8; 24 hr = 14.0* + 1.1%) HIIE (pre-exercise = 12.5 + 1.3; 1 hr = 15.6* + 1.5; 24 hr = 15.8* + 1.2%) SUMMARY: We report for the first time that brachial artery FMD can be augmented by a single episode of exercise in mid-spectrum CKD. SSE and HIIE, averaging ~65% of VO2reserve, is equally effective at transiently improving conduit artery vascular function in this clinical population.

Clinical correlation of brachial artery flow-mediated dilation in patients with systemic sclerosis

Objective To investigate the clinical significance of flow-mediated dilation (FMD) in systemic sclerosis (SSc).Methods Thirty-three SSc patients and 12 healthy controls were studied. Ultrasound assessment of the brachial artery FMD was performed on all subjects. The results were expressed as the percentage of increase in brachial artery diameter following hyperemia.Results Limited cutaneous SSc (lcSSc) patients had significantly lower FMD values than healthy controls (5.3 ± 2.7 versus 7.7 ± 2.0 %, p < 0.05), while the values in diffuse cutaneous SSc (dcSSc) patients (6.7 ± 4.0 %) were comparable to those in lcSSc patients and healthy controls. Although FMD values did not correlate with any clinical features in dcSSc patients, there was an inverse correlation between FMD values and disease duration in lcSSc patients (r = −0.64, p < 0.05). Furthermore, lcSSc patients with decreased FMD values showed significantly higher prevalence of digital ulcers and elevated right ventricular systolic pressure than those with normal values (for each; 75 versus 10 %, p < 0.05).Conclusion The FMD values represent the severity of vascular damages, which progress along with disease duration and lead to digital ulcers and pulmonary arterial hypertension, in lcSSc patients.

Clinical correlation of brachial artery flow-mediated dilation in patients with systemic sclerosis.

OBJECTIVE: To investigate the clinical significance of flow-mediated dilation (FMD) in systemic sclerosis (SSc). METHODS: Thirty-three SSc patients and 12 healthy controls were studied. Ultrasound assessment of the brachial artery FMD was performed on all subjects. The results were expressed as the percentage of increase in brachial artery diameter following hyperemia. RESULTS: Limited cutaneous SSc (lcSSc) patients had significantly lower FMD values than healthy controls (5.3±2.7 versus 7.7±2.0%, p<0.05), while the values in diffuse cutaneous SSc (dcSSc) patients (6.7±4.0%) were comparable to those in lcSSc patients and healthy controls. Although FMD values did not correlate with any clinical features in dcSSc patients, there was an inverse correlation between FMD values and disease duration in lcSSc patients (r=-0.64, p<0.05). Furthermore, lcSSc patients with decreased FMD values showed significantly higher prevalence of digital ulcers and elevated right ventricular systolic pressure than those with normal values (for each; 75 versus 10%, p<0.05). CONCLUSION: The FMD values represent the severity of vascular damages, which progress along with disease duration and lead to digital ulcers and pulmonary arterial hypertension, in lcSSc patients.

Brachial Artery Flow-mediated Dilation in Patients with Tako-Tsubo Cardiomyopathy

Background Tako-Tsubo cardiomyopathy (TTC) is a heart syndrome associated with transient myocardial contractile dysfunction. The pathogenesis of TTC remains unclear. The purpose of this study was to investigate brachial artery flow-mediated dilation (FMD) in patients with TTC. Methods The results of FMD tests of 4 women with TTC were compared with the results from 18 women with ST-elevation acute myocardial infarction (STEMI) and from 26 healthy female volunteers. FMD tests in all patients were performed within 24 hours of admission and again at 1-3 weeks as a follow-up. Results The FMD levels were significantly lower at the acute phase in patients with TTC than in patients with STEMI and in healthy volunteers ( P <.01). After 1-3 weeks, the FMD test results of patients with TTC had greatly increased, and no significant differences were found between these results and the results from patients with STEMI ( P >.05). Also, there were no significant differences in the FMD test results between the group of patients with TTC and the group of healthy volunteers ( P >.05). Conclusions There is a pronounced and reversible endothelial dysfunction in patients with TTC, which can impair myocardial perfusion.

Letter by Gloekler et al Regarding Article, “Enhanced External Counterpulsation Improves Peripheral Artery Flow-Mediated Dilation in Patients With Chronic Angina: A Randomized Sham-Controlled Study”

To The Editor: We read with great interest the study by Braith et al,1 who examined vascular effects of external counterpulsation (ECP) in patients with coronary artery disease refractory to standard therapy. The improvement of flow-mediated vasodilation assessed in the brachial and femoral artery and the concomitant changes of endothelium-derived factors are remarkable.1 In the introduction, the authors state that the mechanisms for the well known clinical effects of ECP (decreased angina and increased exercise tolerance) are largely unknown, but may be related to coronary angiogenesis. They further argue that inflation of the ECP cuffs with high pressure produces a retrograde flow in the …

Enhanced External Counterpulsation Improves Peripheral Artery Flow-Mediated Dilation in Patients With Chronic Angina: A Randomized sham-Controlled Study

Enhanced External Counterpulsation Improves Peripheral Artery Flow-Mediated Dilation in Patients With Chronic Angina: A Randomized sham-Controlled Study

Enhanced External Counterpulsation Improves Peripheral Artery Flow-Mediated Dilation in Patients With Chronic Angina

Background— Mechanisms responsible for anti-ischemic benefits of enhanced external counterpulsation (EECP) remain unknown. This was the first randomized sham-controlled study to investigate the extracardiac effects of EECP on peripheral artery flow-mediated dilation. Methods and Results— Forty-two symptomatic patients with coronary artery disease were randomized (2:1 ratio) to thirty-five 1-hour sessions of either EECP (n=28) or sham EECP (n=14). Flow-mediated dilation of the brachial and femoral arteries was performed with the use of ultrasound. Plasma levels of nitrate and nitrite, 6-keto-prostaglandin F 1α , endothelin-1, asymmetrical dimethylarginine, tumor necrosis factor-α, monocyte chemoattractant protein-1, soluble vascular cell adhesion molecule, high-sensitivity C-reactive protein, and 8-isoprostane were measured. EECP increased brachial (+51% versus +2%) and femoral (+30% versus +3%) artery flow-mediated dilation, the nitric oxide turnover/production markers nitrate and nitrite (+36% versus +2%), and 6-keto-prostaglandin F 1α (+71% versus +1%), whereas it decreased endothelin-1 (−25% versus +5%) and the nitric oxide synthase inhibitor asymmetrical dimethylarginine (−28% versus +0.2%) in treatment versus sham groups, respectively (all P &lt;0.05). EECP decreased the proinflammatory cytokines tumor necrosis factor-α (−16% versus +12%), monocyte chemoattractant protein-1 (−13% versus +0.2%), soluble vascular cell adhesion molecule-1 (−6% versus +1%), high-sensitivity C-reactive protein (−32% versus +5%), and the lipid peroxidation marker 8-isoprostane (−21% versus +1.3%) in treatment versus sham groups, respectively (all P &lt;0.05). EECP reduced angina classification (−62% versus 0%; P &lt;0.001) in treatment versus sham groups, respectively. Conclusions— Our findings provide novel mechanistic evidence that EECP has a beneficial effect on peripheral artery flow-mediated dilation and endothelial-derived vasoactive agents in patients with symptomatic coronary artery disease.

Total occlusion of the infarct-related coronary artery correlates with brachial artery flow-mediated dilation in patients with ST-elevation myocardial infarction

Occlusion of the coronary artery is the main cause of ST-elevation myocardial infarction (STEMI). In some patients, it is followed by early spontaneous thrombolysis. In this study, we tried to determine whether spontaneous thrombolysis in the infarct-related artery (IRA) correlates with the state of the endothelium, which we assessed using the brachial artery flow-mediated dilation (FMD) test. 52 patients with STEMI were included in the study. Based on the results of coronary angiography performed during the first three days of STEMI, the patients were divided into two groups: Group I (n=33), consisting of patients with remaining total occlusion of the IRA, and Group II (n=19), consisting of patients with spontaneous thrombolysis. We assessed the endothelial function, using the brachial artery FMD test. In Group I, during the first three days of STEMI, brachial artery FMD results were significantly lower than those in Group II: 5.41+/- (3.23-7.41)% versus 10.81+/-(8.00-14.89)%, respectively; P=0.000036. After 7-14 days, this difference disappeared because of significant elevation of the FMD levels in the first group. Group I was characterized by higher levels of high sensitive C-reactive protein (CRP), cholesterol, and cholesterol-LDL and lower usage of angiotensin-converting enzyme (ACE) inhibitors before STEMI. The data presented above reveal that spontaneous coronary thrombolysis in patients with acute STEMI is associated with a preserved endothelium-dependent vasodilator response in the brachial artery. It can depend on the levels of hs-CRP, of fasting glucose, and of ACE-inhibitors from previous treatment.

Successful lower extremity angioplasty improves brachial artery flow-mediated dilation in patients with peripheral arterial disease

Peripheral arterial disease (PAD) is associated with systemic impaired flow-mediated dilation (FMD) and increased risk for cardiovascular events. Decreased FMD may be caused by a decrease in arterial shear stress due to claudication and inflammation due to muscle ischemia and reperfusion. We assumed that endovascular revascularization of lower limb arterial obstructions ameliorates FMD and lowers inflammation through improvement of peripheral perfusion. The study was a prospective, open, randomized, controlled, single-center follow-up evaluation assessing the effect of endovascular revascularization on brachial artery reactivity (FMD) measured by ultrasound, white blood cell (WBC) count, high-sensitive C-reactive protein (hs-CRP), and fibrinogen. We investigated 33 patients (23 men) with chronic and stable PAD (Rutherford 2 to 3) due to femoropopliteal obstruction. Variables were assessed at baseline and after 4 weeks in 17 patients (group A) who underwent endovascular revascularization and best medical treatment, and in 16 patients (group B) who received best medical treatment only. FMD did not differ between group A and B (4.96% +/- 1.86% vs 4.60% +/- 2.95%; P = .87) at baseline. It significantly improved after revascularization in group A (6.44% +/- 2.88%; P = .02) compared with group B at 4 weeks of follow-up (4.53% +/- 3.17%; P = .92), where it remained unchanged. The baseline ankle-brachial index (ABI) was similar for group A and B (0.63 +/- 0.15 vs 0.66 +/- 0.10; P = .36). At 4 weeks of follow-up, ABI was significantly increased in group A (1.05 +/- 0.15; P = .0004) but remained unchanged in group B (0.62 +/- 0.1). WBC counts of the two groups were comparable at baseline (group A: 7.6 +/- 2.26 x 10(6)/mL and group B: 7.8 +/- 2.02 x 10(6)/mL, P = .81). In group A, the leukocyte count significantly decreased after angioplasty from 7.6 +/- 2.26 to 6.89 +/- 1.35 x 10(6)/mL (P = .03). For group B, WBC count did not differ significantly compared with baseline (7.76 +/- 2.64 x 10(6)/mL; P = .94). No effects were observed on hs-CRP or fibrinogen from endovascular therapy. Endovascular revascularization with reestablishment of peripheral arterial perfusion improves FMD and reduces WBC count in patients with claudication. Revascularization may therefore have clinical implications beyond relief of symptoms, for example, reducing oxidative stress caused by repeated muscle ischemia or increased shear stress due to improved ambulatory activity.

High-dose atorvastatin in peripheral arterial disease (PAD): Effect on endothelial function, intima-media-thickness and local progression of PAD

Beneficial effects of aggressive lipid-lowering with high-dose atorvastatin (80 mg/day) have been demonstrated in patients with coronary and cerebrovascular disease. The impact of such a therapy in patients with peripheral arterial disease (PAD) is less known so far. Here we studied the effects of high-dose atorvastatin on brachial artery endothelial function, common carotid intima-media thickness (IMT) and local progression of PAD in these patients. One hundred of 500 patients screened with documented PAD were randomly assigned to receive 80 mg of atorvastatin daily for six months or to continue on conventional medical treatment. Ninety-six percent of patients in the control group were on standard statin treatment. High resolution B-mode ultrasonography was used to study brachial artery flow-mediated dilation (FMD), IMT and ankle-brachial index (ABI) at baseline and at six months. FMD and IMT at baseline and at six months were 4.1 (0.06-8.6) versus 5.0 (0.76 vs. 8.1) %, p = 0.96, and 0.76 (0.66-0.82) versus 0.73 (0.63-0.81) mm, p = 0.41, respectively, in the atorvastatin group, and 2.66 (-1.9-6.9) versus 3.65 (0.0-8.6)%, p = 0.02, and 0.78 (0.71-0.90) versus 0.77 (0.70-0.90) mm, p = 0.48, in the control group. ABI at baseline and at six months was not different in either group. LDL cholesterol was reduced from 2.53 (2.21-3.28) to 1.86 (1.38-2.29) mM (p < 0.0001) in the atorvastatin group, whereas levels remained stable in the control group [2.38 (1.94-3.16) vs. 2.33 (1.82-2.84) mM, p = 0.61]. Major adverse cardiovascular events occurred in 2.1% in the atorvastatin group and 1.9% in the control group (p = 0.61). In conclusion, in this pilot trial aggressive lipid-lowering with 80 mg of atorvastatin daily for six months had no effect on brachial artery FMD in patients with PAD. IMT and ABI were also similar in patients with and without high-dose atorvastatin at six months.