Brachial Artery In Patients Research Articles

Função endotelial vascular em pacientes com fluxo coronário lento e os efeitos do nebivolol

Brachial endothelial function has been associated with coronary slow flow (CSF). Increasing blood flow to brachial artery provokes endothelium to release nitric oxide (NO) with subsequent vasodilatation. Besides its β1-blocker activity, nebivolol causes vasodilatation by increasing endothelial NO release. To assess the effects of nebivolol on vascular endothelial function in patients with CSF. Forty-six patients with CSF and 23 individuals with normal epicardial coronary arteries were examined with transthoracic echocardiography and brachial artery ultrasonography. The patients were reevaluated two months after treatment with aspirin or aspirin plus nebivolol. Patients with CSF had higher body mass index (26.5 ± 3.3 vs. 23.8 ± 2.8, p < 0.001), mitral inflow isovolumetric relaxation time (IVRT) (114.9 ± 18.0 vs. 95.0 ± 22.0 msec, p < 0.001) and lower left ventricular ejection fraction (LVEF) (63.5 ± 3.1% vs. 65.4 ± 2.2, p = 0.009), HDL-cholesterol (39.4 ± 8.5 vs. 45.8 ± 7.7 mg/dL, p = 0.003) and brachial flow-mediated dilatation (FMD) (6.1 ± 3.9% vs. 17.6 ± 4.5%, p < 0.001). There were significant correlations between FMD and the presence of CSF (r = 0.800, p < 0.001) and HDL-cholesterol (r = 0.349, p = 0.003). Among Patients with CSF, although pretreatment mean FMD values were similar (6.1 ± 4.3% vs. 6.0 ± ,6%, p = 0.917) compared to aspirin alone group, posttreatment FMD was significantly higher in patients treated with aspirin plus nebivolol (6.0 ± 3.5% vs. 8.0 ± 2.9%, p = 0.047). Treatment with nebivolol was associated with a significant increase in FMD (6.0 ± 3.6 to 8.0 ± 2.9 %, p = 0.030) whereas treatment with aspirin alone was not. Endothelial function may be impaired in both coronary and brachial arteries in patients with CSF and nebivolol may be effective in the improvement of endothelial function in patients with CSF.

PP-062: VASCULAR ENDOTHELIAL FUNCTION IN PATIENTS WITH CORONARY SLOW FLOW AND THE EFFECTS OF NEBIVOLOL

Background: Brachial endothelial function has been associated with coronary slow flow (CSF). Increasing blood flow to brachial artery provokes endothelium to release nitric oxide (NO) with subsequent vasodilatation. Besides its β1-blocker activity, nebivolol causes vasodilatation by increasing endothelial NO release. Objective: To assess the effects of nebivolol on vascular endothelial function in patients with CSF. Methods: Forty-six patients with CSF and 23 individuals with normal epicardial coronary arteries were examined with transthoracic echocardiography and brachial artery ultrasonography. The patients were reevaluated two months after treatment with aspirin or aspirin plus nebivolol. Results: Patients with CSF had higher body mass index (26.5 ± 3.3 vs. 23.8 ± 2.8, p < 0.001), mitral inflow isovolumetric relaxation time (IVRT) (114.9 ± 18.0 vs. 95.0 ± 22.0 msec, p < 0.001) and lower left ventricular ejection fraction (LVEF) (63.5 ± 3.1% vs. 65.4 ± 2.2, p = 0.009), HDL-cholesterol (39.4 ± 8.5 vs. 45.8 ± 7.7 mg/dL, p = 0.003) and brachial flow-mediated dilatation (FMD) (6.1 ± 3.9% vs. 17.6 ± 4.5%, p < 0.001). There were significant correlations between FMD and the presence of CSF (r = 0.800, p < 0.001) and HDL-cholesterol (r = 0.349, p = 0.003). Among Patients with CSF, although pretreatment mean FMD values were similar (6.1 ± 4.3% vs. 6.0 ±,6%, p = 0.917) compared to aspirin alone group, posttreatment FMD was significantly higher in patients treated with aspirin plus nebivolol (6.0 ± 3.5% vs. 8.0 ± 2.9%, p = 0.047). Treatment with nebivolol was associated with a significant increase in FMD (6.0 ± 3.6 to 8.0 ± 2.9 %, p = 0.030) whereas treatment with aspirin alone was not. Conclusions: Endothelial function may be impaired in both coronary and brachial arteries in patients with CSF and nebivolol may be effective in the improvement of endothelial function in patients with CSF. (Arq Bras Cardiol 2011;97(4):275-280)

Should we be on the fence or can we open the gate? Evidence that QRS gating in FMD analysis is not essential

the function of arterial endothelial cells is now recognized as an important factor in the pathogenesis of atherosclerosis. Almost two decades ago, Celermajer and colleagues ([2][1]) introduced a noninvasive assessment technique to evaluate endothelial function in humans. In this test, the magnitude

Impairment of the Vasodilatation Capability of the Brachial Artery in Patients with Idiopathic Venous Thrombosis

Determination of the functional capability of the peripheral arteries is increasingly used as an early marker of vessel disease. The aim of this study was to evaluate flow-mediated (FMD) and glyceryl trinitrate-mediated (NMD) dilation of the brachial artery in patients with idiopathic venous thrombosis (VT). Flow-mediated brachial artery dilatation and the dilatation response to glyceryl trinitrate were measured using high-resolution ultrasound in 97 subjects (49 eligible patients of both sexes, mean age 51.5 ± 14.6 years, with idiopathic venous thrombosis, and 48 age-matched healthy controls). Compared to the control group, FMD was significantly reduced in the group of patients with idiopathic venous thrombosis -4.9% (95% CI 1.1-8.7%) vs. 12.7% (95% CI 7.8-17.6%), p<0.001. Patients also had diminished NMD of the brachial artery -12.5% (95% CI 6.6-18.4%) vs. 18.5% (95% CI 10.1-26.9%), p<0.001. In patients, significantly higher levels of circulatory markers (P-selectin, von Willebrand factor) of endothelial dysfunction were registered. Idiopathic venous thrombosis is associated with impaired flow- and GTN-mediated vasodilatory response of the brachial artery. This may suggest involvement of the functional deterioration of the vessel wall in the pathogenesis of idiopathic VT and indicate a relationship between VT and atherothrombosis.

Effects of Statins on Endothelial Function in Patients with Coronary Artery Disease

Flow-mediated dilatation (FMD) of the brachial artery is a method capable of detecting endothelium dysfunction. Statins are generally consent drugs for reducing cardiovascular morbidity and mortality and are shown to improve the systemic endothelial function. The aim of our study was to assess the endothelial function using FMD of the brachial artery in patients with different degrees of coronary artery stenosis with respect to their treatment with statins. We evaluated the FMD of 221 patients with coronary arteriography performed, of whom 99 (44.8%) were receiving statins and 122 (55.2%) were not receiving statins. We did not find a statistically significant difference in the FMD values between the patients with and without a statin treatment: 5.57 +/- 5.68 and 4.69 +/- 4.48, respectively, P = .581. In the subgroup of patients without angiographically visible coronary artery stenoses or with stenoses <20% (86 patients), patients undergoing statin treatment had a significantly better endothelial function compared to patients without such a treatment: FMD 9.24 +/- 6.87 and 6.50 +/- 4.51, respectively, P = .047. FMD could not distinguish between the patients who were treated with statin and those not treated with statins with the same demographic, clinical, and angiographic characteristics. The only exception was in the group of patients with a minor coronary disease. Statin treatment had a more pronounced effect in the earlier stages of coronary atherosclerosis.

I018 Short and long lasting action of shear stress changes on diameter of conduit arteries in patients with arterial hypertension

Aim of the study was to investigate short and long lasting actions of shear stress changes on vascular diameter of brachial artery in patients with arterial hypertension. 57 patients with arterial hypertension (mean age±SD, 51.26±1.94; 30 men and 27 women) and 17 healthy controls (mean age±SD, 51±5.41 ; 9 men and 8 women) were included in the study. All the subjects underwent to the investigation of vascular characteristics via high resolution vascular dopplerechography and clinical blood pressure investigations. Patients with cardiovascular, peripheral and cerebrovascular diseases, diabetes mellitus, smokers, pregnant, obese as well as those with secondary forms of hypertension, ischemic heart disease and heart failure were excluded from the study. Compared with normotensive control subjects, initial vascular diameter (D0), was higher in hypertensive subjects (3.76±0.28 vs. 4.32±0.14, P<0.01). Initial shear stress was not significantly different between the two groups. Therefore, after reactive hyperemia test (RHtest) shear stress as well as changes of shear stress were higher in hypertensive population compared with healthy control subjects (5.86±0.32 vs. 5.15±0.32, P<0.05 and -0.35±0.09 vs. -0.71±0.09; P<0.001). Initial vascular diameter was in a negative correlation with initial shear stress, as well as with after RHtest shear stress, but there was appeared positive correlation between initial vascular diameter and changes of it. Arterial hypertension is associated with permanent changes of vascular wall diameter via neuro-humoral factors. Therefore, obtained results confirm an opinion that different from the short action of the changes of shear stress, vascular diameter of conduit arteries increases in response to the chronic increase of the shear stress.

Roles and Mechanisms of Human Immunodeficiency Virus Protease Inhibitor Ritonavir and Other Anti-Human Immunodeficiency Virus Drugs in Endothelial Dysfunction of Porcine Pulmonary Arteries and Human Pulmonary Artery Endothelial Cells

The objective of this study was to determine the effects of highly active antiretroviral therapy (HAART) drugs on pulmonary endothelial function. Porcine pulmonary arteries or human pulmonary arterial endothelial cells (HPAECs) were incubated with eight HAART drugs [ritonavir, indinavir, lopinavir, zidovudine (AZT), abacavir, stavudine, didanosine (ddI), and lamivudine] individually or in combination [three HAART drugs (3-plex; indinavir, stavudine, and ddI)] at their clinical plasma concentrations for 24 hours. Endothelium-dependent vasorelaxation in response to bradykinin was reduced significantly by the ritonavir in a concentration-dependent manner. Five other HAART drugs (indinavir, lamivudine, abacavir, AZT, and ddI) and the 3-plex significantly also impaired endothelium-dependent vasorelaxation in response to bradykinin. Five HAART drugs (ritonavir, indinavir, lamivudine, abacavir, and AZT) significantly decreased endothelial nitric oxide synthase (eNOS) expression and increased superoxide anion levels in both vessels and HPAECs. Furthermore, both ritonavir and AZT substantially activated ERK2 in HPAECs. Additionally, the antioxidants ginsenoside Rb1 and ginkgolide A effectively reversed HAART drug-induced vasomotor dysfunction and eNOS down-regulation. Inhibition of ERK1/2 also partially blocked ritonavir- and AZT-induced down-regulation of eNOS and vasomotor dysfunction. Thus, HAART drugs significantly impair endothelial functions of porcine pulmonary arteries and HPAECs, which may be mediated by eNOS down-regulation, oxidative stress, and ERK1/2 activation. These findings suggest that HAART drugs may contribute to the high incidence of pulmonary artery hypertension in human immunodeficiency virus-infected patients.

Impairment in Flow-Mediated Vasodilatation of the Brachial Artery in Acromegaly

Objective: The aim of this study was to assess flow-mediated dilatation (FMD) of the brachial artery in patients with acromegaly. Subjects and Methods: We prospectively evaluated 25 patients with acromegaly (14 females, 11 males; aged 42 ± 12 years; growth hormone (GH) levels 34 ± 14 ng/ml) and 27 control subjects (15 females, 12 males; aged 45 ± 8 years; GH levels 3 ± 1.5 ng/ml). The patients and controls were matched for age, gender, body mass index, cigarette smoking, blood pressure, lipid levels, diabetes mellitus, hypertension, and its duration. Endothelial function, measured as FMD of the brachial artery using ultrasound, was calculated in the 2 groups. The endothelial function was evaluated by assessing 1-min postischemic FMD of the brachial artery. Results: The FMD was lower in patients with acromegaly (9.97 ± 3.5%) than in controls (16.1 ± 3.4%), and the difference was statistically significant (p = 0.0001). Conclusion: Endothelial dysfunction may develop in the preclinical phase of atherosclerosis in patients with acromegaly. Endothelium-dependent FMD may be impaired in acromegalic patients, and measurement of endothelial function may identify high-risk individuals earlier.

Systemische Endotheldysfunktion bei Patienten mit Pseudoexfoliationssyndrom

Recent studies have shown that pseudoexfoliation syndrome (PEX) is not limited to the anterior segment of the eye, but also affects different structures, such as blood vessels, heart, liver and lungs. Vascular endothelial dysfunction is associated with an increased cardiovascular risk. The purpose of our study was to evaluate endothelial function of the brachial artery in patients with PEX. We prospectively examined 21 patients with PEX and 21 age- and sex-matched individuals in a control group. Brachial artery endothelial function was assessed by the response to flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) using high resolution ultrasound. Dilation was expressed as the percent change in diameter relative to the baseline diameter. Patients with PEX had significantly lower FMD (1.9-2.8 versus 4.1-3.3 in the control group, p = 0.02). NMD in PEX patients was lower than in the control group (10.1-5.1 versus 10.8-5.8 in the control group, p < 0.69), but the difference was not statistically significant. Our study showed a statistically significant association between PEX and systemic vascular endothelial dysfunction. Larger clinical studies are needed to prove the higher cardiovascular risk in PEX patients.

Endothelial function in patients with and without diabetes mellitus with different degrees of coronary artery stenosis

To evaluate endothelial function using flow-mediated dilatation (FMD) of the brachial artery in patients with and without diabetes mellitus (DM) with different degrees of coronary artery stenosis. We investigated 293 patients, 69 (23.6%) of whom had DM. FMD and coronary arteriography were performed. Patients with DM had a significantly lower FMD (mean +/- SD, 3.7 +/- 3.8%) compared with patients without DM (mean +/- SD, 5.2 +/- 5.3%) (p < 0.05). When the results were broken down by the severity of coronary artery disease (CAD) (no significant coronary artery stenosis, 1-vessel disease, 2-vessel disease, and 3-vessel disease) the only statistically significant difference between diabetics and nondiabetics was found in patients without significant coronary stenosis (mean FMD +/- SD: 5.2 +/- 4.4% in diabetics, 7.6 +/- 5.4% in nondiabetics [p < 0.05]). In CAD patients, the presence of DM was associated with endothelial dysfunction. The difference in the FMD was clearly expressed between patients with and without DM in the subgroup without significant coronary stenosis, and was no longer present with advanced coronary atherosclerosis.

A Modified Technique for Ultrasound-guided Cannulation of Radial and Brachial Arteries in Patients with Circulation Collapse

We present a modified method for arterial cannulation using ultrasound guidance in patients with collapsed circulation. The method makes use of ultrasonographic landmarks that enable cannulation of both the radial and brachial arteries, even when the pulse is extremely faint.

Impaired Flow-Mediated Endothelium-Dependent and Endothelium-Independent Vasodilation of the Brachial Artery in Patients With Atherosclerotic Peripheral Vascular Disease

A flow-mediated endothelium-dependent vasodilation and endothelium-independent nitroglycerin-induced vasodilation were carried out in 70 patients and 15 age-matched adults without any atherosclerotic risk factors to clarify vascular responsiveness in patients with atherosclerotic peripheral vascular disease. The percent change in flow-mediated vasodilation was significantly lower in patients than in controls (5.4 +/- 0.7% vs 12.8 +/- 2.2%, P < .001). Moreover, the percent change in nitroglycerin-induced vasodilation measured after sublingual administration of nitroglycerin was lower in patients than in controls (5.8 +/- 0.6% vs 10.2 +/- 1.5%, P < .01). On multiple regression analysis, none of the determinant factors showed a significant correlation with flow-mediated vasodilation. In contrast, Fontaine classification was found to be a significant predictor for nitroglycerin-induced vasodilation (r = -0.307, P < .05). There is a significant positive correlation between nitroglycerin-induced vasodilation and ankle-brachial pressure index in the patients. The data showed that vasoditation function were markedly impaired in end-stage patients with peripheral vascular disease.

Interrelation Between Dynamics of Changes Endothelium-Dependent Dilatation and Local Rigidity of the Brachial Artery in Patients with Hyperlipideamia on a Background of Reception Statins within 6 Months

Interrelation Between Dynamics of Changes Endothelium-Dependent Dilatation and Local Rigidity of the Brachial Artery in Patients with Hyperlipideamia on a Background of Reception Statins within 6 Months

Impairment of flow-mediated vasodilatation of brachial artery in patients with Cushing’s Syndrome

Cushing's Syndrome (CS) is associated with excess and premature cardiovascular disease. Endothelial dysfunction is the initiating event in the development of atherosclerosis. Endothelial function is assessed by flow-mediated dilatation (FMD) of brachial artery. The aim of this study was to assess FMD in patients with CS. We prospectively evaluated 22 patients with CS (12 women, 10 men; aged 42 +/- 11 years, serum cortisol 28.2 +/- 14 microg/dl, 24-h urinary free cortisol (UFC) 269 +/- 92 microg/day), and 23 control subjects (13 women, 10 men; aged 43 +/- 10 years, serum cortisol 14 +/- 4 microg/dl, 24 h cortisol 60 +/- 22 microg/day). Endothelial function, measured as FMD of the brachial artery using ultrasound, was calculated in two groups. Endothelial function was evaluated by assessing 1-min postischemic FMD of the brachial artery. FMD was lower in patients with CS than that in those without (11.7 +/- 4.8% vs. 15.8 +/- 3.2%, P = 0.0001, respectively). There was no significant difference between two groups regarding baseline diameter of brachial artery. But, hyperemia diameter was lower in patients with CS than without CS (3.6 +/- 0.22 mm vs. 3.9 +/- 0.19 mm, P = 0.04, respectively). Endothelium-dependent FMD may impair in patients with CS compared to controls. Measurement of endothelial function may identify high-risk individuals early and therapy to reduce or retard endothelial dysfunction in patients with CS may lead to decreased cardiovascular morbidity and mortality.

The Effect of ACE Gene Polymorphisms on Doppler Blood Flow Parameters of Carotid and Brachial Arteries in Patients With Myocardial Infarction

The authors investigated the relationship between the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism and the blood flow characteristics of common carotid (CCA) and brachial arteries (BA) by color Doppler ultrasound (CDUS) in patients with acute anterior myocardial infarction (AAMI). Sixty four patients (11 women and 53 men), aged 25 to 77 years, with AAMI were studied. The ACE genotypes were established. Peak-systolic (PSV) and end-diastolic velocity (EDV) of right and left CCA, PSV of right BA, and intimal-medial thickness (IMT) of both CCAs were measured by CDUS. All results were evaluated statistically. The ACE genotypes were distributed as follows: 43.8% DD, 43.8% ID, and 12.5% II. PSVs of BA and both CCAs were lower in patients with DD and ID than with II (p<0.05). EDVs of both CCAs were also lower in the same groups, but statistically not significant (p>0.05). IMTs of both CCAs did not differ among patients with various ACE genotypes (p>0.05). These results suggest that ACE I/D polymorphism influences Doppler blood flow parameters of both BA and CCA, but does not affect IMT of CCA.

Impairment of flow mediated vasodilatation of brachial artery in patients with primary hyperparathyroidism

Hyperparathyroid condition might influence endothelial cells. The aim of this study was to assess flow mediated dilatation (FMD) in patients with primary hyperparathyroidism (PHPT). We prospectively evaluated 21 patients with PHPT (9 women, 12 men; aged 50 +/- 11 years, serum calcium 11.6 +/- 0.7 mg/dl, intact parathyroid hormone (iPTH) 489 +/- 495 pg/ml) and 27 healthy control subjects (13 women, 14 men; aged 49 +/- 10 years, serum calcium 9.4 +/- 0.5 mg/dl, iPTH 28 +/- 8.5 pg/ml). Endothelial function, measured as FMD of the brachial artery using ultrasound, was calculated in two groups. To avoid confounding factors, conditions known to affect endothelial function like diabetes mellitus, hypertension, dyslipidemia, smoking, coronary and peripheral artery disease were excluded from both groups. FMD was lower in patients with PHPT than that in those without (10.2 +/- 5.8 vs. 19.8 +/- 5.8, P = 0.0001). FMD negatively correlated with serum calcium (r = -0.55, P = 0.002). Endothelium-dependent FMD may impair in patients with PHPT compared to controls. Endothelial dysfunction can contribute to the deleterious cardiovascular effects of PTH excess. Therapy to reduce or retard endothelial dysfunction in patients with PHPT may lead to decreased cardiovascular morbidity and mortality.

Impaired Endothelial Function in Patients with Myocardial Bridge

The relationship between myocardial bridging (MB) and ischemic heart disease is still controversial. In this study, we aimed to evaluate the existing atherosclerosis and noninvasive endothelial function of brachial artery in patients with MB. The present study included 50 patients (group I) who had MB in left anterior descending (LAD) on coronary angiography. All of the coronary artery segments were evaluated by intravascular ultrasound (IVUS). Endothelial function was assessed with measurement of flow-mediated dilatation (FMD) and nitrate-dependent dilatation in the brachial artery. The study also included 30 healthy control subjects (group II). Patients in the group I were further subdivided into two subgroups based on the findings on IVUS: group IA included 20 patients without atherosclerotic lesions and group IB included 30 patients with atherosclerotic coronary artery disease in addition to MB. FMD values were found to be significantly lower in the patients with MB (group I) than in the control (6.4 +/- 3% vs 11 +/- 4%, P <0.001). In regard to FMD values in subgroups, FMD was 7 +/- 2% in the group IA and 5.8 +/- 1% in the group IB (P = 0.023). On IVUS, atherosclerotic plaque was found proximal to the bridge in the same coronary artery segment in addition to MB in 75% of the patients in group I (group IB). No atherosclerotic plaque was found in within or distal segments of MB. Endothelial function is impaired in patients with MB and there is an increased tendency for atherosclerosis proximal to the bridge in the patients with MB. Endothelial dysfunction is more severe in the patients with atherosclerosis proximal to the bridge.

Thymoma Associated With Keratoconjunctivitis, Lichen Planus, Hypogammaglobinemia, and Absent Circulating B Cells

infusional FU). Oztop and Gencer found significant prolongations of QT interval in 22 patients without overt cardiac disease. These patients were also found to have no echocardiographic nor cardiac enzyme changes with the bolus plus infusional FU. Sudhoff and Enderle found that FU infusion can actually induce arterial vasocontractions. They used high-resolution ultrasound to evaluate the diameter of the brachial artery in patients receiving infusional FU. Fifty percent of the 30 patients receiving FU showed brachial artery constriction, whereas none of the patients receiving non-FU chemotherapy showed constriction. Vessel tone returned to normal within 30 minutes after stopping FU. Vessel contractions reoccurred in 86% of these patients. In additional, patients that were pretreated with glyceroltrinitrate showed no contraction of the brachial artery. The young age, dramatic presentation, and documented absence of pre-existing coronary artery disease on coronary angiography in our patient make the case relatively unique. Many of the currently used chemotherapy regimens for gastrointestinal malignancies integrate the use of newer agents, like irinotecan, oxaliplatin, and bevacizumab, with fluorouracil infusions (eg, oxaliplatin plus FU/ leucovorin [FOLFOX] and folinic acid plus FU and irinotecan [FOLFIRI] regimens). With the demonstrated efficacy of these new chemotherapy regimens, more patients will be receiving these agents in the future. Often in the United States, infusional FU is administered at home via an infusional pump. Therefore, it is important for clinicians need to be aware of this rare but potentially serious adverse effect of infusional fluorouracil and to counsel patients, family, and nursing staff, accordingly. Factors predisposing to acute cardiac toxicity of infusional FU should be investigated.

Decreased nitrate-mediated dilatation in patients with coronary artery ectasia: an ultrasonographic evaluation of brachial artery

Coronary artery ectasia has been defined as localized or diffuse nonobstructive lesions of the epicardial coronary arteries with a luminal dilation exceeding the 1.5-fold of normal adjacent segment or vessel diameter. Although coronary artery disease is supposed to be responsible for more than 50% of coronary ectasia, the precise pathology of coronary artery ectasia is not clearly understood. The brachial artery ultrasound test for flow-mediated endothelial-dependent vasodilatory function includes administration of sublingual nitrates to examine the vasodilating effect of an exogenous source of nitric oxide. In the present study, we aimed to compare flow-mediated and nitrate-mediated responses of brachial artery in patients with coronary artery ectasia and patients with coronary artery disease. Thirty-six consecutive patients with coronary artery ectasia in combination with coronary artery disease and 42 age-matched and sex-matched patients with coronary artery disease alone were included in the study. Flow-mediated and nitrate-mediated dilatations were measured in all patients using a high-resolution B-mode ultrasonographic system. Baseline brachial artery diameters in patients with coronary artery ectasia were not statistically different from those in patients with coronary artery disease (4.2+/-0.6 vs. 4.0+/-0.6 mm, respectively, P=0.16). Although the forearm flow-mediated dilatation of the patients with coronary artery ectasia did not differ from that of patients with coronary artery disease alone (5.5+/-3.8 vs. 4.8+/-3.6%, respectively, P=0.41), nitrate-mediated dilatation was significantly lower than that of patients with coronary artery disease alone (7.9+/-5.2 vs. 10.9+/-5.4%, respectively, P=0.02). We have shown that patients with coronary artery ectasia have decreased nitrate-mediated response of brachial artery compared with patients with coronary artery disease alone, suggesting more severe dysfunction or, possibly, destruction of the media layer in coronary artery ectasia than in coronary artery disease.

&lt;b&gt;Impaired Systemic Endothelial Function in Patients With Pseudoexfoliation Syndrome&lt;/b&gt;

Pseudoexfoliation syndrome (PEX) is the most common clinical precursor of open-angle glaucoma. Recent studies have shown that pseudoexfoliative material is widely distributed throughout the body, including blood vessels. The aim of our study was to evaluate endothelial function in the brachial artery of patients with pseudoexfoliation syndrome. We prospectively examined 23 patients with PEX (mean age, 70 +/- 8 years) and 20 healthy age- and sex-matched individuals (mean age, 68 +/- 9 years) as a control group. Brachial artery endothelial function was assessed by vascular response to reactive hyperemia (flow-mediated dilation (FMD) and sublingual nitroglycerin (NTG-mediated dilation) using high-resolution ultrasound. Flow-mediated and NTG-induced dilation were expressed as the percent change in diameter after reactive hyperemia and after NTG administration relative to the baseline value, respectively. Patients with cardiovascular disease and other conditions associated with endothelial dysfunction were excluded. When compared with controls, patients with PEX had significantly lower flow-mediated dilation (4.5 +/- 2.8 versus 8.2 +/- 3.7, P = 0.01) and NTG-mediated dilation (10.9 +/- 3.1 versus 15.8 +/- 3.8, P = 0.0001). Flow-mediated dilation and NTG-mediated dilation were similar in PEX patients with glaucoma (n = 11) and without glaucoma (n = 12). Flow-mediated and NTG-mediated dilation did not correlate with any measured parameter in any patient or control subject. The findings indicate that systemic endothelial function is impaired in PEX syndrome patients.