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CLINICAL RESEARCH: ENDOTHELIAL FUNCTION

Non-Invasive Assessment of Endothelial Function

Which Technique?

Ann E. Donald, AVS^_*,3,_*, Marietta Charakida, MD^_*,3, Tim J. Cole, ScD^_*, Peter Friberg, MD, PhD^_*, Phil J. Chowienczyk, FRCP^,1, Sandrine C. Millasseau, PhD^,2, John E. Deanfield, MB, FRCP^_* and Julian P. Halcox, MD, MRCP^_*

^_* Institute of Child Health, University College London, London, United Kingdom
King’s College London, Cardiovascular Division, Department of Clinical Pharmacology, St. Thomas’ Hospital, London, United Kingdom.

Manuscript received March 20, 2006; revised manuscript received June 26, 2006, accepted July 3, 2006.

^_* Reprint requests and correspondence: Ms. Ann Donald, Vascular Physiology, Cardiac Unit, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH United Kingdom. (Email: A.Donald{at}ich.ucl.ac.uk).

OBJECTIVES: The purpose of this study was to compare 3 non-invasive techniques for assessment of endothelial function in adults and children and evaluate their utility in acute inflammation.

BACKGROUND: Endothelial dysfunction is a key early event in pre-clinical atherosclerosis. Flow-mediated dilation (FMD), although the established technique, is expensive and technically demanding. Measurements of vascular responses to inhaled salbutamol by pulse wave analysis (PWA) or pulse contour analysis (PCA) are potential alternatives.

METHODS: Sixteen adults (mean age 28 years, range 18 to 39) and 16 children (mean age 13 years, range 7 to 17) underwent concurrent vascular function testing on 2 occasions with ultrasound, PWA, and PCA. Eighteen men were also studied before and after typhoid vaccination.

RESULTS: Reproducibility of FMD was high in adults and children (coefficient of variation [CV] = 7.1 and 6.3, respectively). Salbutamol responses were more variable with PWA (adults CV = 11.5, children CV = 17.1) and PCA particularly in children (adults CV = 18.2, children CV = 36.3). Flow-mediated dilation (p < 0.001) and PWA with salbutamol (p = 0.03) responses fell after typhoid vaccination, and PCA (p = 0.7) was unchanged.

CONCLUSIONS: Vascular dysfunction during acute inflammation can be measured by FMD and by PWA with salbutamol. Flow-mediated dilation is less variable than PWA. Variability of PCA makes this technique currently unsuited to serial measures of endothelial function in children. Flow-mediated dilation remains the most reproducible method.

Abbreviations and Acronyms   D = diameter   DB = baseline diameter   DP = peak diameter   FMD = flow-mediated dilation   GTN = glyceryl trinitrate   NO = nitric oxide   PAI = peripheral augmentation index   PAIG = maximal change in PAI after GTN administration   PAIS = maximal change in PAI after salbutamol administration   PCA = pulse contour analysis   PWA = pulse wave analysis   RI = reflection index   RIG = maximal change in RI after GTN administration   RIS = maximal change in RI after salbutamol administration

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