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Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery

A report of the International Brachial Artery Reactivity Task Force

Mary C. Corretti, MD, FACC^*,*, Todd J. Anderson, MD, Emelia J. Benjamin, MD, MSc, David Celermajer, MD, Francois Charbonneau, MD^||, Mark A. Creager, MD^¶, John Deanfield, MD^#, Helmut Drexler, MD^**, Marie Gerhard-Herman, MD^¶, David Herrington, MD, MHS, Patrick Vallance, MD, Joseph Vita, MD and Robert Vogel, MD^*

^* Division of Cardiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
University of Calgary, Calgary, Alberta, Canada
Boston University School of Medicine, Boston, Massachusetts, USA
Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
^|| Royal Victoria Hospital, Montreal, Quebec, Canada
^¶ Vascular Diagnostic Laboratory Cardiac Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
^# Vascular Physiology Unit, Great Ormond Street Hospital, London, United Kingdom
^** Department of Cardiology and Angiology, Medizinische Hochscule, Hannover, Germany
Departments of Internal Medicine and Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
University College, London, United Kingdom

View larger version (101K): [in a new window]   Figure 1 Ultrasound image of the brachial artery (longitudinally) at 8x magnification, 11-MHz transducer frequency annotated for anatomic landmarks.

View larger version (74K): [in a new window]   Figure 2 Schematic drawing of ultrasound imaging of the brachial artery with upper versus lower cuff placement and transducer position above the antecubital fossa. BP = blood pressure; FMD = flow-mediated vasodilation.

View larger version (85K): [in a new window]   Figure 3 Ultrasound image of the brachial artery at (A) baseline and (B) 1 min after hyperemic stimulus.

View larger version (17K): [in a new window]   Figure 4 Time course of brachial artery flow-mediated vasodilation (FMD) in a healthy individual. The FMD was determined with the occlusion cuff on the upper arm as previously described (17). Images of the brachial artery were digitized (one image/cardiac cycle on the R-wave) at baseline (Pre) and continuously for 2 min beginning 20 s after cuff release using a commercially available image acquisition system (CVI Acquisition, Information Integrity, Stow, Massachusetts). Brachial artery diameters were measured using an automated edge-detection system (Brachial Tools, Medical Imaging Applications, Iowa City, Iowa).