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Mohammadi L, Han DD, Xu F, Huang A, Derakhshandeh R, Rao P, Whitlatch A, Cheng J, Keith RJ, Hamburg NM, Ganz P, Hellman J, Schick SF, Springer ML. Chronic E-Cigarette Use Impairs Endothelial Function on the Physiological and Cellular Levels. Arterioscler Thromb Vasc Biol 2022; 42:1333-1350. [PMID: 36288290 PMCID: PMC9625085 DOI: 10.1161/atvbaha.121.317749] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The harmful vascular effects of smoking are well established, but the effects of chronic use of electronic cigarettes (e-cigarettes) on endothelial function are less understood. We hypothesized that e-cigarette use causes changes in blood milieu that impair endothelial function. METHODS Endothelial function was measured in chronic e-cigarette users, chronic cigarette smokers, and nonusers. We measured effects of participants' sera, or e-cigarette aerosol condensate, on NO and H2O2 release and cell permeability in cultured endothelial cells (ECs). RESULTS E-cigarette users and smokers had lower flow-mediated dilation (FMD) than nonusers. Sera from e-cigarette users and smokers reduced VEGF (vascular endothelial growth factor)-induced NO secretion by ECs relative to nonuser sera, without significant reduction in endothelial NO synthase mRNA or protein levels. E-cigarette user sera caused increased endothelial release of H2O2, and more permeability than nonuser sera. E-cigarette users and smokers exhibited changes in circulating biomarkers of inflammation, thrombosis, and cell adhesion relative to nonusers, but with distinct profiles. E-cigarette user sera had higher concentrations of the receptor for advanced glycation end products (RAGE) ligands S100A8 and HMGB1 (high mobility group box 1) than smoker and nonuser sera, and receptor for advanced glycation end product inhibition reduced permeability induced by e-cigarette user sera but did not affect NO production. CONCLUSIONS Chronic vaping and smoking both impair FMD and cause changes in the blood that inhibit endothelial NO release. Vaping, but not smoking, causes changes in the blood that increase microvascular endothelial permeability and may have a vaping-specific effect on intracellular oxidative state. Our results suggest a role for RAGE in e-cigarette-induced changes in endothelial function.
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Affiliation(s)
- Leila Mohammadi
- Division of Cardiology (L.M., D.D.H., R.D., P.R., P.G., M.L.S.), University of California, San Francisco
| | - Daniel D Han
- Division of Cardiology (L.M., D.D.H., R.D., P.R., P.G., M.L.S.), University of California, San Francisco
- Now with School of Medicine and Dentistry, University of Rochester, NY (D.D.H.)
| | - Fengyun Xu
- Department of Anesthesia and Perioperative Care (F.X., J.H.), University of California, San Francisco
| | - Abel Huang
- Division of Occupational and Environmental Medicine (A.H., A.W., S.F.S.), University of California, San Francisco
| | - Ronak Derakhshandeh
- Division of Cardiology (L.M., D.D.H., R.D., P.R., P.G., M.L.S.), University of California, San Francisco
| | - Poonam Rao
- Division of Cardiology (L.M., D.D.H., R.D., P.R., P.G., M.L.S.), University of California, San Francisco
- Now with CHRISTUS Good Shepherd Internal Medicine Residency Program, Longview, TX (P.R.)
| | - Adam Whitlatch
- Division of Occupational and Environmental Medicine (A.H., A.W., S.F.S.), University of California, San Francisco
| | - Jing Cheng
- Division of Oral Epidemiology and Dental Public Health (J.C.), University of California, San Francisco
| | - Rachel J Keith
- Department of Medicine, University of Louisville Medical School, KY (R.J.K.)
| | - Naomi M Hamburg
- Department of Medicine, Boston University School of Medicine, MA (N.M.H.)
| | - Peter Ganz
- Division of Cardiology (L.M., D.D.H., R.D., P.R., P.G., M.L.S.), University of California, San Francisco
| | - Judith Hellman
- Department of Anesthesia and Perioperative Care (F.X., J.H.), University of California, San Francisco
| | - Suzaynn F Schick
- Division of Occupational and Environmental Medicine (A.H., A.W., S.F.S.), University of California, San Francisco
- Center for Tobacco Control Research and Education (S.F.S., M.L.S.), University of California, San Francisco
| | - Matthew L Springer
- Division of Cardiology (L.M., D.D.H., R.D., P.R., P.G., M.L.S.), University of California, San Francisco
- Center for Tobacco Control Research and Education (S.F.S., M.L.S.), University of California, San Francisco
- Cardiovascular Research Institute (M.L.S.), University of California, San Francisco
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Knowles L, Nadeem N, Chowienczyk PJ. Do anti-tumour necrosis factor-α biologics affect subclinical measures of atherosclerosis and arteriosclerosis? A systematic review. Br J Clin Pharmacol 2020; 86:837-851. [PMID: 31957052 DOI: 10.1111/bcp.14215] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/06/2019] [Accepted: 12/16/2019] [Indexed: 12/13/2022] Open
Abstract
AIMS Inflammatory cytokines, particularly tumour necrosis factor-α (TNFα), are thought to promote arterial disease through a variety of mechanisms leading to arteriosclerosis and atherosclerosis. We reviewed the existing evidence of the effect of anti-TNFα treatment on arteriosclerosis and atherosclerosis in chronic inflammatory disease. METHODS We performed a systematic review of studies examining effects of monoclonal antibodies against TNFα on subclinical measures of arteriosclerosis (arterial pulse wave velocity) and atherosclerosis (endothelial function measured by flow-mediated dilation or forearm blood flow responses to endothelium-dependent agonists, and common carotid intima-media thickness). RESULTS We identified 60 studies (of 854 potential studies identified using a systematic search) in which effects of anti-TNFα biologics on these measures were assessed in patients receiving anti-TNFα therapy for a clinical indication (usually an inflammatory disease such as an inflammatory arthritis, psoriasis or inflammatory bowel disease). Of these, only 6 were randomised clinical controlled trials. Whilst many observational studies and noncontrolled studies reported positive findings, positive finding were reported in only 1 of 6 randomised clinical controlled trials. CONCLUSIONS There is no strong evidence for an effect of anti-TNFα biologics on the subclinical measures of arteriosclerosis or atherosclerosis examined in this review. This does not exclude a positive effect of TNFα biologics on clinical outcomes through alternate pathways including those induced by remission of the primary inflammatory disease.
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Affiliation(s)
| | - Nida Nadeem
- King's College London, British Heart Foundation Centre, London, UK
| | - Philip J Chowienczyk
- Guy's and St Thomas's Foundation Trust, London, UK.,King's College London, British Heart Foundation Centre, London, UK
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Vascular function in asthmatic children and adolescents. Respir Res 2017; 18:17. [PMID: 28095859 PMCID: PMC5240276 DOI: 10.1186/s12931-016-0488-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 12/10/2016] [Indexed: 12/02/2022] Open
Abstract
Background Epidemiological studies have demonstrated an increased incidence of cardiovascular events in patients with bronchial asthma, but little is known about the relationship between asthma and vascular function. The purpose of this study was to evaluate endothelial function and arterial stiffness in children and adolescents with asthma. Methods A cross-sectional controlled study was designed. Measurements of endothelial function and arterial stiffness in asthmatic (13.6 ± 0.6 years) and control groups (14.9 ± 0.7 years) were taken by the non-invasive peripheral arterial tonometry (EndoPAT2000) determined by using the natural logarithm of the reactive hyperemia index (LnRHI) and the augmentation index (AIx@75%), respectively. Patients with asthma were also administered two questionnaires to evaluate asthma control and quality of life. Exercise functional capacity was evaluated using the Shuttle Walking Test (SWT). Only male participants were included in the present study. Results LnRHI and the walked distance during the SWT were similar between groups (p = 0.23 and p = 0.50, respectively). AIx@75% was significantly higher in the asthmatic group (-7.75 ± 1.7) compared to the control group (-15.25 ± 1.8), p < 0.04. In the control group, the LnRHI correlated positively with baseline systolic blood pressure (r = 0.53, p = 0.02) and mean arterial pressure (r = 0.50, p = 0.03), age (r = 0.61, p = 0.007), weight (r = 0.63, p = 0.004) and height (r = 0.56, p = 0.015). Besides that LnRHI correlated with FVC (r = 0.69, p = 0.002), FEV1, (r = 0.53, p = 0.03) and negatively with Tiffeneau index (FEV1/FVC%, r = −0.49 p = 0.04). The LnRHI of the asthmatic group did not correlate with the different variables evaluated. Conclusion The increased AIx@75% without changes in LnRHI in asthmatic patients could mean that an early detection of vascular impairment may precede endothelial dysfunction, and that different mechanisms may contribute to the pathogenesis and progression of cardiovascular events in this population. A large prospective and randomized controlled study should be done to evaluate the physiopathological mechanisms underlying the association between arterial stiffness and asthma. Electronic supplementary material The online version of this article (doi:10.1186/s12931-016-0488-3) contains supplementary material, which is available to authorized users.
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Grassi D, Draijer R, Schalkwijk C, Desideri G, D'Angeli A, Francavilla S, Mulder T, Ferri C. Black Tea Increases Circulating Endothelial Progenitor Cells and Improves Flow Mediated Dilatation Counteracting Deleterious Effects from a Fat Load in Hypertensive Patients: A Randomized Controlled Study. Nutrients 2016; 8:nu8110727. [PMID: 27854314 PMCID: PMC5133112 DOI: 10.3390/nu8110727] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 01/17/2023] Open
Abstract
(1) Background: Endothelial dysfunction predicts cardiovascular events. Circulating angiogenic cells (CACs) maintain and repair the endothelium regulating its function. Tea flavonoids reduce cardiovascular risk. We investigated the effects of black tea on the number of CACs and on flow-mediated dilation (FMD) before and after an oral fat in hypertensives; (2) Methods: In a randomized, double-blind, controlled, cross-over study, 19 patients were assigned to black tea (150 mg polyphenols) or a placebo twice a day for eight days. Measurements were obtained in a fasted state and after consuming whipping cream, and FMD was measured at baseline and after consumption of the products; (3) Results: Compared with the placebo, black tea ingestion increased functionally active CACs (36 ± 22 vs. 56 ± 21 cells per high-power field; p = 0.006) and FMD (5.0% ± 0.3% vs. 6.6% ± 0.3%, p < 0.0001). Tea further increased FMD 1, 2, 3, and 4 h after consumption, with maximal response 2 h after intake (p < 0.0001). Fat challenge decreased FMD, while tea consumption counteracted FMD impairment (p < 0.0001); (4) Conclusions: We demonstrated the vascular protective properties of black tea by increasing the number of CACs and preventing endothelial dysfunction induced by acute oral fat load in hypertensive patients. Considering that tea is the most consumed beverage after water, our findings are of clinical relevance and interest.
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Affiliation(s)
- Davide Grassi
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, Viale S Salvatore, Delta 6 Medicina, 67100 L'Aquila, Italy.
| | - Richard Draijer
- Unilever Research and Development, 3133 AT Vlaardingen, The Netherlands.
| | - Casper Schalkwijk
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands.
| | - Giovambattista Desideri
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, Viale S Salvatore, Delta 6 Medicina, 67100 L'Aquila, Italy.
| | - Anatolia D'Angeli
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, Viale S Salvatore, Delta 6 Medicina, 67100 L'Aquila, Italy.
| | - Sandro Francavilla
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, Viale S Salvatore, Delta 6 Medicina, 67100 L'Aquila, Italy.
| | - Theo Mulder
- Unilever Research and Development, 3133 AT Vlaardingen, The Netherlands.
| | - Claudio Ferri
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, Viale S Salvatore, Delta 6 Medicina, 67100 L'Aquila, Italy.
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Rodriguez-Miguelez P, Seigler N, Harris RA. Ultrasound Assessment of Endothelial Function: A Technical Guideline of the Flow-mediated Dilation Test. J Vis Exp 2016:54011. [PMID: 27167596 PMCID: PMC4942014 DOI: 10.3791/54011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Cardiovascular disease is the primary cause of mortality and a major cause of disability worldwide. The dysfunction of the vascular endothelium is a pathological condition characterized mainly by a disruption in the balance between vasodilator and vasoconstrictor substances and is proposed to play an important role in the development of atherosclerotic cardiovascular disease. Therefore, a precise evaluation of endothelial function in humans represents an important tool that could help better understand the etiology of multiple cardio-centric pathologies. Over the past twenty-five years, many methodological approaches have been developed to provide an assessment of endothelial function in humans. Introduced in 1989, the FMD test incorporates a forearm occlusion and subsequent reactive hyperemia that promotes nitric oxide production and vasodilation of the brachial artery. The FMD test is now the most widely utilized, non-invasive, ultrasonic assessment of endothelial function in humans and has been associated with future cardiovascular events. Although the FMD test could have clinical utility, it is a physiological assessment that has inherited several confounding factors that need to be considered. This article describes a standardized protocol for determining FMD including the recommended methodology to help minimize the physiological and technical issues and improve the precision and reproducibility of the assessment.
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Affiliation(s)
- Paula Rodriguez-Miguelez
- Division of Clinical and Translational Sciences, Georgia Prevention Institute, Georgia Regents University
| | - Nichole Seigler
- Division of Clinical and Translational Sciences, Georgia Prevention Institute, Georgia Regents University
| | - Ryan A Harris
- Division of Clinical and Translational Sciences, Georgia Prevention Institute, Georgia Regents University; Sport and Exercise Science Research Institute, University of Ulster;
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Rodriguez-Miguelez P, Seigler N, Bass L, Dillard TA, Harris RA. Assessments of endothelial function and arterial stiffness are reproducible in patients with COPD. Int J Chron Obstruct Pulmon Dis 2015; 10:1977-86. [PMID: 26396509 PMCID: PMC4577266 DOI: 10.2147/copd.s92775] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Elevated cardiovascular disease risk is observed in patients with COPD. Non-invasive assessments of endothelial dysfunction and arterial stiffness have recently emerged to provide mechanistic insight into cardiovascular disease risk in COPD; however, the reproducibility of endothelial function and arterial stiffness has yet to be investigated in this patient population. Objectives This study sought to examine the within-day and between-day reproducibility of endothelial function and arterial stiffness in patients with COPD. Methods Baseline diameter, peak diameter, flow-mediated dilation, augmentation index, augmentation index at 75 beats per minute, and pulse wave velocity were assessed three times in 17 patients with COPD (six males, eleven females, age range 47–75 years old; forced expiratory volume in 1 second =51.5% predicted). Session A and B were separated by 3 hours (within-day), whereas session C was conducted at least 7 days following session B (between-day). Reproducibility was assessed by: 1) paired t-tests, 2) coefficients of variation, 3) coefficients of variation prime, 4) intra-class correlation coefficient, 5) Pearson’s correlations (r), and 6) Bland–Altman plots. Five acceptable assessments were required to confirm reproducibility. Results Six out of six within-day criteria were met for endothelial function and arterial stiffness outcomes. Six out of six between-day criteria were met for baseline and peak diameter, augmentation index and pulse wave velocity, whereas five out of six criteria were met for flow-mediated dilation. Conclusion The present study provides evidence for within-day and between-day reproducibility of endothelial function and arterial stiffness in patients with COPD.
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Affiliation(s)
- Paula Rodriguez-Miguelez
- Division of Clinical and Translational Sciences, Georgia Prevention Institute, Georgia Regents University, Augusta, GA, USA
| | - Nichole Seigler
- Division of Clinical and Translational Sciences, Georgia Prevention Institute, Georgia Regents University, Augusta, GA, USA
| | - Leon Bass
- Pulmonary and Critical Care Medicine, Department of Medicine, Georgia Regents University, Augusta, GA, USA
| | - Thomas A Dillard
- Pulmonary and Critical Care Medicine, Department of Medicine, Georgia Regents University, Augusta, GA, USA
| | - Ryan A Harris
- Division of Clinical and Translational Sciences, Georgia Prevention Institute, Georgia Regents University, Augusta, GA, USA ; Sport and Exercise Science Research Institute, University of Ulster, Jordanstown, Northern Ireland, UK
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Bruno RM, Gori T, Ghiadoni L. Endothelial function testing and cardiovascular disease: focus on peripheral arterial tonometry. Vasc Health Risk Manag 2014; 10:577-84. [PMID: 25328403 PMCID: PMC4196841 DOI: 10.2147/vhrm.s44471] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
During recent decades, a number of methods have been developed to assess endothelial function, contributing to a better understanding of the pathophysiology of cardiovascular disease. Recently, the advent of noninvasive, reproducible techniques for assessment of endothelial function has opened novel possibilities of application in the clinical setting. Peripheral arterial tonometry is a relatively novel, user-friendly technique measuring finger pulse volume amplitude changes induced by reactive hyperemia following 5 minutes of ischemia in the upper limb. Current evidence indicates that this technique has the potential to significantly impact the field of cardiovascular research and prevention of cardiovascular disease. However, a number of methodological, pathophysiological, and clinical aspects still need to be clarified before widespread application of this promising technique. This review focuses on the current knowledge and future perspectives of peripheral arterial tonometry, in comparison with the most widely used noninvasive technique, ie, flow-mediated dilation.
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Affiliation(s)
| | - Tommaso Gori
- Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Veglia F, Amato M, Giovannardi M, Ravani A, Tedesco CC, Frigerio B, Sansaro D, Tremoli E, Baldassarre D. Potentially spurious correlations between arterial size, flow-mediated dilation, and shear rate. Hypertension 2014; 64:1328-33. [PMID: 25245392 DOI: 10.1161/hypertensionaha.114.03608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The use of indices formed from the ratio of 2 variables often generates spurious correlations with other variables that are mathematically coupled. In this context, we examined the correlations between percent flow-mediated dilation, baseline diameter, and shear rate. In a sample of 315 participants, with and without substantial vascular risk factors, the observed correlation coefficients between the variables were of a similar magnitude to those reported in the literature. We then applied a Monte Carlo procedure based on random permutations to remove any physical or physiological explanation for these correlations. We found that the median residual correlation coefficients were comparable with those observed in our original sample. When the confounding influence of artery size was adjusted for, the mean difference in percent flow-mediated dilation between high-risk and low-risk samples was halved. These findings indicate that the widely reported correlations between flow-mediated dilation, basal artery diameter, and shear rate have a substantial spurious component. This is because percent flow-mediated dilation and shear rate are mathematically coupled to artery size.
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Affiliation(s)
- Fabrizio Veglia
- From Centro Cardiologico Monzino IRCCS, Milan, Italy (F.V., M.A., M.G., A.R., C.C.T., B.F., E.T., D.B.); and Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano, Milan, Italy (E.T., D.B.).
| | - Mauro Amato
- From Centro Cardiologico Monzino IRCCS, Milan, Italy (F.V., M.A., M.G., A.R., C.C.T., B.F., E.T., D.B.); and Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano, Milan, Italy (E.T., D.B.)
| | - Marta Giovannardi
- From Centro Cardiologico Monzino IRCCS, Milan, Italy (F.V., M.A., M.G., A.R., C.C.T., B.F., E.T., D.B.); and Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano, Milan, Italy (E.T., D.B.)
| | - Alessio Ravani
- From Centro Cardiologico Monzino IRCCS, Milan, Italy (F.V., M.A., M.G., A.R., C.C.T., B.F., E.T., D.B.); and Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano, Milan, Italy (E.T., D.B.)
| | - Calogero C Tedesco
- From Centro Cardiologico Monzino IRCCS, Milan, Italy (F.V., M.A., M.G., A.R., C.C.T., B.F., E.T., D.B.); and Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano, Milan, Italy (E.T., D.B.)
| | - Beatrice Frigerio
- From Centro Cardiologico Monzino IRCCS, Milan, Italy (F.V., M.A., M.G., A.R., C.C.T., B.F., E.T., D.B.); and Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano, Milan, Italy (E.T., D.B.)
| | - Daniela Sansaro
- From Centro Cardiologico Monzino IRCCS, Milan, Italy (F.V., M.A., M.G., A.R., C.C.T., B.F., E.T., D.B.); and Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano, Milan, Italy (E.T., D.B.)
| | - Elena Tremoli
- From Centro Cardiologico Monzino IRCCS, Milan, Italy (F.V., M.A., M.G., A.R., C.C.T., B.F., E.T., D.B.); and Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano, Milan, Italy (E.T., D.B.)
| | - Damiano Baldassarre
- From Centro Cardiologico Monzino IRCCS, Milan, Italy (F.V., M.A., M.G., A.R., C.C.T., B.F., E.T., D.B.); and Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano, Milan, Italy (E.T., D.B.)
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Charakida M, de Groot E, Loukogeorgakis SP, Khan T, Lüscher T, Kastelein JJ, Gasser T, Deanfield JE. Variability and reproducibility of flow-mediated dilatation in a multicentre clinical trial. Eur Heart J 2013; 34:3501-7. [PMID: 23821401 DOI: 10.1093/eurheartj/eht223] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIMS The aim of this study was to assess the reproducibility of flow-mediated dilatation (FMD) in a multicentre setting. METHODS AND RESULTS This study was performed as part of the dal-VESSEL trial in which FMD was measured in 19 vascular imaging centres in six European countries. A subgroup of patients who were allocated in the placebo group and scanned twice at each trial time point (substudy) was analysed. Intra-sonographer variability was calculated from FMD measurements 48 h apart. Centre variability and short-, medium-, and long-term reproducibility of FMD were calculated at 48 h and at 3 and 9 months intervals, respectively. Intra- and inter-reader variability was assessed by re-analysing the FMD images by three certified readers at two time intervals, 7 days apart. Sixty-seven patients were included. Variability between centres was comparable at 48 h and 3 months interval but almost doubled at 9 months. The mean absolute difference in %FMD was 1.04, 0.99, and 1.45% at the three time intervals, respectively. Curves were generated to indicate the number of patients required for adequate power in crossover and parallel study designs. CONCLUSION This study demonstrates for the first time that in a multicentre setting reproducible FMD measurements can be achieved for short- and medium-term evaluation, which are comparable with those reported from specialized laboratories. These findings justify the use of FMD as an outcome measure for short- and medium-term assessment of pharmacological interventions.
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Affiliation(s)
- Marietta Charakida
- National Institute for Cardiovascular Outcome Research, UCL, 170 Tottenham Court Road, London W1T 7HA, UK
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Ganz P, Hsue PY. Endothelial dysfunction in coronary heart disease is more than a systemic process. Eur Heart J 2013; 34:2025-7. [DOI: 10.1093/eurheartj/eht199] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Flammer AJ, Anderson T, Celermajer DS, Creager MA, Deanfield J, Ganz P, Hamburg NM, Lüscher TF, Shechter M, Taddei S, Vita JA, Lerman A. The assessment of endothelial function: from research into clinical practice. Circulation 2012; 126:753-67. [PMID: 22869857 DOI: 10.1161/circulationaha.112.093245] [Citation(s) in RCA: 827] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Andreas J Flammer
- Division of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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Abstract
OBJECTIVE Impaired flow-mediated dilation (FMD) is associated with cardiovascular risk factors and provides prognostic information. Despite the noninvasive nature of this technique, a major limitation to its widespread use is low reproducibility. The aim of this study was to evaluate impact of methodological standardization among different investigation sites on brachial artery FMD reproducibility. METHODS Seven Italian centers recruited 135 healthy volunteers, aged 20-60 years. FMD was assessed by high-resolution ultrasound equipped with a stereotactic probe-holding device. Certified sonographers recorded brachial artery scans at baseline (day 1a), 1 h after (day 1b), and 1 month later (day 30). Endothelium-independent vasodilation (EIVD) to sublingual glyceril-trinitrate was recorded at day 1 and day 30. FMD and EIVD were blindly evaluated at the coordinating center by an automated edge detection system. The intra-session (day 1a versus 1b) and inter-session (day 1a versus 30) coefficients of variation were calculated. RESULTS FMD was not significantly (P = 0.91) different at day 1a, day 1b and day 30 (6.52 ± 2.9, 6.42 ± 3.1, 6.57 ± 2.8%, respectively). The FMD intra-session coefficient of variation was 9.9 ± 8.4% (from 7.6 to 11.9% across centers). The FMD inter-session coefficient of variation was 12.9 ± 11.6% (from 11.6 to 16.1% across centers). Inter-session coefficient of variation for EIDV was 19.7 ± 16.8%. CONCLUSIONS This study shows a homogeneous coefficient of variation for FMD among different centers. The inter-session coefficient of variation was similar to the intra-session coefficient of variation, representing the intrinsic FMD variability. We demonstrate for the first time that rigorous and standardized procedure may provide reproducible FMD assessment to study endothelial function in multicenter clinical trials.
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Ellins EA, Halcox JPJ. Where are we heading with noninvasive clinical vascular physiology? Why and how should we assess endothelial function? Cardiol Res Pract 2011; 2011:870132. [PMID: 21876826 PMCID: PMC3157674 DOI: 10.4061/2011/870132] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 05/18/2011] [Accepted: 06/05/2011] [Indexed: 01/22/2023] Open
Abstract
There are several invasive and noninvasive methods available to the clinical researcher for the assessment of endothelial function. The first investigations in humans involved invasive pharmacological vascular function testing, which have been used to gain a detailed understanding of the mechanisms involved in the pathogenesis of endothelial dysfunction and atherosclerosis as well as novel targets for intervention. Techniques for endothelial function testing have evolved over time from these invasive methods, which, by their nature, are restricted to small studies in the research laboratory, to more standardized noninvasive methods, which are suitable for use in large prospective cohort studies and clinical trials. This paper describes currently available methods for assessment of endothelial function and their potential application in cardiovascular research and clinical practice.
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Affiliation(s)
- Elizabeth A Ellins
- Wales Heart Research Institute, Cardiff University, Heath Park, Cardiff CF14 4XN, UK
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Unal O, Karatepe O, Ugurlucan M, Koc B, Filizcan U, Aksoy M. Effects of lower extremity revascularization on the endothelial functions measured with noninvasive brachial artery flow-mediated dilatation. Ann Vasc Surg 2011; 25:969-74. [PMID: 21530156 DOI: 10.1016/j.avsg.2011.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Revised: 11/01/2010] [Accepted: 02/08/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endothelial function is best measured with the noninvasive brachial artery flow-mediated dilatation (FMD) method. Peripheral arterial diseases and systemic cardiovascular diseases have FMD-lowering effect. The effects of lower extremity ischemia are associated with muscle inflammation and claudication, which may further lead to arterial stress. Our aim in this study was to investigate the effects of peripheral arterial revascularization on the endothelial functions through noninvasive brachial artery FMD. METHODS Between January 2007 and February 2008, 54 patients diagnosed with lower extremity arterial disease undergoing revascularization were included in the study. Endothelial function is measured preoperatively and at the fourth week postoperatively using the brachial artery FMD method. Blood samples were collected at the same intervals for the measurement of interleukin-6, leukocyte count, tumor necrosis factor-alpha, and nitric oxide values. RESULTS Femoropopliteal bypass grafting was performed in all patients with a synthetic graft. The mean ankle-brachial index in the preoperative period was 0.29 ± 0.083, and after the operation, dorsalis pedis and/or posterior tibial artery became palpable in all patients. The nitric oxide, interleukin-6, high-sensitivity C-reactive protein, and tumor necrosis factor-alpha levels decreased significantly after 4 weeks postoperatively as compared with the preoperative levels (p < 0.05). Postoperative Doppler ultrasonography FMD of brachial artery increased from preoperative value of 9.2 ± 2.1 to 16.2 ± 4.5 (p < 0.01) at postoperative week 4. CONCLUSIONS Systemic inflammation and muscle ischemia lead to reduced endothelial functions. After successful lower extremity revascularization, endothelial functions improve dramatically, which may be easily detected with the noninvasive brachial artery FMD method.
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Affiliation(s)
- Orcun Unal
- Department of Vascular Surgery, Okmeydani Training Hospital, Istanbul, Turkey
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Axtell AL, Gomari FA, Cooke JP. Assessing endothelial vasodilator function with the Endo-PAT 2000. J Vis Exp 2010:2167. [PMID: 20972417 DOI: 10.3791/2167] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The endothelium is a delicate monolayer of cells that lines all blood vessels, and which comprises the systemic and lymphatic capillaries. By virtue of the panoply of paracrine factors that it secretes, the endothelium regulates the contractile and proliferative state of the underlying vascular smooth muscle, as well as the interaction of the vessel wall with circulating blood elements. Because of its central role in mediating vessel tone and growth, its position as gateway to circulating immune cells, and its local regulation of hemostasis and coagulation, the the properly functioning endothelium is the key to cardiovascular health. Conversely, the earliest disorder in most vascular diseases is endothelial dysfunction. In the arterial circulation, the healthy endothelium generally exerts a vasodilator influence on the vascular smooth muscle. There are a number of methods to assess endothelial vasodilator function. The Endo-PAT 2000 is a new device that is used to assess endothelial vasodilator function in a rapid and non-invasive fashion. Unlike the commonly used technique of duplex ultra-sonography to assess flow-mediated vasodilation, it is totally non-operator-dependent, and the equipment is an order of magnitude less expensive. The device records endothelium-mediated changes in the digital pulse waveform known as the PAT (peripheral Arterial Tone) signal, measured with a pair of novel modified plethysmographic probes situated on the finger index of each hand. Endothelium-mediated changes in the PAT signal are elicited by creating a downstream hyperemic response. Hyperemia is induced by occluding blood flow through the brachial artery for 5 minutes using an inflatable cuff on one hand. The response to reactive hyperemia is calculated automatically by the system. A PAT ratio is created using the post and pre occlusion values. These values are normalized to measurements from the contra-lateral arm, which serves as control for non-endothelial dependent systemic effects. Most notably, this normalization controls for fluctuations in sympathetic nerve outflow that may induce changes in peripheral arterial tone that are superimposed on the hyperemic response. In this video we demonstrate how to use the Endo-PAT 2000 to perform a clinically relevant assessment of endothelial vasodilator function.
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Affiliation(s)
- Andrea L Axtell
- Department of Cardiovascular Medicine, Stanford University, USA
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