doi: 10.1161/01.CIR.0000075928.54461.33
(Circulation. 2003;107:3243.)
© 2003 American Heart Association, Inc.
Brief Review: Current Perspective |
Clinical Utility of Endothelial Function Testing
Ready for Prime Time?
From the Division of Cardiology, Department of Medicine, Tufts-New England Medical Center, Boston, Mass.
Correspondence to Jeffrey T. Kuvin, MD, Division of Cardiology, Tufts-New England Medical Center, 750 Washington St, Box 315, Boston, MA 02111. E-mail jkuvin@tufts-nemc.org
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
"...Arteriosclerosis...is the expression of the natural wear and tear to which the tubes are subjected...the onset of arteriosclerosis depends on the quality of arterial tissue (vital rubber)...in the make up of the machine, bad material was used for the tubing..."1
— William Osler, The Principles and Practice of Medicine, 1892
The arterial endothelium comprises cells resting on a basement membrane that exert autocrine, paracrine, and endocrine functions. This monolayer of endothelial cells plays a crucial role in the regulation of vascular tone in part by the release of vasoactive substances, notably NO, endothelin, prostacyclin, and angiotensinogen.2–4 In addition, endothelial cells are involved in the modulation of platelet activation, leukocyte adhesion, and thrombosis. The endothelium, therefore, delicately balances the counterregulatory pathways that control vasomotion, cell proliferation, thrombosis, inflammation, and oxidation.
Endothelial function becomes impaired early in the atherogenic process, and this diminishes the normal vasodilator response. Impaired endothelium-dependent vasorelaxation can be detected by measuring the response to pharmacological and physiological stressors before the development of angiographically significant atherosclerotic plaque in the coronary5,6 and peripheral vasculature.7 Well-known cardiac risk factors, including age, gender, hypertension, hyperlipidemia, diabetes mellitus, and smoking, as well as novel risk factors, such as inflammation and hyperhomocystinemia, have been associated with abnormal vasorelaxation. Pharmacological therapies and lifestyle changes aimed at improving cardiovascular risk, in many instances, may also improve vasomotor function.8
Techniques for Assessing Endothelial Function
Because atherosclerosis is a diffuse disease process, endothelial function can be assessed in either the coronary or the peripheral circulation. Coronary artery endothelial function is most commonly assessed
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