Circulation. 2003;108:2054-2059
doi: 10.1161/01.CIR.0000089191.72957.ED
doi: 10.1161/01.CIR.0000089191.72957.ED
(Circulation. 2003;108:2054.)
© 2003 American Heart Association, Inc.
Mini-Review: Expert Opinions |
Endothelial Function Testing as a Biomarker of Vascular Disease
From the Department of Cardiac Surgery, University of Toronto, Toronto, Ontario, and Department of Pharmacology and Therapeutics, University of Calgary, Calgary, Alberta, Canada (S.V.); the Department of Pathology and Molecular Science, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada (M.B.); and the Department of Medicine, University of Calgary, Calgary, Alberta, Canada (T.J.A.).
Correspondence to Subodh Verma, MD, PhD, Division of Cardiac Surgery, 14EN-215, 200 Elizabeth St, Toronto General Hospital, Toronto, Ontario, Canada M5G 2C4. E-mail Subodh.Verma@Sympatico.ca
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Introduction |
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The endothelium is the monolayer of endothelial cells lining the lumen of all blood vessels. These cells function as a protective biocompatible barrier between all tissues and the circulating blood. Endothelial cells also function as a selective sieve to facilitate bidirectional passage of macromolecules and blood gases to and from tissues and blood. The strategic location of the endothelium allows it to "sense" changes in hemodynamic forces and blood-borne signals and "respond" by releasing a number of autocrine and paracrine substances. A balanced release of these bioactive factors facilitates vascular homeostasis. Endothelial cell dysfunction disrupts this balance, thereby predisposing the vessel wall to vasoconstriction, leukocyte adherence, platelet activation, mitogenesis, pro-oxidation, thrombosis, impaired coagulation, vascular inflammation, and atherosclerosis.1 Our understanding of these endothelial cell responses has led to the development of tests that are believed to reflect endothelial cell dysfunction or integrity in vivo. Given the central role of the endothelium in the development and clinical course of atherosclerosis, endothelial function testing may serve as a useful biomarker of atherosclerosis.
Nitric oxide (NO) is the key endothelium-derived relaxing factor that plays a pivotal role in the maintenance of vascular tone and reactivity.2 In addition to being the main determinant of basal vascular smooth muscle tone, NO acts to negate the actions of potent endothelium-derived contracting factors such as angiotensin II and endothelin-1. In addition, NO serves to inhibit platelet and white cell activation and to maintain the vascular smooth muscle in a nonproliferative state. NO is synthesized from L-arginine under
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