This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Willerson, J. T. Articles by Kereiakes, D. J. Search for Related Content PubMed PubMed Citation Articles by Willerson, J. T. Articles by Kereiakes, D. J. Related Collections Cardiovascular Pharmacology Primary prevention Restenosis ACE/Angiotension receptors Angiogenesis Pathophysiology Risk Factors Other hypertension Other arteriosclerosis Ischemic biology - basic studies Smooth muscle proliferation and differentiation Other etiology Other diagnostic testing Acute myocardial infarction Chronic ischemic heart disease Oxidant stress Platelets Endothelium/vascular type/nitric oxide Mechanism of atherosclerosis/growth factors Other Vascular biology

(Circulation. 2003;108:2060.)
© 2003 American Heart Association, Inc.

Mini-Review: Expert Opinions

Endothelial Dysfunction

James T. Willerson, MD; Dean J. Kereiakes, MD

From St Luke’s Episcopal Hospital/Texas Heart Institute (J.T.W.), Houston, Tex, and the Carl and Edyth Lindner Center for Research and Education (D.J.K.), Ohio Heart Health Center, Cincinnati, Ohio.

Correspondence to James T. Willerson, MD, SLEH/THI, 6720 Bertner Ave, Room B 524, Houston, TX 77030. E-mail suzy.lanier@uth.tmc.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Drs Ganz and Vita¹ and Verma, Buchanan, and Anderson² have presented persuasive evidence that endothelial function is dynamically regulated and that the endothelium’s vasodilator, antiinflammatory, and antithrombotic properties are markedly diminished by a variety of injuries, including atherosclerosis, hypertension, diabetes, inflammation, and aging. Moreover, they identify several recent studies that provide evidence that endothelial dysfunction in both coronary and peripheral arteries precedes the development of the clinical consequences of atherothrombosis. Testing of endothelial function still rests largely in the administration of an endothelium-dependent vasodilator, such as acetylcholine, or in evaluating brief periods of occlusion of an artery followed by functional assessment of that artery, which is vasodilation when normal and failure of vasodilation or vasoconstriction when abnormal. Quantitative coronary arteriography has been used in the past to measure coronary vasomotor responses, and more recently, ultrasound has been used as a noninvasive measurement of endothelial function, especially when examining brachial arteries.

However, what is missing from these assessments is an evaluation of other aspects of endothelial function, including antithrombotic, metabolic, and antiinflammatory properties. It is likely that subtle or early injury to the endothelium alters only one or two of the endothelial functional properties, whereas more extensive injury alters most or all of endothelial function, hastening the development of atherothrombosis and progressive vascular disease. This is an area where development needs to occur so that one might be able to assess a broader array of endothelial functional properties, anticipating greater predictive ability with regard to acute coronary artery syndromes, cerebrovascular accidents, . . . [Full Text of this Article]

This article has been cited by other articles:

				R. Vogel Listening to the Endothelium: A Story of Signal and Noise J. Am. Coll. Cardiol., May 20, 2008; 51(20): 1965 - 1966. [Full Text] [PDF]

				E. Falk Pathogenesis of atherosclerosis. J. Am. Coll. Cardiol., April 18, 2006; 47(8 Suppl): C7 - C12. [Abstract] [Full Text] [PDF]

				G. Patti, V. Pasceri, R. Melfi, C. Goffredo, M. Chello, A. D'Ambrosio, R. Montesanti, and G. Di Sciascio Impaired Flow-Mediated Dilation and Risk of Restenosis in Patients Undergoing Coronary Stent Implantation Circulation, January 4, 2005; 111(1): 70 - 75. [Abstract] [Full Text] [PDF]

				J. C. Wang, S.-L. T. Normand, L. Mauri, and R. E. Kuntz Coronary Artery Spatial Distribution of Acute Myocardial Infarction Occlusions Circulation, July 20, 2004; 110(3): 278 - 284. [Abstract] [Full Text] [PDF]