Az endothelialis funkció non-invazív vizsgálata

Az endothelialis funkció non-invazív vizsgálata
Melyik technika?
Jelen tanulmány célja az volt, hogy összehasonlítsunk három non-invazív, gyermekekben és felnőttekben endothelialis funkciót vizsgáló technikát, és kiértékeljük hasznosságukat az akut Háttér- Az endothelialis dysfunkció egy korai kulcsfontosságú állapot a pre-klinikai
atherosclerosisban. Az áramlás-mediált dilatáció (FMD), annak ellenére, hogy megalapozott technika, költséges és technikai hozzáértést igényel. A belélegzett salbutamolra bekövetkező vascularis változások pulzushullám analízissel (PWA) vagy pulzuskontúr analízissel (PCA) történő vizsgálatai potenciális alternatívák. Módszerek- 16 felnőttet (átlagéletkor: 28 év, 18-39 év) és 16 gyermeket (átlagéletkor: 13 év,
7-17 év) vizsgáltunk egyidejűleg a vascularis funkció tekintetében két alkalommal ultrahanggal, PWA-val és PCA-val. 18 férfit is bevettünk a vizsgálatba, akiket typus vakcináció előtt és után is megmértünk.
Eredmények- Az FMD reprodukálhatósága felnőttekben és gyermekekben magas volt
(variációs koefficiens (CV)=7,1, illetőleg 6,3). A Salbutamolra adott válasz nagyobb variabilitást mutatott PWA-val (felnőtt CV=11,5, gyermek CV=17,1) és PCA-val főként gyermekekben (felnőtt CV=18,2, gyermek CV=36,3). Az áramlás-mediálta dilatáció (p<0,001) és a PWA salbutamolra adott válasszal (p=0,03) a vakcináció után lecsökkent, míg PCA-val (p=0,7) változatlan maradt.
Következtetés- Akut gyulladásos folyamat során a vascularis dysfunkció FMD-vel és
salbutamolra adott válasz PWA-val mérhető. Az áramlás-mediálta dilatáció kevésbé variábilis, mint a PWA. A PCA variabilitás ezt a technikát alkalmatlanná teszi az endothelialis funkció mérésére gyermekekben. Az áramlás-mediálta dilatáció a legreprodukálhatóbb módszer. (J Am Coll Cardiol 2006; 48:1845-50)
Endothelial Function
Non-Invasive Assessment of Endothelial Function
Which Technique?
Ann E. Donald, AVS,* Marietta Charakida, MD,* Tim J. Cole, SCD,* Peter Friberg, MD, PHD,*
Phil J. Chowienczyk, FRCP,† Sandrine C. Millasseau, PHD,† John E. Deanfield, MB, FRCP,*
Julian P. Halcox, MD, MRCP*
London, United Kingdom
OBJECTIVES The purpose of this study was to compare 3 non-invasive techniques for assessment of
endothelial function in adults and children and evaluate their utility in acute inflammation.
BACKGROUND Endothelial dysfunction is a key early event in pre-clinical atherosclerosis. Flow-mediated
dilation (FMD), although the established technique, is expensive and technically demanding.
Measurements of vascular responses to inhaled salbutamol by pulse wave analysis (PWA) or
pulse contour analysis (PCA) are potential alternatives.
METHODS Sixteen adults (mean age 28 years, range 18 to 39) and 16 children (mean age 13 years, range
7 to 17) underwent concurrent vascular function testing on 2 occasions with ultrasound,
PWA, and PCA. Eighteen men were also studied before and after typhoid vaccination.
RESULTS Reproducibility of FMD was high in adults and children (coefficient of variation [CV] _ 7.1
and 6.3, respectively). Salbutamol responses were more variable with PWA (adults CV _
11.5, children CV _ 17.1) and PCA particularly in children (adults CV _ 18.2, children
CV _ 36.3). Flow-mediated dilation (p _ 0.001) and PWA with salbutamol (p _ 0.03)
responses fell after typhoid vaccination, and PCA (p _ 0.7) was unchanged.
CONCLUSIONS Vascular dysfunction during acute inflammation can be measured by FMD and by PWA with
salbutamol. Flow-mediated dilation is less variable than PWA. Variability of PCA makes this
technique currently unsuited to serial measures of endothelial function in children. Flowmediated
dilation remains the most reproducible method. (J Am Coll Cardiol 2006;48:
1846–50) 2006 by the American College of Cardiology Foundation
The vascular endothelium is a key signal transducer in
atherogenesis (1). Study of preclinical vascular disease has
been facilitated by use of non-invasive ultrasound techniques
(2). The vasodilator response to increased conduit
arterial flow (flow-mediated dilation [FMD]) is dependent on
local nitric oxide (NO) bioavailability, and measurement of this
response has been widely used in clinical studies (3,4).
Recently, alternative non-invasive techniques have been
developed with beta2 adrenoceptor agonist-mediated endothelial
NO release, using measurement of the response with
radial artery applanation tonometry (pulse wave analysis
[PWA]) or digital photoplethysmography (pulse contour
analysis [PCA]) (5–7). Although the equipment is small,
portable, and easy to use, the comparative reproducibility of
PWA and PCA and their ability to detect acute vascular
changes have not been determined. We designed this study
to assess the reproducibility of PWA, PCA, and FMD in
children and adults and compared their ability to detect
inflammation-induced changes in vascular function.
METHODS
Study population. We studied 16 children (11 boys, mean
age 13 years, range 7 to 17) and 16 adults (9 men, mean age
28 years, range 18 to 39) to determine reproducibility and
18 men (mean age 26 years, range 18 to 39) to study vascular
responses during acute inflammation. All were healthy and
free from cardiovascular risk factors. All adults and parents
gave written consent; children gave verbal assent. The study
was approved by the local ethics committee.
Study protocol. All investigations were performed by 2
experienced investigators. Subjects refrained from
caffeine-containing drinks and food for 4 h before study
and from vigorous exercise on the day of study. All
studies were undertaken in a warm, temperaturecontrolled
room by the same operator at the same time of
day on both occasions.
STUDY 1—REPRODUCIBILITY: ADULTS. Adults attended on
consecutive days (Fig. 1A). Brachial FMD was assessed.
The effect of a 25-_g sublingual dose of glyceryl trinitrate
(GTN) was then assessed simultaneously by ultrasound,
PWA, and PCA for _15 min after administration, until the
brachial artery diameter (D) had returned to baseline. The
PWA and PCA were assessed before and at 2.5-min intervals
From the *Institute of Child Health, University College London, London, United
Kingdom; and †King’s College London, Cardiovascular Division, Department of
Clinical Pharmacology, St. Thomas’ Hospital, London, United Kingdom. Support
was provided by the Coronary Artery Disease Research Association (to Ms. Donald),
the Greek State Scholarship Foundation (to Dr. Charakida), the UK Medical
Research Council (to Prof. Cole), the British Heart Foundation (to Prof. Deanfield
and Dr. Halcox), and the Swedish Medical Research Council (to Prof. Friberg). Dr.
Chowienzyck was a director of Micromedical until March 2005. Dr. Millasseau is
supported by Micromedical. Ms. Donald and Dr. Charakida contributed equally to
this study.
Manuscript received March 20, 2006; revised manuscript received June 26, 2006,
accepted July 3, 2006.
Journal of the American College of Cardiology Vol. 48, No. 9, 2006
2006 by the American College of Cardiology Foundation ISSN 0735-1097/06/$32.00
Published by Elsevier Inc. doi:10.1016/j.jacc.2006.07.039

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