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VASCULAR ENDOTHELIUM & ITS FUNCTIONAL ASSESSMENT. Upa Kukongviriyapan Department of Physiology, Faculty of Medicine Khon Kaen University, Thailand. B.Sc. Experimental Pathology Queen Mary’s School of Medicine and Dentistry The Royal London Hospital October 12, 2005. Topic Contents.

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vascular endothelium its functional assessment

VASCULAR ENDOTHELIUM &ITSFUNCTIONAL ASSESSMENT

Upa Kukongviriyapan

Department of Physiology, Faculty of Medicine

Khon Kaen University, Thailand.

B.Sc. Experimental Pathology

Queen Mary’s School of Medicine and Dentistry

The Royal London Hospital

October 12, 2005

slide2

Topic Contents

  • Structure and functions of vascular endothelial cell.
  • The endothelial dysfunction.
  • The oxidant- stress induced endothelial dysfunction.
  • How to assess endothelial functions.
  • Summary
the normal vascular endothelium
The Normal Vascular Endothelium
  • Historically viewed as a passive
  • vascular lining.
vascular endothelium
Vascular Endothelium
  • Many important roles to maintain vascular homeostasis:
    • Vascular tone regulation
    • VSMC proliferation
    • Inflammatory responses
    • Haemostasis
  • It produces and releases vasoactive, thromboregulatory and growth factor substances.
slide5

Endothelial cell functions

  • Maintaining the vascular tone: Vasodilation and Vasoconstriction

Tousoulis, et al., Heart 2005; 91: 353-358.

endothelial cell functions

Inflammation Proinflammatory Antiinflammatory

Adhesion molecules

Selectin-E, VCAM-1, ICAM-1, PECAM-1

Endothelial cell functions

Functional targets Physiological action/Mediators

Growth Stimulation Inhibition

PDGF, FGF NO, PGI2, TGF

IGF-1, ET, AII

endothelial cell functions7
Endothelial cell functions

Functional targets Physiological action/Mediators

Haemostasis Prothrombotic Antithrombotic

PAI-1 PGI2, TPA

Calles-Escandon and Cipolla, Endocrine Rev 2001; 22: 36-52.

slide9

“ An impairment of endothelium-dependent vasorelaxation

caused by a loss of NO bioactivity in the vessel wall.

Endothelial Dysfunction

  • pathological conditions
  • altered anticoagulant &
  • anti-inflammatory properties
  • impaired modulation of
  • vascular growth &
  • dysregulation of vascular
  • remodeling
slide13
How can we assess the

endothelial function?

slide15

Clinical Studies Supporting the Prognostic Value of Endothelial Vasomotor Function Testing.(Ganz, et al. Circulation 2003; 108: 2049-2053.)

Patients with endothelial dysfunction had a far greater incidenceof adverse cardiovascular events in follow-up comparedwith patients with preserved endothelial function.

key points for evaluating ed
Key points for evaluating ED.

Tousoulis D, et al., Heart 2005; 91: 353-358.

evaluating endothelial function in humans non invasive techniques
Evaluating Endothelial Function in HumansNon-invasive techniques
  • High resolution ultrasonography: Assessment of flow-mediated dilatation (FMD).
  • Strain-gauge plethysmography: Evaluation of

forearm blood flow (FBF).

slide18

Flow-mediated dilatation (FMD)

  • Is defined as an endothelium-dependent process that reflects the relaxation of a conduit artery when exposed to increased flow and, thereby, increased shear stress.
  • An impaired FMD response reflects endothelial dysfunction.
  • A temporary increase in shear stress can be induced by increasing the local blood flow, the so-called
  • “reactive hyperemia”.
  • An abrupt decrease in vascular resistance mediated by the EDNO caused FMD.

Tousoulis D, et al., Heart 2005: 91: 553-558.

the genesis of fmd
The genesis of FMD

Moens, et al., Chest 2005; 127: 2254-2263.

slide21

Equipment: Ultrasonic imaging of

brachial artery diameter

Measurement of vasodilation response by ultrasonic imaging of arterial diameter:

  • should be equipped withvascular software for2D imaging, color andspectral Doppler, aninternal ECG monitorand high frequency vascular transducerattached to a high-quality mainframe ultrasound. and
  • Noninvasive, simple, costly, widely available, need further
  • validation.
slide22

Brachial Artery Flow-Mediated DilationBaseline5 MinutesPost-OcclusionBlood Pressure Cuff Occlusion – 1 Minute Release

3.6 mm

3.1 mm

forearm blood flow strain gauge plethysmogr a phy
Forearm blood flow(Strain-gauge plethysmography)
  • Noninvasive, simple, reproducible and less observer dependent, need further validation.
  • The strain-gauge is attached to the upper forearm, and connected to plethysmographic device.

.

  • FBF is measured by temporarily occluding the venous return (by a cuff inflated to 40 mmHg) and measured the slight swelling of the distal portion of the limb due to continued arterial inflow.
forearm blood flow strain gauge plethysmogr a phy24
Forearm blood flow(Strain-gauge plethysmography)
  • The initial rate of swelling represents the arterial inflow.
  • The technique evaluates the percentage change of flow from baseline to the maximum flow during reactive hyperaemia following a five minute ischaemia of the forearm.

Tousoulis D, et al., Heart 2005: 91: 553-558.

slide25

Sample window

  • The FBF is estimated by the gradient of the tangent to the curve
  • duringthe first cardiac cycles.
  • Result of forearm flow is expressed as ml/100 ml tiss/min or the
  • percent changes in flow.
timetable of fmd fbf
Timetable of FMD & FBF

Tousoulis D, et al., Heart 2005; 91: 353-358.

slide27

Application in clinical trials

  • Study design:Acute or long-term intervention trials.
  • Sample size:A crossover or a parallel- group design study.
  • Methodology:Select most reproducible results.
    • Evaluating precision of the technique.
    • Individual training in the principles and technical
    • aspect of Doppler ultrasonography and Strain-gauge
    • plethysmography.
summary
SUMMARY
  • Endothelial functional testing can be used as an indicator for vascular damage or vascular disease and also other diseases relating to oxidative stress conditions.
  • Reversal of endothelial dysfunction protects against progression of vascular disease.
summary29
SUMMARY
  • Proposed new tests for evaluating endothelial function should be developed with optimal characteristics;
    • Cost-effective, reproducible and standardization.
    • Ability to predict risk and relationship to established tests of risk.
    • Useful as a screen for drug development.
    • Can identify individual patients.
    • Can predict a reduction in the risk of clinical events.
questions
QUESTIONS
  • What are the main functions of the vascular endothelial cell?
  • What is the endothelial dysfunction? How can it lead to the cardiovascular disease?
  • How can we evaluate the endothelial functions?
  • What are the key points for evaluating the

endothelial dysfunction?