Zusammenfassung
Die flussabhängige Dilatation (FMD) wird zur Qualifizierung der
Endothelfunktion genutzt. Studienziel: Ziel dieser
Studie war es, eine FMD in der A. brachialis im Echtzeit-Modus zu registrieren
zur Analyse des zeitlichen Verlaufs sowie der (zeitlichen) Relation zur
Reizstärke. Durch wiederholte Messungen wurde die Reproduzierbarkeit der
Echtzeitregistrierung ermittelt. Methode: Bei 10
Probanden erfolgte eine wiederholte Messung der FMD.
Gefäßdurchmesser und Flussgeschwindigkeit wurden simultan in
Echtzeit mit einem 7,5 MHz Linearschallkopf bzw. mit einem 8 MHz
Continuous wave-Dopplerschallkopf erfasst. Ergebnisse:
Es wurde eine post-ischämische mittlere Diameterzunahme von
5,9 ± 2,9 % (p < 0,001)
registriert bei einer durchschnittlichen Steigerung der
Blutflussgeschwindigkeit von 487 ± 174 %.
Die relative Gefäßveränderung lässt keine Korrelation mit
der relativen Zunahme der Flussgeschwindigkeit erkennen. Schlussfolgerung: Die Echtzeitmessung einer FMD ist
grundsätzlich möglich. Die Anfälligkeit dieser Methodik für
Bewegungsartefakte erschwert allerdings die Echtzeitmessung.
Abstract
Flow-mediated dilatation (FMD) is used to qualify vascular
endothelial function. Aim: To evaluate the feasibility
of real-time assessment of the stimulus-to-response (i. e.
flow-velocity-to-diameter) relationship, repeated FMD was assessed in healthy
subjects. Methods: Brachial artery diameter and flow
velocity were measured simultaneously in 10 healthy male subjects lying in the
supine position. These parameters were registered in real-time mode and
beat-to-beat by means of a 7.5 MHz linear array transducer attached to a
custom-built Wall Track System and an 8 MHz continuous wave Doppler.
Results: Post-ischaemic increase in arterial diameter
amounted to 5.9 ± 2.9 % with an average
increase in blood flow velocity of
487 ± 174 %. The relative change in diameter
was not correlated to the relative increase in flow velocity. Conclusion: Continuous registration of FMD can be performed.
Motion artefacts, however, interfere with the real-time registration of
FMD.
Schlüsselwörter
Flussabhängige Dilatation - Reaktive Hyperämie - Endothelfunktion - Ultraschall - Wanddetektionssysteme
Key words
Flow-mediated dilatation - reactive hyperaemia - endothelial function - ultrasound - wall detection systems
Literatur
-
1
Furchgott R F, Zawadzki J V.
The obligatory role of endothelial cells in the relaxation of
arterial smooth muscle by acetylcholine.
Nature.
1980;
288
373-376
-
2
Hintze T H, Vatner S F.
Reactive dilation of large coronary arteries in conscious
dogs.
Circ Res.
1984;
54
50-57
-
3
Joannides R, Haefeli W E, Linder L, Richard V, Bakkali E H, Thuillez C, Luscher T F.
Nitric oxide is responsible for flow-dependent dilatation of
human peripheral conduit arteries in vivo.
Circulation.
1995;
91
1314-1319
-
4
Cardillo C, Panza J A.
Impaired endothelial regulation of vascular tone in patients
with systemic arterial hypertension.
Vasc Med.
1998;
3
138-144
-
5
Anderson T J, Gerhard M D, Meredith I T, Charbonneau F, Delagrange D, Creager M A, Selwyn A P, Ganz P.
Systemic nature of endothelial dysfunction in
atherosclerosis.
Am J Cardiol.
1995;
75
71-74
-
6
Levenson J A, Peronneau P A, Simon A, Safar M E.
Pulsed Doppler: determination of diameter, blood flow
velocity, and volumic flow of brachial artery in man.
Cardiovasc Res.
1981;
15
164-170
-
7
Celermajer D S, Sorensen K E, Gooch V M, Spiegelhalter D J, Miller O I, Sullivan I D, Lloyd J K, Deanfield J E.
Non-invasive detection of endothelial dysfunction in children
and adults at risk of atherosclerosis.
Lancet.
1992;
340
1111-1115
-
8
Anderson T J, Uehata A, Gerhard M D, Meredith I T, Knab S, Delagrange D, Lieberman E H, Ganz P, Creager M A, Yeung A C. et al .
Close relation of endothelial function in the human coronary
and peripheral circulations.
J Am Coll Cardiol.
1995;
26
1235-1241
-
9
Hashimoto M, Akishita M, Eto M, Ishikawa M, Kozaki K, Toba K, Sagara Y, Taketani Y, Orimo H, Ouchi Y.
Modulation of endothelium-dependent flow-mediated dilatation
of the brachial artery by sex and menstrual cycle.
Circulation.
1995;
92
3431-3435
-
10
Kosch M, Hausberg M, Vormbrock K, Kisters K, Gabriels G, Heinz Rahn K, Barenbrock M.
Impaired flow-mediated vasodilation of the brachial artery in
patients with primary hyperparathyroidism improves after
parathyroidectomy.
Cardiovasc Res.
2000;
47
813-818
-
11
Maiorano G, Bartolomucci F, Contursi V, Minenna F S, Di Mise R, Palasciano A, Allegrini B, Amoruso M, Kozakova M.
Noninvasive detection of vascular dysfunction in alcoholic
patients.
Am J Hypertens.
1999;
12
137-144
-
12
Schroeder S, Enderle M D, Ossen R, Meisner C, Baumbach A, Pfohl M, Herdeg C, Oberhoff M, Haering H U, Karsch K R.
Noninvasive determination of endothelium-mediated
vasodilation as a screening test for coronary artery disease: pilot study to
assess the predictive value in comparison with angina pectoris, exercise
electrocardiography, and myocardial perfusion imaging.
Am Heart J.
1999;
138
731-739
-
13
Tawakol A, Omland T, Gerhard M, Wu J T, Creager M A.
Hyperhomocyst(e)inemia is associated with impaired
endothelium-dependent vasodilation in humans.
Circulation.
1997;
95
1119-1121
-
14
Thambyrajah J, Landray M J, McGlynn F J, Jones H J, Wheeler D C, Townend J N.
Abnormalities of endothelial function in patients with
predialysis renal failure.
Heart.
2000;
83
205-209
-
15
Woo K S, Chook P, Lolin Y I, Cheung A S, Chan L T, Sun Y Y, Sanderson J E, Metreweli C, Celermajer D S.
Hyperhomocyst(e)inemia is a risk factor for arterial
endothelial dysfunction in humans.
Circulation.
1997;
96
2542-2544
-
16
Brands P J, Hoeks A P, Willigers J, Willekes C, Reneman R S.
An integrated system for the non-invasive assessment of
vessel wall and hemodynamic properties of large arteries by means of
ultrasound.
Eur J Ultrasound.
1999;
9
257-266
-
17
Bland J M, Altman D G.
Statistical methods for assessing agreement between two
methods of clinical measurement.
Lancet.
1986;
1
307-310
-
18
Reneman R S, Hoeks A PG, Westerhof N.
Non-invasive assessment of artery wall properties in humans
- methods and interpretation.
J Vasc Inv.
1996;
2
53-64
-
19
Stadler R W, Ibrahim S F, Lees R S.
Measurement of the time course of peripheral vasoactivity:
results in cigarette smokers.
Atherosclerosis.
1998;
138
197-205
-
20
Preik M, Lauer T, Heiss C, Tabery S, Strauer B E, Kelm M.
Automated ultrasonic measurement of human arteries for the
determination of endothelial function.
Ultraschall Med.
2000;
21
195-198
-
21
Uehata A, Lieberman E H, Gerhard M D, Anderson T J, Ganz P, Polak J F, Creager M A, Yeung A C.
Noninvasive assessment of endothelium-dependent flow-mediated
dilation of the brachial artery.
Vasc Med.
1997;
2
87-92
-
22
Stadler R W, Karl W C, Lees R S.
New methods for arterial diameter measurement from B-mode
images.
Ultrasound Med Biol.
1996;
22
25-34
Prof. Dr. Ir. A. Hoeks
Universität Maastricht · Fachbereich für
Biophysik
Postfach 616 · 6200 MD Maastricht · Niederlande
·
Phone: (31) 43 3881667
Fax: (31) 43 3884178
Email: A.Hoeks@BF.UNIMAAS.NL
