Indikatoren einer beginnenden Atherosklerose: Erfassung der endothelialen Dysfunktion mittels hochauflösendem Ultraschall

Zusammenfassung

Endothelialen Funktionsstörungen wird eine zentrale Rolle im Prozess der Atherosklerose wie auch in der Pathogenese der arteriellen Hypertonie und der chronischen Herzinsuffizienz beigemessen. In den letzten Jahren wurde eine nicht-invasive Technik entwickelt, die Endothelfunktion als endothelabhängige Vasodilatation der A. brachialis mittels hochauflösendem Ultraschall (7 - 13 MHz) zu erfassen. Diese Methode basiert auf Ergebnissen von Grundlagenstudien, die eine gesteigerte endotheliale Stickoxid-(NO-)Produktion nach Scherkraft-Einwirkung auf die Endotheloberfläche zeigen konnten. Der Vorteil dieser Methode liegt in ihrem nicht-invasiven Charakter, so dass die Messung sowohl bei jungen Menschen bzw. Kindern als auch wiederholt (z. B. im Rahmen einer therapeutischen Intervention) risikolos durchgeführt werden kann. Trotz des täuschend einfachen Untersuchungsprotokolls hängt die Erfassung der flussmediierten Vasodilatation allerdings von zahlreichen Faktoren ab, deren Kenntnis für die Durchführung und die Interpretation der Ergebnisse von entscheidender Bedeutung ist. In der folgenden Übersicht wird deshalb zu methodischen Details, Variationen in der Durchführung, Methode der Bildanalyse, Probandenvorbereitung, Ausrüstungsanforderungen, Untersuchererfahrung und Befundinterpretation Stellung genommen. Des Weiteren werden klinische Studien zu kardiovaskulären Erkrankungen, Risikofaktorprofilen und der prognostischen Bedeutung der Erfassung der flussmediierten Vasodilatation diskutiert.

Abstract

Endothelial function is thought to play a central role in the process of atherosclerosis, and in the pathogenesis of arterial hypertension and chronic heart failure. In the last decade a non-invasive ultrasound technique has been developed to measure endothelium-dependent vasodilation of the brachial artery which allows quantification of endothelial function. This method is based upon results in basic research, which show increased endothelial NO-production following the impact of shear forces on the endothelial surface. The resulting vasodilation can be quantified with high resolution ultrasound (7 - 13 MHz). The advantage of this technique is its non-invasive nature, which allows a risk-free use even in young individuals. Repeated measurements to control the success of medical intervention are also unproblematic. Despite the possibility of widespread use because of its deceptively simple protocol, there are numerous factors affecting flow-mediated vascular reactivity. Details of the methods applied, variations in examination procedure, image acquisition, subjects preparation, equipment, training requirements and data interpretation are reviewed in this paper. Clinical studies of cardiovascular disease, risk factor profiles and the prognostic impact of measuring flow-mediated vasodilation are also discussed.

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