imaging endothelial function andre dejam. endothelial function
TRANSCRIPT
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Imaging Endothelial Function
Imaging Endothelial Function
Andre DejamAndre Dejam
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Endothelial Function
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Endothelial Dysfunction
10 20 30 40 50 60 70
endothelial dysfunction
Birth
geneticandintrauterinefactors
Age(years)
Early Diagnosis Diagnosis Therapy
atherothrombosis
Environmental factors and risk factors
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Imaging The Natural History of Atherosclerosis
IMT(structural)
FMD or Acetylcholine-mediated Dilation(functional)
stiffness(functional/structural)
Atherothrombosis
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FMD- set up -
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- longitudinal segment of the
brachial artery
- ~ 5 cm proximal of the
antecubital fossa
- anatomical landmarks
(Faszia, veins, arterial branches)
Brachial artery
Imaging the Brachial artery - location -
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Time
Res
ting
Cuf
f def
latio
n
Mea
sure
men
t
GT
N
5 min after 60 s 10 min after 4 min
Cuf
f inf
latio
n
Mea
sure
men
t G
TN
Dila
tatio
n (
% )
0 -
Ischemia
Flow mediated dilation- Protocol -
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NO
F low-M ediated-D ilation
reactive hyperemia
Ischämie
Makro Mikro
Brachial artery
FMD
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What is the Diameter of the Brachial Artery - FMD -
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7.5 MHz 15 MHz
same individual, same location
Comparison of Ultrasound Transducers - 7.5 Mhz vs 15 Mhz -
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good bad
Image Quality- An Important Contributor to Variability -
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Imaging- Unclear Vessel Boundaries -
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Nitric Oxide Dependence of FMD
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FMD Decreases with Atherosclerotic Risk
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Predictive value of FMD- Older Population -
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Predictive value of FMD- Younger Population with no apparent CAD -
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Clinical Measurement of Endothelial Dysfunction
Conduitarteries4 - 5 mm
Resistance vessels100-300 µm
Capillaries1-8 µm
Duplexsonography VOP Shaevitz-Transformator
Veins2 - 4 mm
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Magnetic Resonance Angiography
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Magnetic Resonance Angiography
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Brachial Artery a Surrogate for Coronary arteries?
- Differences in microvascular architecture
- Pattern of blood flow and vascular resistance
- Metabolic regulation
- Receptor distribution of humeral regulation
- Stimuli for hyperemia
- Sympathetic innervation
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Measurement of Coronary Blood Flow
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PET-scanning
UltrasoundMRI
Coronary angiography
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Measurement of Coronary Blood Flow
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Transthoracic Echocardiography
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Transthoracic Echocardiography
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Transthoracic Echocardiography
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Transthoracic Echocardiography
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Summary
- Endothelium plays a pivotal role in vascular homeostasis
- Endothelial function can be measured invasively or non- invasively
- Possible marker of early atherothrombosis
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eNOSNO
1
NO
NOHb
MetHb + NO3-
SNO-Hb
2
3
NO
+ RSH
RSNO
+ O2-
OONO- NO2-+ OH
+ ½O2
+ H2O2
NO2-
HONO
NO3-OONO-
Transport and Storage of NO Bioactivity in Blood