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Colegio de Medicina Interna de México.

2006, Number 6

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Med Int Mex 2006; 22 (6)

Ultrasonographic and clinical assessment of the flow-dependent vasodilatation in patients with cardiovascular risk factors

Jaubert MJ, Sánchez CLF, Morales GVH, Carranza MJ

Language: Spanish
References: 14
Page: 476-483
PDF size: 230.79 Kb.


ABSTRACT

Background: Although vascular endothelium plays an important role in vascular homeostasis, in Mexico there is no data about endothelial function in patients with cardiovascular risk factors.
Objectives: To obtain ultrasound and clinical values of endothelial function in patients with at least one of the following: diabetes mellitus, hypertension, smoking or dyslipidaemia. A second aim was to determine the accuracy of the clinical method respect to ultrasound evaluation.
Patients and method: Fifty one patients with cardiovascular risk factors were included in an open, transversal, comparative trial in which reference ultrasound method and clinical measurement of endothelial function were carried out simultaneously. To evaluate the accuracy of clinical method to detect endothelial dysfunction sensitivity (S), specificity (E), predictive positive value (VPP), predictive negative value (VPN), accuracy (P), positive test probability rate (RPPP) and negative test probability rate (RPPN) were calculated.
Results: Brachial artery diameter measured by ultrasound increases 4.06±0.6 mm and area by 13.5±4.2 mm2 (p‹0.01) after endothelial stimulation. Basal diastolic blood pressure (PAD) was 80.1±12.5 mmHg and measurements made at 2, 5 and 7 minutes after endothelial stimulation were 78.8±11.6, 79.6±11.1 and 79.5±12.1 mmHg, non statistically significant. Clinical method had S 72.4%, E 40.9%, VPP 61.7%, VPN 52.9%, P 58.8%, RPPP 69.2% and RPPN 57.1% to detect endothelial dysfunction.
Conclusions: Endothelial function is decreased in patients with cardiovascular risk factors. Clinical method is able to detect normal and abnormal endothelial function in this kind of subjects.


REFERENCES

  1. Furchgott RF, Vanhoutte PM. Endothelium-derived relaxing and contracting factors. FASEB J 1989;3:2007-18.

  2. Lieberman E, Knab S, Creager M. Nitric oxide mediates the vasodilator responses to flow in humans. Circulation 1994;90(Suppl 1):1-138.

  3. Joannides R, Haefeli W, Linder L, Richard V, et al. Nitric oxide is responsible for flow-dependent dilatation of human peripheral conduit arteries in vivo. Circulation 1995;91:1314-9.

  4. Ludmer PL, Selwyn AP, Shook TL, Wayne RR, et al. Paradoxical vasoconstriction induced by acetylcholine in atherosclerotic coronary arteries. N Engl J Med 1986;315:1046-51.

  5. Simionescu N, Simionescu M. Endothelial cell biology in health and disease. New York: Plenum Press, 1988.

  6. Schachinger V, Britten M, Zeiher AM. Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation 2000;101:1899-906.

  7. Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, al. Noninvasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992;340:1111-15.

  8. Carranza J, Sánchez LF. Propuesta de un método de exploración física para evaluar, desde el punto de vista clínico, la función endotelial en humanos. Med Int Mex 2005;21:171-5.

  9. Correti MC, Anderson TJ, Benjamin EJ, Celermajer DS, et al. Guidelines for the ultrasound assessment of endothelial dependent flow mediated vasodilation of the brachial artery. J Am Coll Cardiol 2002;39:257-65.

  10. Departamento de Epidemiología Clínica y Bioestadística, Universidad McMaster, Hamilton-Ontario, Canadá. Como leer revistas médicas. II. Para aprender sobre una prueba diagnóstica. Rev Inv Clin 1988;40:73-83.

  11. Greenhalgh Trisha. Artículos que describen pruebas diagnósticas o de detección sistemática. En: Las bases de la Medicina Basada en Evidencias. Cómo leer un documento. BMJ Publishing Group 2001;pp:101-15.

  12. Sorensen K, Celermajer DS, Spiegelhalter, Georgakopoulus D, et al. Non invasive measurement of endothelium dependent arterial responses in man: accuracy and reproducibility. Br Heart J 1995;74:247-53.

  13. Anderson TJ, Uehata A, Gerhard MD, Meredith IT, et al. Close relation of endothelial function in the human coronary and peripheral circulation. J Am Coll Cardiol 1995;26:1235-41.

  14. Vilariño JO, Cacharrón JL, Suárez DH, Kura M, et al. Evaluación de la función endotelial por ecoDoppler. Influencia de la edad, sexo y factores de riesgo. Rev Argent Cardiol 1998;66:523-32.




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