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Imaging Endothelial Function

Imaging Endothelial Function. Andre Dejam. Endothelial Function. Endothelial Dysfunction. endothelial dysfunction. atherothrombosis. Age (years). 20. 30. 40. 50. 60. 70. 10. Birth. genetic and intrauterine factors. Environmental factors and risk factors. Therapy.

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Imaging Endothelial Function

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  1. Imaging Endothelial Function Andre Dejam

  2. Endothelial Function

  3. Endothelial Dysfunction endothelial dysfunction atherothrombosis Age (years) 20 30 40 50 60 70 10 Birth genetic and intrauterine factors Environmental factors and risk factors Therapy Early Diagnosis Diagnosis

  4. Imaging The Natural History of Atherosclerosis Atherothrombosis IMT (structural) stiffness (functional/structural) FMD or Acetylcholine-mediated Dilation (functional)

  5. FMD - set up -

  6. Imaging the Brachial artery - location - • longitudinal segment of the • brachial artery • ~ 5 cm proximal of the • antecubital fossa • - anatomical landmarks • (Faszia, veins, arterial branches) Brachial artery

  7. Flow mediated dilation - Protocol - GTN Cuff deflation Measurement Cuff inflation Resting Dilatation ( % ) Measurement GTN Ischemia 0 - 5 min after 60 s 10 min after 4 min Time

  8. FMD Ischämie reactive hyperemia NO F low- M ediated- D ilation Brachial artery Makro Mikro

  9. What is the Diameter of the Brachial Artery - FMD -

  10. Comparison of Ultrasound Transducers - 7.5 Mhz vs 15 Mhz - 7.5 MHz 15 MHz same individual, same location

  11. Image Quality - An Important Contributor to Variability - good bad

  12. Imaging - Unclear Vessel Boundaries -

  13. Nitric Oxide Dependence of FMD

  14. FMD Decreases with Atherosclerotic Risk

  15. Predictive value of FMD - Older Population -

  16. Predictive value of FMD - Younger Population with no apparent CAD -

  17. Clinical Measurement of Endothelial Dysfunction Capillaries 1-8 µm Veins 2 - 4 mm Conduitarteries 4 - 5 mm Resistance vessels 100-300 µm VOP Shaevitz-Transformator Duplexsonography

  18. Magnetic Resonance Angiography

  19. Magnetic Resonance Angiography

  20. 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

  21. Measurement of Coronary Blood Flow Coronary angiography PET-scanning MRI Ultrasound

  22. Measurement of Coronary Blood Flow

  23. Transthoracic Echocardiography

  24. Transthoracic Echocardiography

  25. Transthoracic Echocardiography

  26. Transthoracic Echocardiography

  27. Summary • Endothelium plays a pivotal role in vascular homeostasis • Endothelial function can be measured invasively or non- • invasively • Possible marker of early atherothrombosis

  28. Transport and Storage of NO Bioactivity in Blood 3 1 NOHb 2 NO MetHb + NO3- SNO-Hb RSNO NO2- HONO + ½O2 + RSH OONO- NO2- NO3- OONO- + OH + H2O2 + O2- NO eNOS NO

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