![]() The possible future role of endothelial function measurement for individualized medicine is also considered.Īssessment directly in the coronary vascular bed It is the aim of this review to give a short overview of the most commonly used methods to measure endothelial function in humans, non-invasive techniques in particular ( Table 1) to summarize the clinical implications of endothelial dysfunction in the population as well as in individual patients. 8 Although the ability of measuring endothelial function has boosted clinical research in this field, its use as a clinical tool in daily practice is not established, nor has any method been recommended in clinical guidelines for planning primary or secondary prevention of vascular disease. Over the past 25 years many methodological approaches have been developed to measure the (patho-)physiological function of the endothelium in humans. 6 Importantly, the process of atherosclerosis begins early in life, and endothelial dysfunction contributes to atherogenesis and precedes the development of morphological vascular changes. Endothelial dysfunction has been detected in the coronary epicardial and resistance vasculature as well as in peripheral arteries, so that endothelial dysfunction can be regarded as a systemic condition. Interestingly most, if not all, cardiovascular risk factors are associated with endothelial dysfunction, 5 and risk factor modification leads to improvement in vascular function. Thus, the assessment of its vasodilator properties due to NO and other molecules may provide information on the integrity and function of the endothelium. ![]() Generally, loss of NO bioavailability indicates a broadly dysfunctional phenotype across many properties of the endothelium. Particularly in the microcirculation, prostacyclin and endothelial-derived hyperpolarization factors (EDHF an umbrella term for substances and signals hyperpolarizing vascular myocytes by opening voltage channels 4) also play an important role. 3 Among the most important vasodilator molecule, in muscular arteries in particular, is NO, which also inhibits other key events in the development of atherosclerosis such as platelet adhesion and aggregation, leukocyte adhesion and migration as well as smooth muscle cell proliferation. 1 Endothelial dysfunction is a pathological condition, mainly characterized by an imbalance between substances with vasodilating, anti-mitogenic and anti-thrombogenic properties (endothelium-derived relaxing factors) 2 and substances with vasoconstricting, pro-thrombotic and proliferative characteristics (endothelium-derived contracting factors). The discovery of nitric oxide (NO) as a crucial endothelium-derived molecule for vascular relaxation and the recognition of the endothelium as more than a passive interface between blood and the vessel wall, led to substantial progress in the field of vascular research. We conclude, that non-invasive endothelial function measurements provide valuable additional information, however, to ascertain its use for daily clinical practice, future research should determine whether endothelial function can be used to guide treatment in the individual and if this translates into better outcomes. ![]() Specifically, we provide information why endothelial function is not only a risk marker for cardiovascular risk but may also provides prognostic information beyond commonly used risk scores in primary prevention, and in patients with already established coronary disease. Furthermore we give an overview about clinical settings were endothelial function measurements may be valuable in individual patients. ![]() ![]() We review the most common methods to assess vascular function in humans and discuss their advantages and disadvantages. Despite the possibility to measure endothelial function in the individual and its widespread use in research, its use as a clinical tool in daily medicine is not established yet. The discovery of the endothelium as a crucial organ for the regulation of the vasculature to physiological needs and the recognition of endothelial dysfunction as a key pathological condition - which is associated with most if not all cardiovascular risk factors - led to a tremendous boost of endothelial research in the past 3 decades. ![]()
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