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Imaging Endothelial Function Andre Dejam. Endothelial Function.

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Presentation on theme: "Imaging Endothelial Function Andre Dejam. Endothelial Function."— Presentation transcript:

1 Imaging Endothelial Function Andre Dejam

2 Endothelial Function

3 Endothelial Dysfunction endothelial dysfunction Birth genetic and intrauterine factors Age (years) Early DiagnosisDiagnosis Therapy atherothrombosis Environmental factors and risk factors

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

6 FMD - set up -

7 - 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 -

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

9 NO F low- M ediated- D ilation reactive hyperemia Ischämie MakroMikro Brachial artery FMD

10 What is the Diameter of the Brachial Artery - FMD -

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13 7.5 MHz 15 MHz same individual, same location Comparison of Ultrasound Transducers Mhz vs 15 Mhz -

14 good bad Image Quality - An Important Contributor to Variability -

15 Imaging - Unclear Vessel Boundaries -

16 Nitric Oxide Dependence of FMD

17 FMD Decreases with Atherosclerotic Risk

18 Predictive value of FMD - Older Population -

19 Predictive value of FMD - Younger Population with no apparent CAD -

20 Clinical Measurement of Endothelial Dysfunction Conduitarteries mm Resistance vessels µm Capillaries 1-8 µm Duplexsonography VOPShaevitz- Transformator Veins mm

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22 Magnetic Resonance Angiography

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24 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

25 Measurement of Coronary Blood Flow PET-scanning UltrasoundMRI Coronary angiography

26 Measurement of Coronary Blood Flow

27 Transthoracic Echocardiography

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31 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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33 eNOS NO 1 NOHb MetHb + NO 3 - SNO-Hb 2 3 NO + RSH RSNO + O 2 - OONO - NO OH + ½O 2 + H 2 O 2 NO 2 - HONO NO 3 - OONO - Transport and Storage of NO Bioactivity in Blood


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