New Methodological Approach to Improve Reproducibility of Brachial Artery Flow‐Mediated Dilatation

Kanahara, Masaaki; Harada, Haruhito; Katoh, Atsushi; Ikeda, Hisao

doi:10.1111/echo.12307

Cited by 11 publications

(13 citation statements)

References 15 publications

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“… 26 , 33 , 34 It is important to note; however, that some studies have described low consistency in the stability of brachial artery FMD, 35 , 36 whereas others have reported high reproducibility. 20 , 30 , 37 – 39 Nonetheless, this is the first study to investigate reproducibility of the FMD test in patients with COPD.…”

Section: Discussionmentioning

confidence: 98%

Assessments of endothelial function and arterial stiffness are reproducible in patients with COPD

Rodriguez‐Miguelez

Seigler

Bass

et al. 2015

COPD

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BackgroundElevated cardiovascular disease risk is observed in patients with COPD. Non-invasive assessments of endothelial dysfunction and arterial stiffness have recently emerged to provide mechanistic insight into cardiovascular disease risk in COPD; however, the reproducibility of endothelial function and arterial stiffness has yet to be investigated in this patient population.ObjectivesThis study sought to examine the within-day and between-day reproducibility of endothelial function and arterial stiffness in patients with COPD.MethodsBaseline diameter, peak diameter, flow-mediated dilation, augmentation index, augmentation index at 75 beats per minute, and pulse wave velocity were assessed three times in 17 patients with COPD (six males, eleven females, age range 47–75 years old; forced expiratory volume in 1 second =51.5% predicted). Session A and B were separated by 3 hours (within-day), whereas session C was conducted at least 7 days following session B (between-day). Reproducibility was assessed by: 1) paired t-tests, 2) coefficients of variation, 3) coefficients of variation prime, 4) intra-class correlation coefficient, 5) Pearson’s correlations (r), and 6) Bland–Altman plots. Five acceptable assessments were required to confirm reproducibility.ResultsSix out of six within-day criteria were met for endothelial function and arterial stiffness outcomes. Six out of six between-day criteria were met for baseline and peak diameter, augmentation index and pulse wave velocity, whereas five out of six criteria were met for flow-mediated dilation.ConclusionThe present study provides evidence for within-day and between-day reproducibility of endothelial function and arterial stiffness in patients with COPD.

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Section: Discussionmentioning

confidence: 98%

Assessments of endothelial function and arterial stiffness are reproducible in patients with COPD

Rodriguez‐Miguelez

Seigler

Bass

et al. 2015

COPD

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“…Recent publications have underscored the importance of considering baseline subject characteristics, particularly baseline diameter, when interpreting flow-mediated dilation results (Atkinson & Batterham, 2013a,b;Kanahara et al 2014). Thus, we used two statistical methods to determine the contribution of baseline subject characteristics to the FMD measurement.…”

Section: Comparison Of Baseline Shear (A) and Hyperaemic Shear Methmentioning

confidence: 99%

Association beween resting heart rate, shear and flow‐mediated dilation in healthy adults

Fox

Brantley

White

et al. 2014

Experimental Physiology

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New Findings r What is the central question of this study?The aim was to explore the relationships among resting heart rate, shear and endothelial function in humans. r What is the main finding and its importance?The main finding is that resting heart rate is associated with shear and endothelial function in humans. This finding could have implications when studying endothelial function in humans with varying heart rates.Preclinical data have demonstrated that heart rate (HR) can directly impact vascular endothelial function, in part, through a shear-stress mechanism. This study sought to explore, in humans, the associations between resting heart rate and both shear and endothelial function assessed by flow-mediated dilation (FMD). The brachial artery FMD test was performed in 31 apparently healthy volunteers. Basal (B) and hyperaemic (H) shear were quantified in the following two ways using data from the FMD test: the traditional cumulative shear area under the curve up to peak dilation (Shear cum ) method; and our novel method of shear summation (Shear sum ), which accounts for HR by summing each individual cardiac cycle shear up to peak dilation. Data were grouped by tertiles based on resting HR as follows: low (LHR = 43-56 beats min −1 ; n = 10); middle (MHR = 58-68 beats min −1 ; n = 11); and high (HHR = 69-77 beats min −1 ; n = 10). Within the LHR group, both B-Shear cum and H-Shear cum were significantly higher (P < 0.001) than B-Shear sum and H-Shear sum , respectively, whereas in the HHR group B-Shear cum and H-Shear cum were significantly lower (P < 0.001) than B-Shear sum and H-Shear sum , respectively. The FMD in the LHR group (8.8 ± 0.8%) was significantly greater than that in both the MHR group (5.5 ± 0.8%; P = 0.009) and the HHR group (5.9 ± 0.8%; P = 0.024). These findings demonstrate the existence of a relationship between heart rate and both shear and endothelial function in humans. Moreover, these findings have implications for considering heart rate as an important physiological variable when quantifying shear and performing the FMD test.

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“…9,10 Despite continued success, the technique is also known for user dependence and poor reproducibility. 11,12 The coefficient of variation (CV) for %FMD in healthy volunteers can range from 1.8 to 24.9%. 9,13,14 The sensitivity of the technique is also low.…”

Section: Introductionmentioning

confidence: 99%

“…FMD for evaluating individual patients remains challenging, and it is not recommended for routine clinical examination. 12,17,18 The primary reason for choosing longitudinal imaging to measure FMD is that it exhibits good boundary definition for the vessel wall. This allows convenient measurement of artery diameter with echo tracking.…”

Section: Introductionmentioning

confidence: 99%

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Brachial flow-mediated dilation by continuous monitoring of arterial cross-section with ultrasound imaging

et al. 2019

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Objective Impairment of flow-mediated dilation of the brachial artery is a marker of endothelial dysfunction and often predisposes atherosclerosis and cardiovascular events. In this study, we propose a user-guided automated approach for monitoring arterial cross-section during hyperemic response to improve reproducibility and sensitivity of flow-mediated dilation. Material and methods Ultrasound imaging of the brachial artery was performed in 11 volunteers in cross-sectional and in 5 volunteers in longitudinal view. During each examination, images were recorded continuously before and after inducing ischemia. Time-dilation curves of the brachial lumen cross-section were measured by user-guided automated segmentation of brachial images with the feed-forward active contour (FFAC) algorithm. %FMD was determined by the ratio of peak dilation to the baseline value. Each measurement was repeated twice in two sessions 1 h apart on the same arm to evaluate the reproducibility of the measurements. The intra-subject variation in flow-mediated dilation between two sessions (subject-specific) and inter-group variation in flow-mediated dilation with all the subjects within a session grouped together (group-specific) were measured for FFAC. The FFAC measurements were compared with the conventional diameter measurements made using echo tracking in longitudinal views. Results Flow-mediated dilation values for cross-sectional area were greater than those measured by diameter dilation: 33.1% for cross-sectional area compared to 22.5% for diameter. Group-specific flow-mediated dilation measurements for cross-sectional area were highly reproducible: 33.2% vs. 33.0% ( p > 0.05) with coefficient of variation CV of 0.4%. The group-specific flow-mediated dilations measured by echo tracking for the two sessions were 21.1 vs. 23.9% with CV of 9%. Subject-specific CV for cross-sectional area by FFAC was 10% ± 2% versus 24% ± 10% for the conventional approach. Using correlation as a metric of evaluation also showed better performance for cross-sectional imaging: correlation coefficient, R, between two sessions for cross-sectional area was 0.92 versus 0.72 for the conventional approach based on diameter measurements. Conclusion Peak dilation area measured by continuous automated monitoring of cross-sectional area of the brachial artery provides more reproducible and higher-sensitivity measurement of flow-mediated dilation compared to the conventional approach of using vascular diameter measured using longitudinal imaging.

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New Methodological Approach to Improve Reproducibility of Brachial Artery Flow‐Mediated Dilatation

Abstract: These results suggest that medial epicondyle methodological approach to measure FMD is superior to traditional method.

Cited by 11 publications

References 15 publications

Assessments of endothelial function and arterial stiffness are reproducible in patients with COPD

Assessments of endothelial function and arterial stiffness are reproducible in patients with COPD

Association beween resting heart rate, shear and flow‐mediated dilation in healthy adults

Brachial flow-mediated dilation by continuous monitoring of arterial cross-section with ultrasound imaging

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