Associations of Macro- and Microvascular Endothelial Dysfunction With Subclinical Ventricular Dysfunction in End-Stage Renal Disease

Abstract

Patients with end-stage renal disease (ESRD) suffer high rates of heart failure and cardiovascular mortality, and we lack a thorough understanding of what, if any, modifiable factors contribute to cardiac dysfunction in these high-risk patients. In order to evaluate endothelial function as a potentially modifiable cause of cardiac dysfunction in ESRD, we investigated cross-sectional associations of macro- and microvascular dysfunction with left and right ventricular dysfunction in a well-controlled ESRD cohort. We performed comprehensive echocardiography, including tissue Doppler imaging and speckle tracking echocardiography of the left and right ventricle, in 149 ESRD patients enrolled in an ongoing prospective, observational study. Of these participants, 123 also underwent endothelium-dependent flow-mediated dilation (FMD) of the brachial artery (macrovascular function). Microvascular function was measured as the velocity time integral (VTI) of hyperemic blood flow following cuff deflation. Impaired FMD was associated with higher LV mass, independently of age and blood pressure: per two-fold lower FMD, LV mass was 4.1% higher (95%CI [0.49, 7.7], p=0.03). After adjustment for demographics, blood pressure, comorbidities and medications, a two-fold lower VTI was associated with 9.5% higher E/e’ ratio (95% CI [1.0, 16], p=0.03) and 6.7% lower absolute RV longitudinal strain (95% CI [2.0, 12], p=0.003). Endothelial dysfunction is a major correlate of cardiac dysfunction in ESRD, particularly diastolic and right ventricular dysfunction, in patients whose volume status is well-controlled. Future investigations are needed to determine whether therapies targeting the vascular endothelium could improve cardiac outcomes in ESRD.

Effects of coenzyme Q10 on endothelial and cardiac function in patients undergoing haemodialysis: study protocol for a pilot randomised controlled trial

“…The endothelial function will be assessed by brachial artery FMD with ultrasound equipment on the arm free of vascular access. 21–23 FMD will be assessed by an observer who is blinded to treatment allocation and will be tested at baseline and every 6 months. All vasodilation medication will have to be interrupted for at least 4 hours before the examination, if possible.…”

Microvascular Endothelial Function and Neurocognition Among Adults With Major Depressive Disorder

“…Microvascular function was determined using hyperemic velocity change during FMD, which has recently been validated as a peripheral marker of systemic microvascular functioning. (25, 37) Pulsed Doppler flow signals in the brachial artery were recorded at baseline and for up to 15 seconds after cuff release. The velocity-time integral for baseline and reactive hyperemia was based upon the mean of triplicate pulsed-Doppler flow tracings recorded at each of these phases.…”

Sex differences in vascular dysfunction and cardiovascular outcomes: The cardiac, endothelial function, and arterial stiffness in ESRD (CERES) study

“…PWV was calculated by the SphygmoCor Xcel system using the intersecting tangent algorithm . Detailed methods for endothelial function measurement have been previously published …”