| What is the most appropriate methodology for detection of conduit artery endothelial dysfunction? | |
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MedLine Citation:
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PMID: 17303783 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Use of upper-arm arterial occlusion to induce reactive hyperemia, and endothelium-dependent flow-mediated dilation (FMD) of the brachial artery, induces greater conduit vessel dilatation than lower-arm occlusion. However, brachial artery ischemia after upper arm arterial occlusion may make this approach unreliable. We studied whether upper or lower arm occlusions differ in their ability to detect endothelial dysfunction in cigarette smokers, and its improvement with an antioxidant strategy. METHODS AND RESULTS: Ten cigarette smokers with a >20 pack year history and 10 age- and gender-matched healthy controls participated in a 2-phase randomized controlled study of xanthine oxidase inhibition, using a 600-mg oral dose of allopurinol administered beforehand. Endothelium-dependent dilatation was assessed using ultrasound-Doppler after lower and upper arm occlusion. After lower arm occlusion, FMD was significantly impaired in smokers compared with controls (3.8+/-1.1% versus 8.7+/-2.2%; P=0.001). However, after upper arm occlusion, brachial artery dilatation in smokers was higher (11.8+/-2.7%; P<0.0001 versus lower arm) and did not differ from controls (9.4+/-2.9%; P=0.3). There was no difference in endothelium-independent dilatation to sublingual nitroglycerin between smokers and controls. Inhibition of xanthine oxidase with allopurinol improved lower arm FMD (3.8+/-1.1 to 10.1+/-1.9%; P<0.0001), but did not improve upper arm FMD (11.8+/-2.7 to 14.1+/-3.7%; P=0.4). CONCLUSIONS: Although upper arm occlusion induces robust brachial vasodilatation, it cannot detect endothelial dysfunction induced by smoking or its improvement by inhibition of xanthine oxidase. The increase in brachial artery diameter with upper arm occlusion may be confounded by ischemia of the artery. Conduit artery FMD after release of lower arm occlusion appears to be a more valid method for assessment of endothelial function in humans. |
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Authors:
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Sasidhar Guthikonda; Christine A Sinkey; William G Haynes |
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Publication Detail:
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Type: Clinical Trial, Phase II; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural Date: 2007-02-15 |
Journal Detail:
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Title: Arteriosclerosis, thrombosis, and vascular biology Volume: 27 ISSN: 1524-4636 ISO Abbreviation: Arterioscler. Thromb. Vasc. Biol. Publication Date: 2007 May |
Date Detail:
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Created Date: 2007-04-19 Completed Date: 2007-05-08 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9505803 Medline TA: Arterioscler Thromb Vasc Biol Country: United States |
Other Details:
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Languages: eng Pagination: 1172-6 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Baylor College of Medicine, Houston, Tex, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Administration, Oral Adolescent Adult Aged Aged, 80 and over Allopurinol / administration & dosage*, therapeutic use Brachial Artery / physiopathology*, ultrasonography Cross-Over Studies Endothelium, Vascular / physiopathology*, ultrasonography Enzyme Inhibitors / administration & dosage*, therapeutic use Follow-Up Studies Humans Middle Aged Nitroglycerin / diagnostic use Prognosis Prospective Studies Reference Values Single-Blind Method Smoking / adverse effects Ultrasonography, Doppler / methods* Vascular Diseases / diagnosis, physiopathology, prevention & control* Vasodilation / drug effects, physiology* Vasodilator Agents / diagnostic use Xanthine Oxidase / antagonists & inhibitors |
| Grant Support | |
ID/Acronym/Agency:
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HL58972/HL/NHLBI NIH HHS; RR00059/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Enzyme Inhibitors; 0/Vasodilator Agents; 315-30-0/Allopurinol; 55-63-0/Nitroglycerin; EC 1.17.3.2/Xanthine Oxidase |
| Comments/Corrections | |
Comment In:
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Arterioscler Thromb Vasc Biol. 2007 Aug;27(8):e140; author reply e141
[PMID:
17634516
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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