Recent Findings of Endothelial Function Tests from FMDJ study
Hirofumi Tomiyama MD Professor of Cardiology, Tokyo Medical
University
Slide 2
Why we need to assess endothelial function?
Slide 3
NormaI IMT IMT Hypertrophy We have carotid ultrasound
examination IMT Plaque
Slide 4
Kitta Y et al. 83 83 J Am Coll Cardiol 2009 Coronary Artery
disease 251 Suessenbacher A et al. 85 85 Vasc Med 2006Coronary
Artery disease 68 Modena 8484 J Am Coll Cardiol 2002 Hypertension
400 The improvement of FMD by treatment is related to the
improvement of the prognosis
Slide 5
Endothelial function test has a potential to be a marker for
the managements (not only diagnosis) of cardiovascular disease/its
risk factors
Slide 6
Method Coronary or Peripheral artery Vascular bed Measuremen ts
StimulusInvasive Coronary epicardial vasoreactivity CoronaryConduit
Vessel diameter Infusion of endothelial dependent vasodilator +
Coronary microvascular vasoreactivity CoronaryResistanceBlood flow
Infusion of endothelial dependent vasodilator + FMD Peripheral
(brachial artery) Conduit Vessel diamete r Reactive hyperemia
RH-PAT Peripheral (finger microvas culature) Resistance Plethys
mogram Reactive hyperemia Methods Used to Assess Endothelial
Function
Slide 7
RH-PAT FMD & RH-PAT FMD
Slide 8
2.5.4. Brachial/Peripheral Flow-Mediated Dilation FMD 2.5.4.1.
Recommendation for Brachial/Peripheral Flow-Mediated Dilation Class
III: No Benefit The technique requires a highly skilled
sonographer, highly standardized measurement conditions (including
time of day, temperature, drug administration), and suitable
ultrasound machine. Many examiners also use specialized computer
software to semiautomatically quantitate the brachial artery
diameter. Considerable variability exists for values of FMD
determined by different investigators, even in similar patient
populations, suggesting technical challenges with the measurement.
Circulation. 2010 Dec 21;122(25):e584-636. 2010 ACCF/AHA guideline
for assessment of cardiovascular risk in asymptomatic adults : a
report of the American College of Cardiology Foundation/American
Heart Association Task Force on Practice Guidelines.
Slide 9
Reflects disease state Reversible with interventions Mirrors
coronary endothelial function Improves risk stratification
Reproducible Operator independent Noninvasive (no or low risk for
the patient) Ease of use Inexpensive Criteria for an Optimal
Endothelial Function Test Circulation.Circulation. 2012 Aug
7;126(6):753-67. doi: 10.1161/CIRCULATIONAHA.112.093245. The
assessment of endothelial function: from research into clinical
practice. Flammer AJ Flammer AJ 1, Anderson T, Celermajer DS,
Creager MA, Deanfield J, Ganz P, Hamburg NM, Lscher TF, Shechter M,
Taddei S, Vita JA, Lerman A.Anderson TCelermajer DSCreager
MADeanfield JGanz P Hamburg NMLscher TFShechter MTaddei SVita
JALerman A
Slide 10
Is data of FMD reliable ?
Slide 11
A multicenter study design to assess the clinical usefulness of
semi-automatic measurement of flow-mediated vasodilatation of the
brachial artery. Tomiyama H, Kohro T, Higashi Y, Takase B, Suzuki
T, Ishizu T, Ueda S, Yamazaki T, Furumoto T, Kario K, Inoue T, Koba
S, Watanabe K, Takemoto Y, Hano T, Sata M, Ishibashi Y, Node K,
Maemura K, Ohya Y, Furukawa T, Ito H, Yamashina A. Int Heart J.
2012;53(3):170-5.
Slide 12
Slide 13
Training for FMD measurement in FMDJ study
Slide 14
To examine the reliability of FMD data analyzed in each
institute FMD data analyzed in each institute Number of
participating institutes was 19 Analyzing data was loaded on WEB
site Independent analysis of FMD image at core laboratory Send USB
including the image of FMD without analyzing data Compare the
results of both analyses
Slide 15
Are FMD and RH-PAT interchangeable?
Slide 16
Adjustment FMD PercentHyperemic Flow Velocity r*r* Pr*r* P PAT
ratio Unadjusted 0.094
