Chironi Gilles, Craiem Damian, Miranda-Lacet Janiffer, Levenson Jaime, Simon Alain
AP-HP, European Georges Pompidou Hospital, Center of Cardiovascular Preventive Medicine, René Descartes University, Paris, France.
J Hypertens. 2008 Mar;26(3):508-15. doi: 10.1097/HJH.0b013e3282f3adc4.
Our aim was to analyze flow-mediated dilation (FMD) time-course in response to forearm occlusion in the clinical setting.
In 50 asymptomatic subjects, monitoring software measuring continuous beat-to-beat change in brachial artery diameter was used to determine FMD magnitude in percentage change in peak diameter from baseline (FMD-DeltaD), time to peak diameter after occlusion release (FMD-t(peak)), integrated FMD response calculated as area under dilation curve (FMD-AUC), maximum FMD rate calculated as maximal slope of dilation (FMD-MDR). FMD-DeltaD and FMD-MDR correlated positively with peak wall shear stress (P < 0.05, P < 0.01). FMD-MDR correlated negatively with age (P < 0.001), Framingham risk score (P < 0.01) and carotid intima-media thickness (P < 0.05), while FMD-DeltaD correlated negatively with Framingham risk score only (P < 0.01). After adjustment, all these correlations were independent of antihypertensive, lipid-lowering and antidiabetic therapies. All but that of FMD-MDR with intima-media thickness were also found in a subgroup of 29 untreated subjects and in a subgroup of 24 untreated and low-risk (FRS < 10%) subjects. FMD-t(peak) and FMD-AUC were not associated with shear stimulus, Framingham risk score, and intima-media thickness.
The kinetics of dilation (maximum rate) seem more sensitive than their magnitude in assessing FMD performance and its determinants.
我们的目的是在临床环境中分析血流介导的血管舒张（FMD）对前臂闭塞的时间进程。
在50名无症状受试者中，使用监测软件测量肱动脉直径的逐搏连续变化，以确定FMD幅度，即从基线起峰值直径的百分比变化（FMD-ΔD）、闭塞解除后达到峰值直径的时间（FMD-t(peak)）、通过舒张曲线下面积计算的综合FMD反应（FMD-AUC）、通过舒张最大斜率计算的最大FMD速率（FMD-MDR）。FMD-ΔD和FMD-MDR与峰值壁面切应力呈正相关（P<0.05，P<0.01）。FMD-MDR与年龄（P<0.001）、弗雷明汉风险评分（P<0.01）和颈动脉内膜中层厚度（P<0.05）呈负相关，而FMD-ΔD仅与弗雷明汉风险评分呈负相关（P<0.01）。调整后，所有这些相关性均独立于抗高血压、降脂和抗糖尿病治疗。在29名未治疗受试者的亚组以及24名未治疗且低风险（FRS<10%）受试者的亚组中也发现了除FMD-MDR与内膜中层厚度之外的所有这些相关性。FMD-t(peak)和FMD-AUC与切应力刺激、弗雷明汉风险评分和内膜中层厚度无关。
在评估FMD表现及其决定因素时，舒张动力学（最大速率）似乎比其幅度更敏感。
