Journal
JOURNAL OF APPLIED PHYSIOLOGY
Volume 109, Issue 4, Pages 959-965Publisher
AMER PHYSIOLOGICAL SOC
DOI: 10.1152/japplphysiol.00532.2010
Keywords
endothelium; shear stress; flow-mediated dilation; method
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Funding
- National Heart, Lung, and Blood Institute (NHLBI) [T32 HL-007792-15, HL-094971, HL-080704, K23 HL-085614, K23 HL-089326, HL-081587]
- Advancing a Healthier Wisconsin Grant [5520119-9520094]
- Clinical Translational Research Institute at the Medical College of Wisconsin
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Recommendations for the measurement of brachial flow-mediated dilation (FMD) typically suggest images be obtained at identical times in the cardiac cycle, usually end diastole (QRS complex onset). This recommendation presumes that inter-individual differences in arterial compliance are minimized. However, published evidence is conflicting. Furthermore, ECG gating is not available on many ultrasound systems; it requires an expensive software upgrade or increased image processing time. We tested whether analysis of images acquired with QRS gating or with the more simplified method of image averaging would yield similar results. We analyzed FMD and nitroglycerin-mediated dilation (NMD) in 29 adults with type 2 diabetes mellitus and in 31 older adults and 12 young adults without diabetes, yielding a range of brachial artery distensibility. FMD and NMD were measured using recommended QRS-gated brachial artery diameter measurements and, alternatively, the average brachial diameters over the entire R-R interval. We found strong agreement between both methods for FMD and NMD (intraclass correlation coefficients = 0.88-0.99). Measuring FMD and NMD using average diameter measurements significantly reduced post-image-processing time (658.9 +/- 71.6 vs. 1,024.1 +/- 167.6 s for QRS-gated analysis, P < 0.001). FMD and NMD measurements based on average diameter measurements can be performed without reducing accuracy. This finding may allow for simplification of FMD measurement and aid in the development of FMD as a potentially useful clinical tool.
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