NONINVESIVE ASSESSMENT OF VASCULAR ENDOTHELIAL. FUNCTION BY MEANS OF THE CHANGE IN PULSE CONDUCTION VEROCITY WITH FLOW MEDIATED DILATION

我们开发了一种新的无创性评估血管内皮功能的方法，即通过血流介导的扩张(FMD)时脉搏波传导速度的变化来评估血管内皮功能。尽管FMD作为血管内皮细胞功能的无创性指标越来越受到人们的重视，但传统的血管超声评价方法存在严重的局限性，如伴随血管内径超声测量的伪影和血管内径的生理性自发波动，这使得FMD的分布不能在一般的临床实践中应用。FMD伴随着脉搏波传导速度的减慢，表现为血管管径增大、血管壁厚度和弹性降低。因此，我们尝试用FMD检测脉搏波传导速度的变化，这种变化是由手臂套臂缺血5min引起的反应性充血引起的。与脉冲…相比，脉搏波传导速度有微小变化臂外侧有较高的Se波传导速度。该方法还可以排除全身血压、心率和自主神经活动的变化对脉搏波传导速度的影响。我们制作了该仪器的样机，并测量了120名健康人、高血压和冠心病患者与FMD相关的脉搏波传导速度的变化。脉搏波传导速度在臂套松开后出现一过性下降，峰值出现在松开后约1min。这种反应类似于那些被称为FMD的反应。反应的大小随着年龄的增长而降低，高血压患者和冠心病患者的反应程度也有所降低。此外，舌下含服硝酸甘油后，这种反应消失。这些观察结果表明，我们的方法可能是评估血管内皮功能的有用方法。然而，我们的方法的临床应用需要改进脉搏波传感器和测量脉搏波传导时间的软件。较少

We developed a novel method for noninvasive assessment of vascular endothelial function by means of the changes in pulse wave conduction velocity with flow mediated dilation (FMD). Although FMD is gathering attention as a noninvasive index of vascular endothelial function, conventional assessment using vascular ultrasound imaging has serious limitations, such as artifact accompanying the ultrasound measurement of vascular diameter and physiological spontaneous fluctuations in vascular diameter, which preclude the distribution of FMD in general clinical practice. FMD is accompanied by reduction in pulse wave conduction velocity through an increase in vascular diameter and a decrease in the thickness and elasticity of the vascular wall We therefore tried to detect the changes in pulse wave conduction velocity with FMD induced by reactive hyperemia caused by 5-min ischemia with an arm-cuff on an arm. Small changes in pulse wave conduction velocity were detected with contrasting to the pul … More se wave conduction velocity in the lateral arm. The influences of the changes in systemic blood pressure, heart rate and autonomic neural activity on pulse wave conduction velocity could be also excluded by this method. We made a prototype of the instrument and measured the FMD-related changes in pulse wave conduction velocity in 120 subjects including healthy people and patients with hypertension and coronary artery diseases. The pulse wave conduction velocity showed a transient decrease after release of the arm cuff with the peak response occurring about 1 min after the release. The response resembled to those known as FMD. The magnitude of the response was decreasing with age and reduced in patients with hypertension and those with coronary artery disease. Furthermore, the response disappeared after sublingual nitroglycerin. These observations indicate that our method is potentially useful assessment of vascular endothelial function. The clinical application of our method, however, requires refinement of the pulse wave sensor and software for measurement of pulse wave conduction time. Less