Clinical value of Non Invasive assessment of Endothelial function in the Management of Coronary Artery Disease.

Kathiresan, S (2008) Clinical value of Non Invasive assessment of Endothelial function in the Management of Coronary Artery Disease. Masters thesis, Madras Medical College, Chennai.


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Atherosclerosis begins in childhood, progresses silently through a long preclinical stage, and eventually manifests clinically, usually from middle age. Over the last 30 years, it has become clear that the initiation and progression of disease, and its later activation to increase the risk of morbid events, depends on profound dynamic changes in vascular biology. The endothelium has emerged as the key regulator of vascular homeostasis, in that it has not merely a barrier function but also acts as an active signal transducer for circulating influences that modify the vessel wall phenotype. Alteration in endothelial function precedes the development of morphological atherosclerotic changes and can also contribute to lesion development and later clinical complications. The vascular endothelium is a large paracrine organ that secretes numerous factors regulating vascular tone, cell growth, platelet and leukocyte interactions and thrombogenicity.The endothelium senses and responds to a myriad of internal and external stimuli through complex cell membrane receptors and signal transduction mechanisms, leading to the synthesis and release of various vasoactive,thromboregulatory and growth factor substances. Endothelial dysfunction is thought to be an important factor in the development of atherosclerosis, hypertension, and heart failure. A disturbance of endothelial function is considered as a key event in the development of atherosclerosis . Thus reliable assessment of endothelial function in humans appears highly desirable. With respect to the major endothelial functions, this aim can be achieved by different approaches: 1. measurement of morphological and mechanical characteristics of the vascular wall (intima media thickness, compliance, distensibility, and remodelling indexes); 2. determination of soluble endothelial markers (von Willebrandt factor, plasminogen activator, inhibitor complex thrombomodulin adhesion molecules, and N-oxides); and 3. measurement of the endothelium-dependent regulation of vascular tone at focal sites of the circulation. AIM OF THE STUDY: Most patients in whom myocardial infarction or ischemic stroke develops have one or more conventional risk factors for atherosclerosis, but these risk factors are also prevalent in the general population. As a result, the predictive value of current algorithms based on conventional risk factors is unsatisfactory. There is growing evidence that endothelial function serves as a “barometer” for cardiovascular health and assessment of endothelial function will further help in refining risk in an individual patient and therefore guide in intensity of management. With this background, aimed to study 1. To assess the incremental value of non invasive assessment of endothelial function by flow mediated dilatation of brachial artery and aortic pulse wave velocity in risk stratification and management of low and intermediate risk patients 2. To assess the feasibility of inclusion of flow mediated dilatation and aortic pulse wave velocity in routine cardiac clinical practice CONCLUSION: Brachial artery flow mediated dilatation represents global endothelial function and is significantly associated with the presence of angiographically documented atherosclerosis in a cohort of middle aged south indian population with multiple coronary risk factors. Aortic pulse wave velocity is weakly associated with both brachial flow mediated dilatation and angiographic disease. Both brachial flow mediated dilatation and aortic pulse wave velocity correlated weakly with carotid intima media thickness Thus, brachial flow mediated dilatation when done with meticulous attention to details is safe,inexpensive,rapid,reliable and reproducible and integration of same in routine clinical practice will provide incremental and additive information over conventional risk assessment strategy and better patient care. Development of guidelines for quality control, standardization of measurements, and establishment of thresholds for different risk categories will help optimize the use of brachial flow mediated dilatation in clinical practice.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Non Invasive ; Endothelial function, Management ; Coronary Artery Disease.
Subjects: MEDICAL > Cardiology
Depositing User: Kambaraman B
Date Deposited: 04 Jul 2017 03:49
Last Modified: 04 Jul 2017 03:49

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