Editing Endothelial dysfunction (section)

=== Testing and diagnosis ===

In the [[coronary circulation]], [[angiography]] of [[coronary artery]] responses to vasoactive agents may be used to test for endothelial function, and venous occlusion [[plethysmography]] and [[ultrasonography]] are used to assess endothelial function of peripheral vessels in humans.<ref name=jh/>

A [[Minimally invasive procedures|non-invasive]] method to measure endothelial dysfunction is % [[Flow-mediated dilation|Flow-Mediated Dilation]] (FMD) as measured by Brachial Artery Ultrasound Imaging (BAUI).<ref>{{cite journal|last=Peretz|first=Alon|author2=Daniel F Leotta |author3=Jeffrey H Sullivan |author4=Carol A Trenga |author5=Fiona N Sands |author6=Mary R Aulet |title=Flow mediated dilation of the brachial artery: an investigation of methods requiring further standardization|journal=BMC Cardiovascular Disorders|year=2007|volume=7|issue=11|pages=11|doi=10.1186/1471-2261-7-11|pmid=17376239|pmc=1847451 |doi-access=free }}</ref> Current measurements of endothelial function via FMD vary due to technical and physiological factors. Furthermore, a [[Negative relationship|negative correlation]] between percent flow mediated dilation and baseline artery size is recognised as a fundamental scaling problem, leading to biased estimates of endothelial function.<ref>{{cite journal |vauthors=Thijssen DH, Black MA, Pyke KE, Padilla J, Atkinson G, Harris RA, Parker B, Widlansky ME, Tschakovsky ME, Green DJ | date = Jan 2011 | title = Assessment of flow-mediated dilation in humans: a methodological and physiological guideline | journal = Am J Physiol Heart Circ Physiol | volume = 300 | issue = 1| pages = H2–12 | doi=10.1152/ajpheart.00471.2010| pmid = 20952670 | pmc = 3023245 }}</ref>

[[von Willebrand factor]] is a marker of endothelial dysfunction, and is consistently elevated in [[atrial fibrillation]].<ref name="pmid31631989">{{cite journal | vauthors =  Khan AA, Thomas GN, Lip G, Shantsila A | title=Endothelial function in patients with atrial fibrillation | journal= [[Annals of Medicine]] | volume=52 | issue=1–2 | pages=1–11 | year=2020 | doi= 10.1080/07853890.2019.1711158 | pmc=7877921 | pmid=31903788 }}</ref> 

A non-invasive, [[Food and Drug Administration|FDA]]-approved device for measuring endothelial function that works by measuring [[Hyperaemia#Reactive hyperaemia|Reactive Hyperemia]] Index (RHI) is [[Itamar Medical]]'s EndoPAT.<ref>{{cite journal |vauthors=Kuvin JT, Mammen A, Mooney P, Alsheikh-Ali AA, Karas RH | date = Feb 2007 | title = Assessment of peripheral vascular endothelial function in the ambulatory setting | journal = Vasc. Med. | volume = 12 | issue = 1| pages = 13–6 | doi=10.1177/1358863x06076227| pmid = 17451088 | doi-access = free }}</ref><ref name="pmid20972417">{{cite journal | vauthors = Axtell AL, Gomari FA, Cooke JP | title = Assessing endothelial vasodilator function with the Endo-PAT 2000 | journal = Journal of Visualized Experiments | issue = 44 | date = October 2010 | pmid = 20972417 | pmc = 3143035 | doi = 10.3791/2167 }}</ref> It has shown an 80% sensitivity and 86% specificity to diagnose [[coronary artery disease]] when compared against the gold standard, acetylcholine angiogram.<ref>{{cite journal |vauthors=Bonetti PO, Pumper GM, Higano ST, ((Holmes DR Jr)), Kuvin JT, Lerman A | date = Dec 2004 | title = Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia | journal = J Am Coll Cardiol | volume = 44 | issue = 11| pages = 2137–41 | doi=10.1016/j.jacc.2004.08.062| pmid = 15582310 | doi-access = free }}</ref> This results suggests that this peripheral test reflects the physiology of the [[Coronary circulation|coronary]] endothelium.

Since NO maintains low tone and high compliance of the small arteries at rest,<ref>{{cite journal |vauthors=Gilani M, Kaiser DR, Bratteli CW, Alinder C, Rajala Bank AJ, Cohn JN | year = 2007 | title = Role of nitric oxide deficiency and its detection as a risk factor in pre-hypertension | journal = JASH | volume = 1 | issue = 1| pages = 45–56 | doi=10.1016/j.jash.2006.11.002| pmid = 20409832 }}</ref> a reduction of age-dependent small artery compliance is a marker for endothelial dysfunction that is associated with both functional and structural changes in the microcirculation.<ref>{{cite journal |vauthors=Duprez DA, Jacobs DR, Lutsey PL, Bluemke FA, Brumback LC, Polak JF, Peralta CA, Greenland P, Kronmal RA | year = 2011 | title = Association of small artery elasticity with incident cardiovascular disease in older adults: the multiethnic study of atherosclerosis | journal = Am J Epidemiol | volume = 174 | issue = 5| pages = 528–36 | doi=10.1093/aje/kwr120| pmid = 21709134 | pmc = 3202150 }}</ref> Small artery compliance or stiffness can be assessed simply and at rest and can be distinguished from large artery stiffness by use of pulsewave analysis.<ref>{{cite journal |vauthors=Cohn JN, Duprez DA, Finkelstein SM | year = 2009 | title = Comprehensive noninvasive arterial vascular evaluation | journal = Future Cardiology | volume = 5 | issue = 6| pages = 573–9 | doi=10.2217/fca.09.44| pmid = 19886784 }}</ref>