Medical & Biological Engineering & Computing

, Volume 50, Issue 12, pp 1239–1247 | Cite as

Novel non-invasive method of measurement of endothelial function: enclosed-zone flow-mediated dilatation (ezFMD)

  • Teiji Ukawa
  • Tsuneo Takayanagi
  • Haruka Morimoto
  • Yukihito Higashi
  • Naomi Idei
  • Masao Yoshizumi
  • Toshio Tsuji
Original Article
  • 278 Downloads

Abstract

Measurement of flow-mediated dilatation (FMD) is the conventional non-invasive method for assessment of endothelial function; however, it requires an expensive ultrasound system and high levels of technical skill. Therefore, we developed a novel method for measurement of endothelial function, namely, measurement of ezFMD. ezFMD estimates the degree of vasodilatation from the oscillation signals transmitted to a sphygmomanometer cuff attached to the upper arm. The objective of this study was to validate the principle underlying the measurement of ezFMD, and to evaluate the repeatability of the ezFMD measurements. We observed the blood vessel behavior and oscillometric pattern in ten subjects. When the cuff was inflated to the level of the mean blood pressure, the oscillation amplitude increased with increasing degree of vasodilatation. In experiment to evaluate the repeatability of the ezFMD measurement, the average difference between the paired measurements was 3.7 %, the standard deviation was 11.5 %, and the average coefficient of variation value for the 11 paired measurements was 23.7 %. These results suggest the validity of the principle underlying the measurement of the ezFMD for the assessment of endothelial function. And, this study suggests that the repeatability of the ezFMD measurements is superior to that of the conventional measurement of FMD.

Keywords

Atherosclerosis Endothelial function FMD Oscillometric sphygmomanometer ezFMD 

References

  1. 1.
    Bank AJ, Wilson RF, Kubo H, Holte JE, Dresing TJ, Wang H (1995) Direct effect of smooth muscle relaxation and contraction on in vivo human brachial artery elastic properties. Circ Res 77:1008–1016PubMedCrossRefGoogle Scholar
  2. 2.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMedCrossRefGoogle Scholar
  3. 3.
    Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, Lloid JK, Deanfield JE (1992) Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 340:1111–1115PubMedCrossRefGoogle Scholar
  4. 4.
    Chinn S (1999) The assessment of methods of measurements. Stat Med 9:351–362CrossRefGoogle Scholar
  5. 5.
    Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, Deanfield J, Dlexler H, Gerhard-Herman M, Herrington D, Vallance P, Vita J, Vogel R (2002) Guidelines for the ultrasound assessment of endothelial-dependent flow mediated vasodilation of the brachial artery: a report of the international brachial artery reactivity task force. J Am Coll Cardiol 39:257–265PubMedCrossRefGoogle Scholar
  6. 6.
    Harris RA, Padilla J, Rink LD, Wallance JP (2006) Variability of flow-mediated dilation measurements with repetitive reactive hyperemia. Vasc Med 11:1–6PubMedCrossRefGoogle Scholar
  7. 7.
    Idei N, Higashi Y, Soga J, Hata T, Hidaka T, Fujii Y, Fujimura N, Mikami S, Maruhashi T, Yoshizumi M, Kihara Y (2010) A new noninvasive method for assessment of endothelial function: enclosed zone flow-mediated vasodilation (ezFMD) Circ J 74 (Suppl I):498 (abstract)Google Scholar
  8. 8.
    Malik J, Wichterle D, Haas T, Melenovsky V, Simek J, Stulc T (2004) Repeatability of noninvasive surrogates of endothelial function. Am J Cardiol 94:693–696PubMedCrossRefGoogle Scholar
  9. 9.
    Mauck GW, Smith CR, Geddes LA, Bourland DJ (1980) The meaning of the point of maximum oscillations in cuff pressure in the indirect measurement of blood pressure—part II. J Biomech Eng 102:28–33PubMedCrossRefGoogle Scholar
  10. 10.
    Meyer B, Moertl D, Strecker K, Huelsmann M, Kulemann V, Neunteufl T, Pacher R, Berger R (2005) Flow-mediated vasodilation predicts outcome in patients with chronic heart failure: comparison with B-type natriuretic peptide. J Am Coll Cardiol 46:1011–1018PubMedCrossRefGoogle Scholar
  11. 11.
    Michard F (2005) Changes in arterial pressure during mechanical ventilation. Anesthesiology 103:419–428PubMedCrossRefGoogle Scholar
  12. 12.
    Peretz A, Leotta DF, Sullivan JH, Trenga CA, Sands FN, Aulet MR, Paun M, Gill EA, Kaufman JD (2007) Flow mediated dilation of the brachial artery: an investigation of methods requiring further standardization. BMC Cardiovasc Disord 7:11PubMedCrossRefGoogle Scholar
  13. 13.
    Ramsey M (1979) Normotensive automatic determination of mean arterial pressure. Med Biol Eng Comput 17:11–18PubMedCrossRefGoogle Scholar
  14. 14.
    Roman MJ, Naqvi TZ, Gardin JM, Gerhard-Herman M, Jaff M, Mohler E (2006) Clinical application of noninvasive vascular ultrasound in cardiovascular risk stratification: a report from the American Society of Echocardiography and the Society of Vascular Medicine and Biology. J Am Soc Echocardiogr 19:943–954PubMedCrossRefGoogle Scholar
  15. 15.
    Ross R (1999) Atherosclerosis—an inflammatory disease. N Engl J Med 340:115–126PubMedCrossRefGoogle Scholar
  16. 16.
    Soga J, Nishioka K, Nakamura S, Umemura T, Jitsuiki D, Hidaka T, Teragawa H, Takemoto H, Goto C, Yoshizumi M, Chayama K, Higashi Y (2007) Measurement of flow-mediated vasodilation of the brachial artery—a comparison of measurements in the seated position and supine position. Circ J 71:736–740PubMedCrossRefGoogle Scholar
  17. 17.
    Yoboah J, Folsom AR, Burke GL, Johnson C, Polak JF, Post W, Lima JA, Crouse JR, Herrington DM (2009) Predictive value of brachial flow mediated dilation for incident cardiovascular events in a population-based study. Circulation 120:502–509CrossRefGoogle Scholar

Copyright information

© International Federation for Medical and Biological Engineering 2012

Authors and Affiliations

  • Teiji Ukawa
    • 1
    • 5
  • Tsuneo Takayanagi
    • 1
  • Haruka Morimoto
    • 1
  • Yukihito Higashi
    • 2
  • Naomi Idei
    • 3
  • Masao Yoshizumi
    • 4
  • Toshio Tsuji
    • 5
  1. 1.Nihon Kohden CorporationTokyoJapan
  2. 2.Department of Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Research Center for Radiation Genome MedicineHiroshima UniversityHiroshimaJapan
  3. 3.Department of Cardiovascular Physiology and MedicineHiroshima University Graduate School of Biomedical SciencesHiroshimaJapan
  4. 4.Department of Cardiovascular MedicineHiroshima University Graduate School of Biomedical SciencesHiroshimaJapan
  5. 5.Hiroshima University Graduate School of EngineeringHigashi-HiroshimaJapan

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