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Evaluation of Endothelial Function by Flow-Mediated Dilation: a Comprehensive Review in Rheumatic Disease

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  • Published:
Archivum Immunologiae et Therapiae Experimentalis Aims and scope

Abstract

Flow-mediated dilation (FMD) represents a non-invasive marker of endothelial function to evaluate vascular homeostasis, which reflects the effects of several mechanisms, including vessel tone regulation, cell proliferation, and inflammatory responses. Beyond classical atherosclerotic risk factors such as arterial hypertension, diabetes mellitus, smoking, obesity, and dyslipidemia, chronic inflammation contributes to the endothelial dysfunction causing plaque formation and there is growing evidence of a significantly higher cardiovascular morbidity associated with autoimmune diseases. The endothelium reacts to several endogenous and exogenous stimuli, through surface receptors and intracellular signalling, and releases numerous vasoactive substances, including endothelins, prostacyclins, and nitric oxide (NO). Chronic inflammatory rheumatic diseases are commonly associated with decreased endothelial NO production, vascular damage, and premature atherosclerosis. Despite partially eclipsed by pulse wave velocity measure in the modern scientific literature, we provide a comprehensive overview and critically discuss the available data supporting FMD as a surrogate marker of endothelial function and, therefore, its potential role in predicting early atherosclerosis in patients with rheumatic diseases.

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Abbreviations

APS:

Anti-phospholipid syndrome

aPL:

Anti-phospholipid antibodies

CVD:

Cardiovascular disease

EDHF:

Endothelium-derived hyperpolarizing factor

eNOS:

Endothelial NO synthase

FMD:

Flow-mediated dilation

MCTD:

Mixed connective tissue disease

MTX:

Methotrexate

NO:

Nitric oxide

oxLDL:

Oxidized low-density lipoproteins

PsA:

Psoriatic arthritis

RA:

Rheumatoid arthritis

SLE:

Systemic lupus erythematosus

SpA:

Spondyloarthropathies

SSc:

Systemic sclerosis

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Authors and Affiliations

  1. Department of Internal Medicine, IRCCS Policlinico San Donato, University of Milan, Milan, Italy

    Luca Moroni

  2. Systemic Autoimmune Diseases Unit, Hospital Clìnic, Barcelona, Spain

    Luca Moroni

  3. Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy

    Carlo Selmi

  4. University of Milan, Milan, Italy

    Carlo Selmi & Pier Luigi Meroni

  5. Division of Internal Medicine and Nephrology, Humanitas Research Hospital, Milan, Italy

    Claudio Angelini

  6. Rheumatology, Gaetano Pini Hospital, Milan, Italy

    Pier Luigi Meroni

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  1. Luca Moroni
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  2. Carlo Selmi
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  3. Claudio Angelini
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  4. Pier Luigi Meroni
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Correspondence to Carlo Selmi.

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Moroni, L., Selmi, C., Angelini, C. et al. Evaluation of Endothelial Function by Flow-Mediated Dilation: a Comprehensive Review in Rheumatic Disease. Arch. Immunol. Ther. Exp. 65, 463–475 (2017). https://doi.org/10.1007/s00005-017-0465-7

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