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Expert consensus and evidence-based recommendations for the assessment of flow-mediated dilation in humans.

Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK. Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. Department of Clinical and Experimental Medicine, University of Pisa, Italy. Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, Pisa, Italy. Department Nutrition & Health, Unilever Vlaardingen, Vlaardingen, The Netherlands. Institute of Cardiovascular Sciences, University College of London, 1 St Martin le Grand, London, UK. Royal Brompton and Harefield Hospitals, London University Heart Center, Sydney Street, London, UK. School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, Western Australia, Perth, Australia.

European heart journal. 2019;(30):2534-2547
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Abstract

Endothelial dysfunction is involved in the development of atherosclerosis, which precedes asymptomatic structural vascular alterations as well as clinical manifestations of cardiovascular disease (CVD). Endothelial function can be assessed non-invasively using the flow-mediated dilation (FMD) technique. Flow-mediated dilation represents an endothelium-dependent, largely nitric oxide (NO)-mediated dilatation of conduit arteries in response to an imposed increase in blood flow and shear stress. Flow-mediated dilation is affected by cardiovascular (CV) risk factors, relates to coronary artery endothelial function, and independently predicts CVD outcome. Accordingly, FMD is a tool for examining the pathophysiology of CVD and possibly identifying subjects at increased risk for future CV events. Moreover, it has merit in examining the acute and long-term impact of physiological and pharmacological interventions in humans. Despite concerns about its reproducibility, the available evidence shows that highly reliable FMD measurements can be achieved when specialized laboratories follow standardized protocols. For this purpose, updated expert consensus guidelines for the performance of FMD are presented, which are based on critical appraisal of novel technical approaches, development of analysis software, and studies exploring the physiological principles underlying the technique. Uniformity in FMD performance will (i) improve comparability between studies, (ii) contribute to construction of reference values, and (iii) offer an easy accessible and early marker of atherosclerosis that could complement clinical symptoms of structural arterial disease and facilitate early diagnosis and prediction of CVD outcomes.