Endothelial function in cardiovascular medicine: a consensus paper of the European Society of Cardiology Working Groups on Atherosclerosis and Vascular Biology, Aorta and Peripheral Vascular Diseases, Coronary Pathophysiology and Microcirculation, and Thrombosis

Yvonne Alexander (1) , Elena Osto (2) , Arno Schmidt-Trucksäss (3) , Michael Shechter (4) , Danijela Trifunovic (5) , Dirk Duncker (6) , Victor Aboyans (7, 8) , Magnus Bäck (9) , Lina Badimon (10) , Francesco Cosentino (11) , Marco de Carlo (12) , Maria Dorobantu (13) , David Harrison (14) , Tomasz Guzik (15) , Imo Hoefer (16) , Paul Morris (17) , Giuseppe Norata (18) , Rosa Suades (19) , Stefano Taddei (20) , Gemma Vilahur (21) , Johannes Waltenberger (22) , Christian Weber (22) , Fiona Wilkinson (1) , Marie-Luce Bochaton-Piallat (23) , Paul Evans (18)

1 Manchester Metropolitan University, Manchester, UK
2 University hospital of Zurich [Zurich]
3 Unibas - Université de Bâle = University of Basel = Basel Universität
4 TAU - Tel Aviv University
5 University of Belgrade [Belgrade]
6 Erasmus MC - Erasmus University Medical Center [Rotterdam]
7 Service de cardiologie [CHU Limoges]
8 NET - Neuroépidémiologie Tropicale
9 Department of Cardiology, Karolinska University Hospital
10 University of Barcelona
11 Karolinska Institutet at Karolinska University Hospital
12 Azienda Ospedaliero-Universitaria Pisana [Pisa, Italy]
13 University of Bucarest
14 Vanderbilt University School of Medicine [Nashville]
15 College of Medical, Veterinary and Life Sciences [Glasgow]
16 UJ - Uniwersytet Jagielloński w Krakowie = Jagiellonian University
17 University Medical Center [Utrecht]
18 INSIGNEO Institute for in Silico Medicine
19 Karolinska Institute and University Hospital
20 University of Pisa - Università di Pisa
21 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
22 SyNergy - Munich Cluster for systems neurology [Munich]
23 UNIGE - Université de Genève = University of Geneva

Abstract Endothelial cells (ECs) are sentinels of cardiovascular health. Their function is reduced by the presence of cardiovascular risk factors, and is regained once pathological stimuli are removed. In this European Society for Cardiology Position Paper, we describe endothelial dysfunction as a spectrum of phenotypic states and advocate further studies to determine the role of EC subtypes in cardiovascular disease. We conclude that there is no single ideal method for measurement of endothelial function. Techniques to measure coronary epicardial and micro-vascular function are well established but they are invasive, time-consuming, and expensive. Flow-mediated dilatation (FMD) of the brachial arteries provides a non-invasive alternative but is technically challenging and requires extensive training and standardization. We, therefore, propose that a consensus methodology for FMD is universally adopted to minimize technical variation between studies, and that reference FMD values are established for different populations of healthy individuals and patient groups. Newer techniques to measure endothelial function that are relatively easy to perform, such as finger plethysmography and the retinal flicker test, have the potential for increased clinical use provided a consensus is achieved on the measurement protocol used. We recommend further clinical studies to establish reference values for these techniques and to assess their ability to improve cardiovascular risk stratification. We advocate future studies to determine whether integration of endothelial function measurements with patient-specific epigenetic data and other biomarkers can enhance the stratification of patients for differential diagnosis, disease progression, and responses to therapy.

Domaines: Santé publique et épidémiologie

Yvonne Alexander, Elena Osto, Arno Schmidt-Trucksäss, Michael Shechter, Danijela Trifunovic, et al.. Endothelial function in cardiovascular medicine: a consensus paper of the European Society of Cardiology Working Groups on Atherosclerosis and Vascular Biology, Aorta and Peripheral Vascular Diseases, Coronary Pathophysiology and Microcirculation, and Thrombosis. Cardiovascular Research, 2021, 117 (1), pp.29-42. ⟨10.1093/cvr/cvaa085⟩. ⟨hal-03443781⟩