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. 2018 Jun 18;8(1):9263.
doi: 10.1038/s41598-018-27392-3.

Assessment of Lower-limb Vascular Endothelial Function Based on Enclosed Zone Flow-mediated Dilation

Harutoyo Hirano  1 , Renjo Takama  2 , Ryo Matsumoto  2 , Hiroshi Tanaka  2 , Hiroki Hirano  2 , Zu Soh  3 , Teiji Ukawa  4 , Tsuneo Takayanagi  4 , Haruka Morimoto  4 , Ryuji Nakamura  5 , Noboru Saeki  5 , Haruki Hashimoto  6 , Shogo Matsui  6 , Shinji Kishimoto  7 , Nozomu Oda  6 , Masato Kajikawa  7 , Tatsuya Maruhashi  6 , Masashi Kawamoto  5 , Masao Yoshizumi  8 , Yukihito Higashi  9   10 , Toshio Tsuji  11
Affiliations

Assessment of Lower-limb Vascular Endothelial Function Based on Enclosed Zone Flow-mediated Dilation

Harutoyo Hirano et al. Sci Rep. .

Abstract

This paper proposes a novel non-invasive method for assessing the vascular endothelial function of lower-limb arteries based on the dilation rate of air-cuff plethysmograms measured using the oscillometric approach. The principle of evaluating vascular endothelial function involves flow-mediated dilation. In the study conducted, blood flow in the dorsal pedis artery was first monitored while lower-limb cuff pressure was applied using the proposed system. The results showed blood flow was interrupted when the level of pressure was at least 50 mmHg higher than the subject's lower-limb systolic arterial pressure and that blood flow velocity increased after cuff release. Next, values of the proposed index, %ezFMDL, for assessing the vascular endothelial function of lower-limb arteries were determined from 327 adult subjects: 87 healthy subjects, 150 subjects at high risk of arteriosclerosis and 90 patients with cardiovascular disease (CAD). The mean values and standard deviations calculated using %ezFMDL were 30.5 ± 12.0% for the healthy subjects, 23.6 ± 12.7% for subjects at high risk of arteriosclerosis and 14.5 ± 15.4% for patients with CAD. The %ezFMDL values for the subjects at high risk of arteriosclerosis and the patients with CAD were significantly lower than those for the healthy subjects (p < 0.01). The proposed method may have potential for clinical application.

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Conflict of interest statement

Teiji Ukawa, Tsuneo Takayanagi, Haruka Morimoto and Ryo Matsumoto are employees of Nihon Kohden Corporation. Harutoyo Hirano, Renjo Takama, Hiroshi Tanaka, Hiroki Hirano, Zu Soh, Ryuji Nakamura, Noboru Saeki, Haruki Hashimoto, Shogo Matsui, Shinji Kishimoto, Nozomu Oda, Masato Kajikawa, Tatsuya Maruhashi, Masashi Kawamoto, Masao Yoshizumi, Yukihito Higashi and Toshio Tsuji declare no potential conflict of interest.

Figures

Figure 1
Figure 1
Overview of the proposed lower-limb ezFMD measuring system.
Figure 2
Figure 2
Blood flow velocity during lower-limb ezFMD measurement: (a) time variation of blood flow velocity (Sub. A), (b) RMS of blood flow velocity (Sub. A), (c) RMS of blood flow velocity (all subjects).
Figure 3
Figure 3
Measured results of cuff oscillation: (a) air-cuff oscillation and maximum amplitude measured from a healthy subject (Sub. A) before cuff occlusion, (b) those after cuff occlusion, (c) comparison of maximum amplitude between before and after cuff occlusion in healthy subjects, (d) that in subjects at high risk of arteriosclerosis, (e) that in patients with CAD.
Figure 4
Figure 4
Results of comparison for calculated %ezFMDL among healthy subjects, subjects at high risk of arteriosclerosis and patients with CAD.
Figure 5
Figure 5
Five-day variation of measured %ezFMDL in each healthy subject: (a) time variations in %ezFMDL, (b) comparison of calculated coefficients of variation.
Figure 6
Figure 6
Statistical comparison of indices: (a) comparison between the ezFMD of the upper and lower limbs and (b) comparison between FMD and ezFMD testing of the lower limbs.
Figure 7
Figure 7
Results of ROC analysis: (a) ROC curves for healthy subjects and subjects at high risk of arteriosclerosis, (b) calculated AUC of %ezFMDL and %ezFMDB for healthy subjects and subjects at high risk of arteriosclerosis, (c) ROC curves for healthy subjects and patients with CAD, (d) calculated AUC of %ezFMDL and %ezFMDB for healthy subjects and patients with CAD.
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