Characterization of blood flow patterns and endothelial shear stress during flow-mediated dilation

Abstract

Introduction: Endothelial dysfunction is considered the first step in the development of atherosclerosis. Flow-mediated dilation (FMD) has been the most common assessment of endothelial function in research but it has failed in obtaining a widespread use in clinical settings due to a lack of standardization and a large inter-subject variability. Normalization of FMD to endothelial shear stress (ESS) has been proposed to solve its technical limitations. However, studies have not considered the characteristic of the blood flow during FMD under pulsatile conditions in their ESS estimations.

Methods: A total of 26 young healthy subjects (15 females and 11 males) underwent FMD testing. Microhematocrit measurement was used to determine blood viscosity (μ). ESS was calculated by Womersley's approximation, ESS = μ*2K*Velocity/Diameter, where K is a function of Womersley's parameter (α). Blood flow patterns were determined by critical Reynolds number. Statistical analysis included repeated measures ANOVA to detect ESS differences during FMD until peak dilation. Significance was established at P≤0.05.

Results: The mean (SD) FMD% and time to peak dilation were 7·4 (3·1) % and 35 (9·3) seconds, respectively. ESS was significantly reduced during FMD until peak dilation (P<0·001). Turbulent blood flow was the only pattern observed until peak dilation in 96·15% of the sample.

Conclusion: Peak FMD dilation in a young healthy population is triggered mostly by high-ESS under turbulent flow conditions. Due to the pulsatile nature of blood flow and the appearance of a turbulent pattern during FMD, ESS should be estimated by Womersley's approximation rather than Poiseuille's law.

Keywords: endothelial shear stress; flow-mediated dilation; laminar blood flow; pulsatile blood flow; turbulent blood flow.