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Endothelial Dysfunction in Patients With Coronary Artery Disease: A Comparison of Three Frequently Reported Tests
  1. Stefan H. J. Monnink,
  2. Paul L. van Haelst,
  3. Ad J. van Boven,
  4. Erik S. G. Stroes,
  5. René A. Tio,
  6. Thijs W. M. Plokker,
  7. Andries J. Smit,
  8. Nic J. G. M. Veeger,
  9. Harry J. G. M. Crijns,
  10. Wiek H. van Gilst
  1. From the Department of Cardiology (S.H.M., P.L.H., A.J.B., R.A.T., N.J.V., H.J.C., W.H.G.) University Hospital Groningenthe Netherlands
  2. Department of Internal Medicine (A.J.S.) Thoraxcenter, University Hospital Groningenthe Netherlands
  3. Department of Nephrology (E.S.S.), University Hospital Utrechtthe Netherlands
  4. Department of Cardiology (T.W.P.), St Antonius Hospital Nieuwegein, the Netherlands.
  1. Address correspondence to: Ad J. van Boven, MD, PhD, University Hospital Groningen, Department of Cardiology, PO Box 30.001, 9700 RB Groningen, the Netherlands. E-mail A.J.van.boven{at}
  2. The study, including the Hokanson plethysmography equipment that was used, was sponsored by the Sorbo Heart Foundation (98037), Department of Cardiology, St Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, the Netherlands.
  3. E.S.S, P.L.H., and R.A.T. are fellows of the Netherlands Heart Foundation (grants D97-023, D99-020, and D95-019, respectively).


Background Endothelial dysfunction is useful in predicting future cardiovascular disease. At present several tests are available to test endothelial function: coronary diameter response to acetylcholine, forearm bloodflow (FBF) response to acetylcholine, and brachial artery flow-mediated dilative (FMD) response to postischemic hyperemia. This study aimed to compare the three most frequently reported endothelial function tests.

Methods Twenty-eight patients (19 males and nine females, mean age 57 years) referred for diagnostic coronary angiography were considered for endothelial function measurement in the coronary artery as well as in the forearm by FBF and FMD.

Results Acetylcholine decreased the mean coronary diameter by 7.4% (SD 6.3%) and increased the mean FBF by 230% (SD 152%). Hyperemia increased the mean brachial diameter by 6.7% (SD 4.8%). The effect of acetylcholine on forearm resistance vessels was significantly related to the effect of acetylcholine on the coronary conduit vessels (P=0.039). Nonetheless, FMD was not related to FBF nor to the coronary response.

Conclusion In patients with mild coronary endothelial dysfunction, forearm vasoreactivity is related to the coronary response, provided that the same stimulus is used.

Key Words
  • acetylcholine
  • coronary circulation
  • endothelial function
  • microcirculation
  • ultrasound
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