European Heart Journal Advance Access originally published online on December 1, 2004
European Heart Journal 2005 26(4):363-368; doi:10.1093/eurheartj/ehi017
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Assessment of flow-mediated vasodilatation (FMD) of the brachial artery: effects of technical aspects of the FMD measurement on the FMD response
1Julius Center for Health Sciences and Primary Care, HP Str. 6.131 University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
2Department of Internal and Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
3Department of Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
Received 1 June 2004; revised 7 September 2004; accepted 9 September 2004; online publish-ahead-of-print 1 December 2004.
* Corresponding author. Tel: +31 30 250 9352; fax: +31 30 2505485. E-mail address: m.l.bots{at}jc.azu.nl
Aims The ability to assess endothelial function non-invasively with B-mode ultrasound has lead to its widespread application in a variety of studies. However, the absolute values obtained using this approach vary considerably across studies. We studied whether technical aspects of the methodology can explain the wide variety in absolute values across studies.
Methods and results A literature search was performed to identify published reports on flow-mediated vasodilatation (FMD) of the brachial artery published between 1992 and 2001. Information on type of equipment (wall track/B-mode), location of the measurement (antecubital fossa/upper arm), occlusion site (lower/upper arm), occlusion duration (min), and occlusion pressure was extracted. Patient characteristics were also extracted. For the healthy populations, mean FMD varied from 0.20 to 19.2%; for the coronary heart disease (CHD) patients FMD varied from –1.3 to 14%; for subjects with diabetes mellitus FMD varied from 0.75 to 12%. Compared with occlusion at the upper arm, lower arm occlusion was related to decreased FMD (mean difference in FMD –2.47%; 95% CI 0.55–4.39). An occlusion duration of 
4.5 min was related to an increased FMD compared with an occlusion time of 
4 min (mean difference 1.30%; 95% CI 0.35–2.46). These findings were adjusted for other technical aspects of the methodology and for differences in risk factors between populations.
Conclusion Mean FMD differs widely between studies. There is a great overlap between populations (healthy, CHD, diabetics). Our findings suggest that the technical aspects of the measurements, the location, and the duration of the occlusion may explain some of these differences, whereas type of equipment, location of the measurement, and occlusion pressure do not.
Key Words: Trials • Endothelial function • Prevention • Subclinical atherosclerosis • Cardiovascular risk
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