Diagnosis of multifocal atherosclerosis using the Celermajer test

Aim. To study the effectiveness of determining atherosclerosis and its severity in the brachiocephalic (BCA), coronary (CA) and femoral (FA) arteries based on the endothelial function test proposed by Celermajer DS.

Material and methods. The study included 216 patients: 115 men and 101 women aged 24-87 years (mean age, 61,5±10,73 years). All patients underwent coronary angiography to assess the presence and severity of coronary artery atherosclerosis, and duplex ultrasound of BCA and FA atherosclerosis. The functional activity of the endothelium was assessed using the Celermajer test.

Results. Depending on the presence and severity of atherosclerosis in each arterial region (BCA, CA and FA), patients were divided into the following groups: group 1 — patients with intact arteries, group 2 — patients with moderate atherosclerosis, group 3 — patients with severe atherosclerosis. Comparative analysis of brachial artery diameters identified by the Celermajer test revealed a significant difference between the groups. Comparison of Celermajer test results in CA groups was as follows: groups 1 and 2 (p=0,34), groups 1 and 3 (p<0,0001), groups 2 and 3 (p<0,0001). The results of comparing the three BCA groups were as follows: groups 1 and 2 (p<0,05), groups 1 and 3 (p<0,001), groups 2 and 3 (p<0,001); for FA — groups 1 and 2 (p=0,008), groups 1 and 3 (p<0,0001), groups 2 and 3 (p<0,0001).

Conclusion. The results showed the applicability of Celermajer test for preliminary assessment of presence and severity of atherosclerosis of BCA, CA and FA. Using Celermajer test, severe atherosclerotic lesion can be verified in all studied arterial systems. Moderate atherosclerosis of BCA and FA was also revealed. However, no reliable results were obtained for detecting moderate CA atherosclerosis with Celermajer test.

1. Herrington W, Lacey B, Sherliker P, et al. Epidemiology of Atherosclerosis and the Potential to Reduce the Global Burden of Atherothrombotic Disease. Circ Res. 2016; 118(4):535-46. https://doi.org/10.1161/CIRCRESAHA.115.307611.

2. Markov ChM. Molecular mechanisms of vascular endothelium dysfunction. Kardiologiia. 2005;12:62-7 (In Russ.)

3. Davignon J, Ganz P. Role of endothelial dysfunction in atherosclerosis. Circulation. 2004;109(23 Suppl 1):III27-32. https://doi.org/10.1161/01.CIR.0000131515.03336.f8.

4. Landmesser U, Hornig B, Drexler H. Endothelial function: a critical determinant in atherosclerosis? Circulation. 2004;109:27-33. https://doi.org/10.1161/01.CIR.0000129501.88485.1f.

5. Gurevich VS. Modern concepts of the pathogenesis of atherosclerosis. Cardiovascular diseases. 2006;4:4-8. (In Russ.)

6. Teerlink JR. Endothelins: Pathophysiology and treatment implications in chronic heart failure. Current Heart Failure Reports. 2005;2:191-7 https://doi.org/10.1007/bf02696649.

7. Rich S, McLaughlin VV. Endothelial receptors blockers in cardiovascular disease. Circulation. 2003;108:2184-90. https://doi.org/10.1161/01.CIR.000009439719932.78.

8. Vanhoutte PM. Endothelial dysfunction: the first step toward coronary arteriosclerosis. Circ J. 2009;73:595-601. https://doi.org/10.1253/circj.CJ-08-1169.

9. Higashi Y, Noma K, Yoshizumi M, et al. Endothelial function and oxidative stress in cardiovascular diseases. Circ J. 2009;73(3):411-8. https://doi.org/10.1253/circj.CJ-08-1102.

10. Packard RR, Libby P. Inflammation in atherosclerosis: from vascular biology to biomarker discovery and risk prediction. Clin Chem. 2008;54(1):24-38. https://doi.org/10.1373/clinchem.2007097360.

11. Poloneckiy OL, Poloneckiy LZ. Endothelial dysfunction and atherosclerosis. Medical news. 2012;6:6-11. (In Russ.) ID: 90728442.

12. Shabrov AV, Apresyan AG, Dobkes AL, et al. Current Methods of Endothelial Dysfunction Assessment and their Possible Use in the Practical Medicine. Rational Pharmacotherapy in Cardiology. 2016;12(6):733-742. (In Russ.) https://doi.org/10.20996/1819-6446-2016-12-6-733-742.

13. Kuznecov AN. Multifocal atherosclerosis. Modern treatment guidelines of multifocal atherosclerosis. Journal of the Pirogov’s National Medical and Surgical Center. 2008;3(2):78-83. (In Russ.)

14. Tarantini G, Napodano M, Gasparetto N, et al. Impact of multivessel coronary artery disease on early ischemic injury, late clinical outcome, and remodeling in patients with acute myocardial infarction treated by primary coronary angioplasty. Coronary Artery Disease. 2010;21(2):78-86. https://doi.org/10.1097/MCA.0b013e328335a074.

15. Gavrilova NE, Zhatkina MV, Metelskaya VA, et al. Assessment methods and possibilities of instrumental diagnosis of subclinical atherosclerosis of coronary arteries. Cardiovascular Therapy and Prevention. 2019; 18(6): 136-41. (In Russ.) https://doi.org/10.15829/1728-8800-2019-6-136-141.

16. Bokeria LA, Spiridonov AA, Buziashvili Yu I, et al. Cardiac complications in patients with atherosclerotic combined damage to the brachiocephalic arteries and abdominal aorta. Bulletin of the NCSSH A. N. Bakulev RAMN. 2005;6(1):8-14. (In Russ.)

17. 17 Barbarash OL, Zykov MV, Kashtalap VV, Barbarash LS. Prevalence and clinical significance of multifocal atherosclerosis in patients with ischemic heart disease. Kardiologiia. 2011;51(8):66-71. https://doi.org/10.1016/S1885-5857(07)60131-5.

18. Janzen J. The microscopic transitional zone between elastic and muscular arteries. Arch Mal Coeur Vaiss Pratique. 2014;97:909-14.

19. Gavrilova NE, Metelskaya VA, Perova NV. Association between the degree of coronary atherosclerosis, risk factors, and markers of carotid and peripheral artery atherosclerosis. Cardiovascular Therapy and Prevention. 2013; 12(1 ):40-5. (In Russ.) https://doi.org/10.15829/1728-8800-2013-1-40-45.

20. Celermajer DS, Sorensen KE, Gooch VM, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. The Lancet. 1992;340:1111-5. https://doi.org/10.1016/0140-6736(92)93147-f.

21. Merculov EV, Mironov VM, Samko AN. Coronary angiography, ventriculography, bypass angiography in graphics and diagrams. M.: Media Medika. 2011; p.100. (In Russ.) ISBN 978-5-905305-03-0.

22. Stein JL, Korcarz CE. American Society of Echocardoigraphy Carotid Intima-Media Thickness Task Force. J Am Soc Echocardiograph. 2008;21:93-111. https://doi.org/10.1016/j.echo.2007.11.011.

23. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the european society for vascular surgery (ESVS). Russian Journal of Cardiology. 2018;(8):164-221. (In Russ). https://doi.org/10.15829/1560-4071-2018-8-164-221.

24. Kulikov VP. Ultrasonic diagnosis of vascular diseases. M.: STROM, 2007 p. 512. (In Russ.) ISBN:978-5-88429-215-4.

25. Versari D, Daghini E, Virdis A, et al. Endothelial dysfunction as a target for prevention of cardiovascular disease. Diabetes Care.2009; 32:5314-21. https://doi.org/10.2337/dc09-S330.

26. Tanashyan MM. Hemostasis, hemoreology and athrombogenic vascular wall activity in angioneurology. Annals of Clinical and Experimental Neurology. 2007;1(2):29-33. (In Russ.)

27. 27 Neumann F-J, Sousa-Uva M, Ahlsson A, et. al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40:87-165. https://doi.org/10.1093/eurheartj/ehy394.

28. Behrendt D, Ganz P. Endothelial function: from vascular biology to clinical applications. Am J Cardiol. 2002;90:8-40. https://doi.org/10.1016/s0002-9149(02)02963-6.

29. Kade AH, Zanin SA, Gubareva EA, et al. Physiological functions of vascular endothelium. Basic researches. 2011; 11(3): 611-7 (In Russ).