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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2008;28:e23.)
© 2008 American Heart Association, Inc.

Letters to the Editor

Reactive Hyperemia Revisited

Daniela Calderaro; Maristela C. Monachini; Carolina L.Z. Vieira; Pai Ching Yu; Danielle M. Gualandro; Andre C. Marques; Bruno Caramelli

Heart Institute (InCor) – Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We read with great interest Dr Huang’s study, published in Arteriosclerosis, Thrombosis, and Vascular Biology.¹ We are in total agreement with the authors about the clinical relevance in the perioperative setting of the hyperemic flow velocity, measured by brachial artery Doppler ultrasound. Dr Huang suggests that reactive hyperemia increases the accuracy of the noninvasive vascular reactivity test, namely the brachial artery flow-mediated dilation, in predicting cardiovascular events after major vascular surgery, even though in his patients the strongest isolated predictor was flow-mediated dilation.

In a population of 96 vascular surgical patients, we assessed brachial artery flow-mediated dilation and reactive hyperemia with the same technique as Dr Huang’s before major vascular surgery was performed, with a Siemens ultrasound system (Sequoia), equipped with a 7.5-mHz vascular transducer. The brachial artery ultrasound was always performed in the morning, after a 6-hour fast and at least 12 hours without smoking. Patients received all medications, including statins, and remained resting in supine position 15 minutes before the beginning until the end of the examination. We acquired 2-dimensional ultrasound images of the brachial artery and pulsed Doppler signals above the antecubital crease at baseline and during a period of reactive hyperemia induced by 5-minute cuff occlusion of the upper arm, at a 250-mm Hg pressure. After at least a 10-minute rest period, for restoration of baseline conditions, we reassessed the brachial artery image and blood flow, before and 3 minutes after administration of sublingual isosorbide dinitrate (5 mg). Images of . . . [Full Text of this Article]