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Q J Med 2003; 96: 253-267
© 2003 Association of Physicians

Review

Assessment of endothelial damage and dysfunction: observations in relation to heart failure

A.-Y. Chong, A.D. Blann and G.Y.H. Lip

From the Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK

The first 150 words of the full text of this article appear below.


   Introduction
 
More than 150 years ago, Virchow proposed that abnormalities in blood flow, vessel wall and blood components predispose to thrombosis, constituting what is now known as ‘Virchow's triad’ for thrombogenesis.1 This rather simplistic view has been continually modified by new discoveries and concepts, as we now know that the process of thrombus formation requires complex interactions involving injury to the vascular endothelium, platelet adherence, aggregation and release, and clotting factor activation, eventually leading to thrombin generation and fibrin formation.2

The endothelium has many vital and diverse (depending on the particular vascular bed) physiological roles, such as regulation of blood vessel tone, permeability, metabolism and haemostasis. Impairment of endothelial function manifests clinically as oedema, hypertension, abnormal vasoconstriction and hypercoagulability. Indeed, it is a widely held view that impaired endothelial function is also the initial step in atherogenesis, which is largely responsible for ischaemic heart disease and thrombotic strokes decades later. Impaired . . . [Full Text of this Article]


   Normal physiology of the endothelium
 

   Plasma markers associated with endothelial damage/dysfunction
 
von Willebrand factor
Soluble thrombomodulin (sTM)
E-selectin
Nitric oxide (‘endothelial-derived relaxing factor’)
Endothelin

   Flow-mediated dilatation/endothelium-dependent dilatation
 

   Circulating endothelial cells
 

   Conclusion
 

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This article has been cited by other articles:


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A. Y. Chong, G. Y.H. Lip, B. Freestone, and A. D. Blann
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Plasma von Willebrand Factor and the Development of the Metabolic Syndrome in Patients with Hypertension
J. Clin. Endocrinol. Metab., November 1, 2004; 89(11): 5377 - 5381.
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