Passive leg raising induced brachial artery dilation: is an old technique a simpler method to measure endothelial function?
OBJECTIVE
Passive leg raising (PLR) is a diagnostic maneuver that has been shown to cause brachial artery dilation (BAD). The objectives of this study were to compare BAD induced by PLR with flow mediated dilation (FMD), and to investigate the mechanism of PLR-BAD. We studied a total of 75 subjects with and without cardiovascular risk factors/disease in order to provide a wide range of FMD responses.


METHODS
Using ultrasound, PLR-BAD and FMD induced by release of arterial cuff occlusion were measured.


RESULTS
BA diameter increased from 0.33+0.06 at baseline to 0.35+/-0.06 cm (p<.001) (4.8% increase) upon PLR and from 0.33+/-0.06 to 0.37+/-0.06 (11.8%) upon hyperemia. PLR induced BAD was significantly correlated with FMD (r=.82, p<.001). On receiver operating characteristic analysis of the two techniques, the area under the curve was 0.86 (95% CI 0.79-0.94, p<.001). Heart rate variability measures remained unchanged upon PLR indicating minimal contributions from changes in autonomic activity. The combination of FMD and PLR did not result in greater BAD than did FMD alone consistent with a common underlying mechanism. Mean blood flow velocity increased prior to BAD suggesting that shear stress increases prior to BAD.


CONCLUSIONS
BAD occurs in response to PLR and is proportional to FMD, although the magnitude of PLR-BAD is less than half that of FMD. It appears to occur by the same endothelial dependent mechanism as FMD. PLR-BAD may be used as a surrogate measure of FMD to evaluate vascular function, and has the advantage of being simpler to perform.
Kamran
Haroon
H
Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA.
Salciccioli
Louis
L
Namana
Vinod
V
Venkatesan
Bhuvaneshwari
B
Santana
Casey
C
Stewart
Mark
M
Lazar
Jason M
JM
D000328:Adult; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D003935:Diagnostic Techniques, Cardiovascular; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006339:Heart Rate; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D007866:Leg; D008297:Male; D008875:Middle Aged; D009518:New York; D056888:Patient Positioning; D011237:Predictive Value of Tests; D012372:ROC Curve; D012039:Regional Blood Flow; D018608:Ultrasonography, Doppler; D014664:Vasodilation