The Impact of Baseline Artery Diameter on Human Flow-Mediated Vasodilation: A Comparison of Brachial and Radial Artery Responses to Matched Levels of Shear Stress

Abstract

Flow-mediated dilation (FMD) can be used to assess the risk of atherosclerosis; however, an inverse relationship between vessel size and FMD has been identified using reactive hyperemia (RH) to create a shear stress (SS) stimulus in human conduit arteries. RH creates a transient and uncontrolled SS stimulus that is inversely related to baseline arterial diameter. It is therefore unclear whether differences in FMD between groups with non-uniform artery sizes are indicative of differences in vascular health or due to the creation of a greater SS stimulus in smaller vessels. Unlike RH, exercise can effectively create sustained and controlled increases in conduit artery SS. The purpose of this study was to compare the FMD responses of two differently sized upper limb arteries (brachial (BA) and radial artery (RA)) to matched graded levels of SS. Using exercise, three distinct sustained shear rate stimuli were created ((SR)=blood flow velocity/vessel diameter; estimate of SS) in the RA and BA. Artery diameter and mean blood flow velocity were assessed with echo and Doppler ultrasound respectively in 15 healthy male subjects (19-25yrs). Data are means ±SE. Subjects performed 6-min each of adductor pollicis and handgrip exercise to increase SR in the RA and BA respectively. Exercise intensity was modulated to achieve uniformity of SR between the RA and BA at three SR targets (40s-1, 60s-1, 80s-1). Three distinct SR levels were successfully created (steady state exercise: 39.8±0.6s-1, 57.3±0.7s-1, 72.4±1.2s-1; p<0.001 between SR levels). The %FMD at the end of exercise was greater in the RA vs. BA (SR40 RA: 5.4±0.8%, BA: 1.0±0.2%; SR60 RA: 9.8±1.0%, BA: 2.5±0.5%; SR80 RA: 15.7±1.5%, BA: 5.4±0.7%; p<0.001). The mean slope of the within-subject FMD-SR dose-response regression lines was significantly greater in the RA (RA: 0.33±0.04, BA: 0.13±0.02; p<0.001) and a strong within-subjects relationship between FMD and SR was observed in both arteries (RA r2: 0.92±0.02; BA r2: 0.90±0.03). These findings suggest that the response to SS is not uniform across differently sized vessels, which is in agreement with previous RH studies. Future research is required to investigate the potential mechanisms that mediate the functional differences observed between differently sized vessels.