Nicholas G. Evanoff

Presence of a high-flow-mediated constriction phenomenon prior to flow-mediated dilation in normal weight, overweight, and obese children and adolescents

When assessing vasomotor endothelial function by reactive hyperemia, the brachial artery, in some individuals, constricts immediately before beginning to dilate following cuff release. We call this response high‐flow‐mediated constriction (H‐FMC). The aim of this study was to describe the rate of the H‐FMC during reactive hyperemia in children and adolescents throughout a range of body mass index (BMI) values, and to investigate differences in flow‐mediated dilation (FMD), cardiovascular, and anthropometric measures between subjects with and without H‐FMC.

Peak shear and peak flow mediated dilation: a time‐course relationship

To explore the temporal relationship between brachial artery peak shear stress (Shear) and flow‐mediated dilation (FMD) in children and adults.

Intra- and inter-day reproducibility of low-flow mediated constriction response in young adults

When assessing brachial endothelial function by reactive hyperaemia, stopping blood flow creates a period of low‐flow‐mediated constriction (L‐FMC). As little is known about how this parameter influences flow‐mediated vasodilation (FMD), the purpose of this study was to better understand this relationship and to determine the intra‐ and interday reproducibility of brachial L‐FMC.

Measurement of Central Aortic Blood Pressure in Youth: Role of Obesity and Sex

BACKGROUND The relationship between pediatric severe obesity (SO) and central aortic blood pressure (BP) has yet to be established. METHODS We conducted a cross-sectional study of 348 youth (48.5% male, age 12.7 ± 0.1 years) with a wide range of body mass index (BMI) values: normal weight (NW; ≥5th and <85th BMI percentiles), overweight/obesity (OW/OB; 85th to <120% of the 95th BMI percentile), and SO (≥120% of the 95th BMI percentile). Measures of central aortic BP were obtained via applanation tonometry with SphygmoCor MM3 software. RESULTS After adjustment for covariates, no significant sex differences were observed for radial-aortic systolic blood pressure (SBP) (P = 0.39), carotid-aortic SBP (P = 0.99), radial-aortic diastolic blood pressure (DBP) (P = 0.44), and carotid-aortic DBP (P = 0.53). Compared to youth with NW, youth with SO exhibited higher radial-aortic SBP (SO vs. NW: 102 ± 1 mm Hg vs. 90 ± 1 mm Hg, P<0.001), carotid-aortic SBP (SO vs. NW: 121 ± 1 mm Hg vs. 109 ± 1 mm Hg, P<0.001), and carotid-aortic DBP (SO vs. NW: 60 ± 1 mm Hg vs. 56 ± 1 mm Hg, P = 0.04). Compared to youth with OW/OB, youth with SO had higher radial-aortic SBP (OW/OB: 97 ± 1 mm Hg, P = 0.002) and carotid-aortic SBP (OW/OB: 114 ± 1 mm Hg, P = 0.007). After adjusting for either total-body percent fat mass or visceral adipose tissue, BMI was still a significant predictor of both radial-aortic and carotid-aortic SBP and DBP (P<0.001, all). CONCLUSIONS In a cohort of youth with a wide range of adiposity levels, central aortic BP was elevated among individuals with SO and associated with BMI but not body fatness.

Determination of bilateral symmetry of carotid artery structure and function in children and adolescents

We compared the symmetry of carotid arteries in youth with high-resolution ultrasound. Participants (n=230 (121 females),13.8 ± 2.9 years old) were assessed for: intima media thickness (cIMT), lumen diameter (cLD), incremental elastic modulus (cIEM), diameter compliance (cDC), cross-sectional compliance (cCSC), diameter distensibility (cDD), and cross-sectional distensibility (cCSD). No significant differences (P >0.05 all) were found for cIMT (0.49 ± 0.09 mm vs. 0.49 ± 0.08 mm), cIEM (1095 ± 382 mmHg vs. 1116 ± 346mmHg), cDC (0.01 ± 0.0 mm/mmHg vs. 0.01 ± 0.0 mm/mmHg), cCSC (0.01 ± 0.001/mmHg vs. 0.01 ± 0.001/mmHg), cDD (14.0 ± 3.16% vs. 13.7 ± 3.18%), and cCSD (30.1 ± 7.37% vs. 29.4 ± 7.36%). Significant differences were found for cLD (6.06 ± 0.62 mm vs. 6.33 ± 0.64 mm, P <0.001). These data suggest that these values may be used interchangeably if one side is inaccessible.

High-flow-mediated constriction in adults is not influenced by biomarkers of cardiovascular and metabolic risk

During reactive hyperemia, the brachial artery in some individuals constricts prior to dilation. Our aim was to describe the frequency of high‐flow‐mediated constriction (H‐FMC) in adults, and its relationship to body composition and biomarkers of cardiovascular and metabolic risk.

Reproducibility of blood oxygen level‐dependent signal changes with end‐tidal carbon dioxide alterations

Hypercapnia has been utilized as a stimulus to elicit changes in cerebral blood flow (CBF). However, in many instances it has been delivered in a non‐controlled method that is often difficult to reproduce. The purpose of this study was to examine the within‐ and between‐visit reproducibility of blood oxygen level‐dependent (BOLD) signal changes to an iso‐oxic square wave alteration in end‐tidal carbon dioxide partial pressure (PetCO2). Two 3‐Tesla (3T) MRI scans were performed on the same visit, with two square wave alterations administered per scan. The protocol was repeated on a separate visit with minimum of 3 days between scanning sessions. PetCO2 was altered to stimulate changes in cerebral vascular reactivity (CVR), while PetO2 was held constant. Eleven subjects (six females; mean age 26·5 ± 5·7 years) completed the full testing protocol. Excellent within‐visit square wave reproducibility (ICC > 0·75) was observed. Similarly, square waves were reproducible between scanning sessions (ICC > 0·7). This study demonstrates BOLD signal changes in response to alterations in PetCO2 are reproducible both within‐ and between‐visit MRI scans.

Comparison of brachial dilatory responses to hypercapnia and reactive hyperemia.

Flow-mediated dilation (FMD) relies on reactive hyperemia to stimulate the endothelium to release nitric oxide, causing smooth muscle relaxation. Hypercapnia also produces vasodilation, which is thought to be nitric oxide-independent. The purpose of this study was to compare and contrast the effects of hypercapnia and reactive hyperemia as stimuli for brachial artery dilation. On separate days, twenty-five participants underwent vasodilation studies via reactive hyperemia or hypercapnia (i.e. 10 mmHg increase in end-tidal carbon dioxide [PetCO2)]). During both studies changes in brachial artery diameter were recorded using continuous ultrasound imaging. Heart rate (HR) was measured throughout both tests. Resting HR (63  ±  11 versus 68  ±  14 beats min(-1), p  =  0.0027) and baseline brachial artery diameter measurements (4.57  ±  1.51 versus 5.28  ±  1.86 mm, p  =  0.022) were significantly different between reactive hyperemia and hypercapnia, respectively. HR at peak dilation (65  ±  11 versus 76  ±  14 beats min(-1), p  <  0.0001), peak vessel dilation (8.68  ±  4.50 versus 5.28  ±  1.86%, p  =  0.002), and time to peak dilation (90.8  ±  120.1 versus 658.3  ±  226.6 s, p  <  0.0001) were also significantly different between reactive hyperemia and hypercapnia. The dynamics by which reactive hyperemia and hypercapnia stimulate vasodilation appear to differ. Hypercapnia produces a smaller and slower vasodilatory effect than reactive hyperemia. Further research is necessary to better understand the mechanisms of vasodilation under hypercapnic conditions.