www.endothelix.com
For follow up on product and pricing information, please contact Will Sotka
william.sotka@endothelix.com
Endothelial Dysfunction
(Vascular Dysfunction)
and Various Diseases
This slide shows the extent of
involvement of endothelial
dysfunction in various diseases,
much like a high blood pressure
measurement or fever that is
indicative of different problems.
This is why we believe
endothelial function monitoring
will be adopted as part of
routine vital sign monitoring,
not as an indicator of an acute
condition but rather for chronic
health and preventive
maintenance.
Endothelial cells serve multiple functions.
(S)
The vascular endothelium serves multiple functions:
1)
2)
3)
4)
it regulates fluid and molecule traffic between blood and tissues
it is an anti-coagulant surface
it contributes to vascular homeostasis and repair
it plays a vital role in vascular tone and blood flow regulation ***
Assessing this function is the most practical way of measuring
endothelial function.
Endothelial and Vascular Dysfunction:
A “Barometer of Cardiovascular Risk”
• Marker of the inherent atherosclerotic risk
• An integrated index of both the overall CV risk
factor burden and the sum of all
vasculoprotective factors in an individual.
Aging
Smoking
Diabetes
↑ Blood Pressure
Genetics
Diet
Inactivity
↑ Cholesterol
Oxidative Stress
Medications
Brachial Artery Ultrasound with FMD
BASELINE
POST OCCLUSION
Reactive Hyperemia
Reactive hyperemia is the transient increase in organ blood flow that occurs following a
brief period of ischemia (e.g., arterial occlusion).
The left panel shows the effects of a 2 min arterial occlusion on blood flow. In this example, blood flow goes to zero
during arterial occlusion. When the occlusion is released, blood flow rapidly increases (i.e., hyperemia occurs) that lasts
for several minutes. The hyperemia occurs because during the period of occlusion, tissue hypoxia and a build up of
vasodilator metabolites (e.g., adenosine) dilate arterioles and decrease vascular resistance. Then when perfusion
pressure is restored (i.e., occlusion released), flow becomes elevated because of the reduced vascular resistance. During
the hyperemia, the tissue becomes reoxygenated and vasodilator metabolites are washed out of the tissue. This causes
the resistance vessels to regain their normal vascular tone, thereby returning flow to control.
http://www.cvphysiology.com/Blood%20Flow/BF006.htm
Endothelial Function
Basic Science to Clinical Practice Clinical practice
Discovery
of NO and the
role of the
endothelium
Endothelial
function with
exercise and
mental stress
First endothelial
function in
humans
1980
Noninvasive
endothelial
function
1989
1986
Basic
science
Comparison
peripheral and
coronary
endothelial
function
Endothelial
function and
myocardial
ischemia
Coronary
endothelial
function in
clinical practice
Association
between
endothelial
function and CV
events
19951997
1995
1992
FDA approved device
to assess endothelial
function
1996
Comparison
between the
PAT and
coronary
endothelial
function
2005
20002004
2006
2005
Clinical
practice
Moving Endothelial Function Testing out of the
Research Lab and into Doctors Offices
Brachial Artery Ultrasound FMD
• Ultrasound measurement of
brachial artery dilation
• 15-minute test
• Not automated
• Requires skilled operator
VENDYS® - Endothelix, Inc.
• Fingertip temperature changes
• 15-minute test
• Fully automated
• Operator independent
®
What is VENDYS technology?
®
How does VENDYS measure
vascular function?
VENDYS® Vascular Function Monitoring
Blood Pressure “Occluding” Cuff on
Right Upper Arm
Fingertip
Temperature
Sensors on Both
Index Fingers
VENDYS® Vascular Function Monitoring
Infrared Imaging
Cuff inflated
Post cuff deflation
To schedule a free demo or learn more, send an email to
info@endothelix.com.
VENDYS® Portable
A complete system to perform automated, vascular function studies
• Cuff management module (CMM)
• Digital thermal monitoring (DTM) module
• VENDYS® fingertip probes
• Laptop computer with pre-installed software
– Data acquisition
– Report generation and data tabulation
Software Screenshots
The VENDYS Report
Software Screenshots
Report Viewer
Temperature Curves
The VENDYS® Report
Red = right finger
Blue = left finger
Flags help to notify user
of conditions that may
affect the technical
quality of the study.
A summary of
VENDYS indices is
shown here.
aTR is the primary
vascular reactivity
index.
Vascular Reactivity Gauge
Green = Good
Yellow = Intermediate
Red = Poor
Ambient room
temperature is recorded
throughout the study.
Sample Report Screen:
“Good” Vascular Reactivity
Sample Report Screen:
“Intermediate” Vascular Reactivity
Sample Report Screen:
“Poor” Vascular Reactivity
Digital Thermal Monitoring of Vascular Function is Reproducible
Variable
D
SDD
CV (%)
CR (%)
ICC
P value
Heart Rate
0.47
0.054
11.4
10.6
0.7
0.01
Mean Arterial
Pressure
0.44
0.038
8.7
7.5
0.79
0.0005
Start Temperature
0.51
0.036
7.1
7.1
0.81
0.0001
DTM (VENDYS®) Indices of Vascular Function
TR (°C)
0.209
0.012
5.7
2.4
0.82
0.0001
AUC
0.292
0.014
4.8
2.8
0.83
0.0001
D: mean absolute difference; SDD: SD of mean differences; CV: coefficient of variability [(SDD /D)*100];
CR: coefficient of repeatability [(SDD *1.96)*100)]; ICC: Intra-class Correlation Coefficient.
12-month Treatment with Aged Garlic Extract was Associated with
Lower Coronary Calcium Progression and Higher Fingertip Temperature Rebound
Comparison with Competitor
VENDYS® - Endothelix, Inc.
• Fingertip temperature changes
• 15-minute test
• Fully automated
EndoPAT® - Itamar Medical Inc.
• Fingertip pressure changes
• 15-minute test
• Not automated
VENDYS Publications
DTM Clinical Papers:
•Association of coronary artery calcium score and vascular dysfunction in long-term hemodialysis patients. Hemodialysis International,
International Society for Hemodialysis (2013). PDF
•Beneficial effects of aged garlic extract and coenzyme Q10 on vascular elasticity and endothelial function: The FAITH randomized clinical trial
Nutrition / Elsevier (2013). PDF
•Evaluation of Digital Thermal Monitoring as a Tool to Assess Perioperative Vascular Reactivity J Atheroscler Thromb (2013). PDF
•A Novel Technique for the Assessment of Preoperative Cardiovascular Risk: Reactive Hyperemic Response to Short-Term Exercise BioMed
Research International (2013). PDF
•Fingertip Digital Thermal Monitoring: A Fingerprint for Cardiovascular Disease? Int J Cardiovasc Imaging (2010). PDF
•Aged garlic extract supplemented with B vitamins, folic acid and L-arginine retards the progression of subclinical atherosclerosis: A randomized
clinical trial. Preventive Medicine (2009). PDF
•Low fingertip temperature rebound measured by digital thermal monitoring strongly correlates with the presence and extent of coronary artery
disease diagnosed by 64-slice multi-detector computed tomography. Int. J Cardiovasc Imaging (2009). PDF
Accompanying Editorial: Digital thermal monitoring of vascular function: a novel tool to improve cardiovascular risk assessment. Vascular
Medicine (2009). PDF
•Concomitant insulin resistance and impaired vascular function is associated with increased coronary artery calcification. Int. Journal of
Cardiology (2009). PDF
•Vascular dysfunction measured by fingertip thermal monitoring is associated with the extent of myocardial perfusion defect. JNC (2009). PDF
•Vascular function measured by fingertip thermal reactivity is impaired in patients with metabolic syndrome and diabetes. J Clin Hypertens
(2009). PDF
•Relations between digital thermal monitoring of vascular function, the Framingham risk score, and coronary artery calcium score. JCCT (2008).
PDF
Accompanying Editorial: Anatomy, physiology, or epidemiology: Which is the best target for assessing vascular health? JCCT (2008). Abstract
•Flow mediated change of finger tip temperature in patients with high cardiovascular risk. Cardiologia Hungarica (2005). PDF English summary
PDF Graphical Data
•Post-Exercise Reactive Hyperemia: A Novel Preoperative Risk Assessment Tool Poster Abstract
•Digital Thermal Monitoring: Non-Invasive Assessment of Perioperative Microvascular Function Poster Abstract
DTM Technical Papers:
Reproducibility and variability of digital thermal monitoring of vascular reactivity. Clin Physiol Funct Imaging
(2011). PDF
Use of temperature alterations to characterize vascular reactivity. Clin Physiol Funct Imaging (2011). PDF
Sensitivity of Digital Thermal Monitoring Parameters to Reactive Hyperemia. Journal of Biomechanical
Engineering, ASME (2010). PDF
Digital Thermal Monitoring (DTM) of Vascular Reactivity Closely Correlates with Doppler Flow Velocity. Conf Proc
IEEE Eng Med Biol Soc (2009). PDF
Lumped parameter thermal model for the study of vascular reactivity in the fingertip. J Biomech Eng (2008).
Abstract
Interrelationships among noninvasive measures of postischemic macro- and microvascular reactivity J Appl Physiol
(2008). PDF
Review Articles about Vascular/Endothelial Dysfunction Measurement:
Endothelial dysfunction over the course of coronary artery disease. Eur Heart J (2013). PDF
The Assessment of Endothelial Function: From Research Into Clinical Practice. Circulation (2012). PDF
The Endothelial Cell in Health and Disease: Its Function, Dysfunction, Measurement and Therapy. Int J Impot Res
(2010). PDF
Endothelial function as a functional expression of cardiovascular risk factors. Biomark Med (2010). PDF
Additional Publications
1. Schier R, Hinkelbein J, Marcus H, Smallwood A, Correa AM, Mehran R, El-Zein R, Riedel B. A
novel technique for the assessment of preoperative cardiovascular risk: reactive hyperemic
response to short-term exercise. Biomed Res Int. 2013;2013:837130. PMID: 23691513
2. Schier R, Marcus HE, Mansur E, Lei X, El-Zein R, Mehran R, Purugganan R, Heir JS, Riedel B,
Gottumukkala V. Evaluation of digital thermal monitoring as a tool to assess perioperative
vascular reactivity J Atheroscler Thromb. 2013;20(3):277-86. PMID: 23197179
3. Ahmadi N, McQuilkin GL, Akhtar MW, Hajsadeghi F, Kleis SJ, Hecht H, Naghavi M, Budoff M.
Reproducibility and variability of digital thermal monitoring of vascular reactivity. Clin Physiol
Funct Imaging. 2011 Nov;31(6):422-8. PMID: 21981452
4. Akhtar MW, Kleis SJ, Metcalfe RW, Naghavi M. Sensitivity of digital thermal monitoring
parameters to reactive hyperemia. J Biomech Eng. 2010 May;132(5):051005. PMID: 20459206
5. Schwartz BG, Economides C, Mayeda GS, Burstein S, Kloner RA. The endothelial cell in health
and disease: its function, dysfunction, measurement and therapy. Int J Impot Res. 2010 MarApr;22(2):77-90. Review. PMID: 20032988
6. van der Wall EE, Schuijf JD, Bax JJ, Jukema JW, Schalij MJ. Fingertip digital thermal monitoring:
a fingerprint for cardiovascular disease? Int J Cardiovasc Imaging. 2010 Feb;26(2):249-52. PMID:
20012695