A Control Systems Approach to Quantify Wall Shear Stress Normalization by Flow-Mediated Dilation in the Brachial Artery

Flow-mediated dilation is aimed at normalization of local wall shear stress under varying blood flow conditions. Blood flow velocity and vessel diameter are continuous and opposing influences that modulate wall shear stress. We derived an index FMDv to quantify wall shear stress normalization performance by flow-mediated dilation in the brachial artery. In 22 fasting presumed healthy men, we first assessed intra-and inter-session reproducibilities of two indices pFMD(v) and mFMD(v), which consider the relative peak and relative mean hyperemic change in flow velocity, respectively. Second, utilizing oral glucose loading, we evaluated the tracking performance of both FMDv indices, in comparison with existing indices [i.e., the relative peak diameter increase (%FMD), the peak to baseline diameter ratio (D-peak/D-base), and the relative peak diameter increase normalized to the full area under the curve of blood flow velocity with hyperemia (FMD/shear(AUC)) or with area integrated to peak hyperemia (FMD/shear(AUC_peak))]. Inter-session and intra-session reproducibilities for pFMD(v), mFMD(v) and %FMD were comparable (intra-class correlation coefficients within 0.521-0.677 range). Both pFMD(v) and mFMD(v) showed more clearly a reduction after glucose loading (reduction of similar to 45%, p <= 0.001) than the other indices (% given are relative reductions): %FMD (similar to 11%, p >= 0.074); D-peak/D-base (similar to 11%, p >= 0.074); FMD/shear(AUC_peak) (similar to 20%, p >= 0.016) and FMD/shear(AUC) (similar to 38%, p <= 0.038). Further analysis indicated that wall shear stress normalization under normal (fasting) conditions is already far from ideal (FMDv << 1), which (therefore) does not materially change with glucose loading. Our approach might be useful in intervention studies to detect intrinsic changes in shear stress normalization performance in conduit arteries.