Śródbłonek tętnic wieńcowych - rola w patogenezie miażdżycy oraz kliniczne metody oceny jego funkcji

The aim of this article is to focus attention on arterial endothelium. We should all be aware of the great importance of this cellular layer which plays a very important role in atherogenesis, platelet activation and inhibition, and thrombogenesis. Endothelium produces plenty of active substances like: prostacyclins, PDGF, PAF, superoxides and the most important nitric oxide — EDRF/NO. This simple agent is one of the most potent factor regulating almost every reaction in human arteries. As was described lack of NO production is the first sign of development of atherogenesis. Even in angiogrphically normal coronary arteries in the presence of coronary heart disease risk factors synthesis of nitric oxide is impaired. Endothelial dysfunction is one of the first signs of developing atherogenesis. To evaluate the functional status of endothelium we can use many both invasive and noninvasive procedures. All these procedures relay on development of endothelium dependant relaxation compared with relaxation after nitroglycerin (endothelium independent factor). Noninvasive procedures like ultrasound assessment of endothelium dependent vasodilatation may be useful because of satisfactory accuracy, specificity and reproducibility. Most widely used is ultrasound assessment of femoral or brachial artery relaxation after reactive hyperemia with cuff inflation compared to oral dose of NTG. With these techniques we are able to perform early assessment of endothelium dysfunction what is useful in identification of patients with early stages of atherogenesis. Further studies should enable a more detailed description of endothelium pathogenesis and coronary artery disease development and treatment.