Mediterr J Rheumatol 2021;32(1):6-14
Non-Invasive Assessment of Endothelial Dysfunction in Pulmonary Arterial Hypertension
Authors Information

1. Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

3. Adult Congenital Heart Centre and National Centre for Pulmonary Arterial Hypertension, Royal Brompton  Hospital, Guy's and St Thomas' NHS Foundation Trust, Imperial College, London, United Kingdom

4. Department of Internal Medicine, General Hospital of Giannitsa, Giannitsa, Greece 

5. Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece

Arvanitaki APagkopoulou E 


Pulmonary arterial hypertension (PAH) is characterised by an increased pressure in the pulmonary arterial circulation, resulting in the elevation of pulmonary vascular resistance. Pulmonary endothelial dysfunction and inflammation, triggered by shear stress and hypoxia, constitute the hallmarks of pulmonary vasculopathy by promoting endothelial and smooth muscle cells proliferation, vasoconstriction, and thrombosis. While research was predominantly focused on pulmonary vasculature, the investigation of peripheral endothelial damage in different vascular beds has attracted the interest over the last years. As a result, effective non-invasive methods that can assess the endothelial function and the architectural integrity have been utilized for the evaluation of pulmonary and peripheral vasculature. Non-invasive plethysmography, pulmonary flow reserve, nailfold videocapillaroscopy, near-infrared spectroscopy, and imaging techniques such as magnetic resonance angiography and perfusion imaging coupled by a number of biomarkers can be used for the assessment of peripheral vascular function in PAH individuals. In this review, we summarise and critically approach the current evidence of more systemic derangement of vascular function in PAH defined by novel, non-invasive methods employed for functional and morphological assessment of endothelium and microcirculation.

Article Submitted: 6 Jan 2021; Revised Form: 25 Jan 2021; Article Accepted: 26 Jan 2021; Available Online: 15 Feb 2021


This work is licensed under a Creative Commons Attribution 4.0 International License (CC-BY). 

©Dara A, Arvanitaki A, Theodorakopoulou M, Christos A, Pagkopoulou E, Boutou A.