Methods for evaluating endothelial function: a position statement from the European Society of Cardiology Working Group on Peripheral Circulation

John Lekakis, Pierre Abraham, Alberto Balbarini, Andrew Blann, Chantal M. Boulanger, John Cockcroft, Francesco Cosentino, John Deanfield, Augusto Gallino, Ignatios Ikonomidis, Dimitrios Kremastinos, Ulf Landmesser, Athanase Protogerou, Christodoulos Stefanadis, Dimitris Tousoulis, Giuseppe Vassalli, Hans Vink, Nikos Werner, Ian Wilkinson, Charalambos Vlachopoulos*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


The endothelium holds a pivotal role in cardiovascular health and disease. Assessment of its function was until recently limited to experimental designs due to its location. The advent of novel techniques has facilitated testing on a more detailed basis, with focus on distinct pathways. This review presents available in-vivo and ex-vivo methods for evaluating endothelial function with special focus on more recent ones. The diagnostic modalities covered include assessment of epicardial and microvascular coronary endothelial function, local vasodilation by venous occlusion plethysmography and flow-mediated dilatation, arterial pulse wave analysis and pulse amplitude tonometry, microvascular blood flow by laser Doppler flowmetry, biochemical markers and bioassays, measurement of endothelial-derived microparticles and progenitor cells, and glycocalyx measurements. Insights and practical information on the theoretical basis, methodological aspects, and clinical application in various disease states are discussed. The ability of these methods to detect endothelial dysfunction before overt cardiovascular disease manifests make them attractive clinical tools for prevention and rehabilitation.
Original languageEnglish
Pages (from-to)775-789
JournalEuropean Journal of Cardiovascular Prevention & Rehabilitation
Issue number6
Publication statusPublished - Dec 2011


  • Biomarkers
  • cell-derived microparticles
  • coronary angiography
  • endothelium
  • glycocalyx
  • laser Doppler flowmetry
  • nitric oxide
  • plethysmography
  • progenitor cells
  • pulse

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