scholarly journals CORP: Ultrasound assessment of vascular function with the passive leg movement technique

2017 ◽  
Vol 123 (6) ◽  
pp. 1708-1720 ◽  
Author(s):  
Jayson R. Gifford ◽  
Russell S. Richardson
Keyword(s):  
Vascular Function ◽  
Cardiovascular Health ◽  
Vascular System ◽  
The Elderly ◽  
Passive Movement ◽  
Flow Mediated Dilation ◽  
Peripheral Vascular ◽  
Ultrasound Assessment ◽  
Leg Movement ◽  
Hyperemic Response

As dysfunction of the vascular system is an early, modifiable step in the progression of many cardiovascular diseases, there is demand for methods to monitor the health of the vascular system noninvasively in clinical and research settings. Validated by very good agreement with more technical assessments of vascular function, like intra-arterial drug infusions and flow-mediated dilation, the passive leg movement (PLM) technique has emerged as a powerful, yet relatively simple, test of peripheral vascular function. In the PLM technique, the change in leg blood flow elicited by the passive movement of the leg through a 90° range of motion is quantified with Doppler ultrasound. This relatively easy-to-learn test has proven to be ≤80% dependent on nitric oxide bioavailability and is especially adept at determining peripheral vascular function across the spectrum of cardiovascular health. Indeed, multiple reports have documented that individuals with decreased cardiovascular health such as the elderly and those with heart failure tend to exhibit a substantially blunted PLM-induced hyperemic response (~50 and ~85% reduction, respectively) compared with populations with good cardiovascular health such as young individuals. As specific guidelines have not yet been put forth, the purpose of this Cores of Reproducibility in Physiology (CORP) article is to provide a comprehensive reference for the assessment and interpretation of vascular function with PLM with the aim to increase reproducibility and consistency among studies and facilitate the use of PLM as a research tool with clinical relevance.

scholarly journals Delineating the age-related attenuation of vascular function: Evidence supporting the efficacy of the single passive leg movement as a screening tool

2019 ◽  
Vol 126 (6) ◽  
pp. 1525-1532 ◽  
Author(s):  
Jay R. Hydren ◽  
Ryan M. Broxterman ◽  
Joel D. Trinity ◽  
Jayson R. Gifford ◽  
Oh Sung Kwon ◽  
...  
Keyword(s):  
Blood Flow ◽  
Vascular Function ◽  
Screening Test ◽  
Vascular Dysfunction ◽  
Peripheral Vascular ◽  
Leg Blood Flow ◽  
Age Related ◽  
Cut Score ◽  
Leg Movement ◽  
Hyperemic Response

Continuous passive leg movement (PLM) is a promising clinical assessment of the age-related decline in peripheral vascular function. To further refine PLM, this study evaluated the efficacy of a single PLM (sPLM), a simplified variant of the more established continuous movement approach, to delineate between healthy young and old men based on vascular function. Twelve young (26 ± 5 yr) and 12 old (70 ± 7 yr) subjects underwent sPLM (a single passive flexion and extension of the knee joint through 90°), with leg blood flow (LBF, common femoral artery with Doppler ultrasound), blood pressure (finger photoplethysmography), and leg vascular conductance (LVC) assessed. A receiver operator characteristic curve analysis was used to determine an age-specific cut score, and a factor analysis was performed to assess covariance. Baseline LBF and LVC were not different between groups ( P = 0.6). The high level of covariance and similar predictive value for all PLM-induced LBF and LVC responses indicates LBF, alone, can act as a surrogate variable in this paradigm. The peak sPLM-induced increase in LBF from baseline was attenuated in the old (Young: 717 ± 227, Old: 260 ± 97 ml/min, P < 0.001; cut score: 372 ml/min), as was the total LBF response (Young: 155 ± 67, Old: 26 ± 17 ml, P < 0.001; cut score: 58 ml). sPLM, a simplified version of PLM, exhibits the prerequisite qualities of a valid screening test for peripheral vascular dysfunction, as evidenced by an age-related attenuation in the peripheral hyperemic response and a clearly delineated age-specific cut score. NEW & NOTEWORTHY Single passive leg movement (sPLM) exhibits the prerequisite qualities of a valid screening test for peripheral vascular dysfunction. sPLM displayed an age-related reduction in the peripheral hemodynamic response for amplitude, duration, initial rate of change, and total change with clearly delineated age-specific cut scores. sPLM has a strong candidate variable that is a simple single numeric value, for which to appraise peripheral vascular function, the 45-s hyperemic response (leg blood flow area under the curve: 45 s).

scholarly journals The role of the endothelium in the hyperemic response to passive leg movement: looking beyond nitric oxide

2020 ◽  
Author(s):  
Joel D. Trinity ◽  
Oh Sung Kwon ◽  
Ryan M. Broxterman ◽  
Jayson R. Gifford ◽  
Andrew C. Kithas ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Blood Flow ◽  
Vascular Function ◽  
No Synthase ◽  
Ketorolac Tromethamine ◽  
Arterial Infusion ◽  
Healthy Men ◽  
Leg Movement ◽  
Hyperemic Response

Passive leg movement (PLM) evokes a robust and predominantly nitric oxide (NO)-mediated increase in blood flow that declines with age and disease. Consequently, PLM is becoming increasingly accepted as a sensitive assessment of endothelium-mediated vascular function. However, a substantial PLM-induced hyperemic response is still evoked despite NO synthase (NOS) inhibition. Therefore, in 9 young healthy men (25±4 yrs), this investigation aimed to determine if the combination of two potent endothelium-dependent vasodilators, specifically prostaglandin (PG) and endothelium-derived hyperpolarizing factor (EDHF), account for the remaining hyperemic response to the two variants of PLM, PLM (60 movements) and single PLM (sPLM, 1 movement) when NOS is inhibited. The leg blood flow (LBF, Doppler ultrasound) response to PLM and sPLM following the intra-arterial infusion of NG-monomethyl L-arginine (L-NMMA), to inhibit NOS, was compared to the combined inhibition of NOS, cyclooxygenase (COX), and cytochrome P450 (CYP450) by L-NMMA, ketorolac tromethamine (KET), and fluconazole (FLUC), respectively. NOS inhibition attenuated the overall LBF (LBFAUC) response to both PLM (control: 456±194, L-NMMA: 168±127 ml, p<0.01) and sPLM (control: 185±171, L-NMMA: 62±31 ml, p=0.03). The combined inhibition of NOS, COX, and CYP450 (i.e. L-NMMA+KET+FLUC) did not further attenuate the hyperemic responses to PLM (LBFAUC: 271±97 ml, p>0.05) or sPLM (LBFAUC: 72±45 ml, p>0.05). Therefore, PG and EDHF do not collectively contribute to the non-NOS-derived NO-mediated, endothelium-dependent, hyperemic response to either PLM or sPLM in healthy young men. These findings add to the mounting evidence and understanding of the vasodilatory pathways assessed by the PLM and sPLM vascular function tests.

scholarly journals Perfusion pressure and movement-induced hyperemia: evidence of limited vascular function and vasodilatory reserve with age

2013 ◽  
Vol 304 (4) ◽  
pp. H610-H619 ◽  
Author(s):  
H. Jonathan Groot ◽  
Joel D. Trinity ◽  
Gwenael Layec ◽  
Matthew J. Rossman ◽  
Stephen J. Ives ◽  
...  
Keyword(s):  
Blood Flow ◽  
Vascular Function ◽  
Perfusion Pressure ◽  
The Elderly ◽  
Passive Movement ◽  
Hemodynamic Responses ◽  
Central Hemodynamic ◽  
Seated Posture ◽  
No Bioavailability ◽  
The Impact

To better understand the mechanisms contributing to reduced blood flow with age, this study sought to elucidate the impact of altered femoral perfusion pressure (FPP) on movement-induced hyperemia. Passive leg movement was performed in 10 young (22 ± 1 yr) and 12 old (72 ± 2 yr) healthy men for 2 min, with and without a posture-induced change in FPP (∼7 ± 1 ΔmmHg). Second-by-second measurements of central and peripheral hemodynamic responses were acquired noninvasively (finger photoplethysmography and Doppler ultrasound, respectively), with FPP confirmed in a subset of four young and four old subjects with arterial and venous catheters. Central hemodynamic responses (heart rate, stroke volume, cardiac output, mean arterial pressure) were not affected by age or position. The young exhibited a ∼70% greater movement-induced peak change in leg blood flow (ΔLBFpeak) in the upright-seated posture (supine: 596±68 ml/min; upright: 1,026 ± 85 ml/min). However, in the old the posture change did not alter ΔLBFpeak (supine: 417±42 ml/min; upright: 412±56 ml/min), despite the similar increases in FPP. Similarly, movement-induced peak change in leg vascular conductance was ∼80% greater for the young in the upright-seated posture (supine: 7.1 ± 0.8 ml·min−1·mmHg−1; upright: 12.8 ± 1.3 ml·min−1·mmHg−1), while the old again exhibited no difference between postures (supine: 4.7 ± 0.4 ml·min−1·mmHg−1; upright: 4.8 ± 0.5 ml·min−1·mmHg−1). Thus this study reveals that, unlike the young, increased FPP does not elicit an increase in movement-induced hyperemia or vasodilation in the old. In light of recent evidence that the majority of the first minute of passive movement-induced hyperemia is predominantly nitric oxide (NO) dependent in the young, these findings in the elderly may be largely due to decreased NO bioavailability, but this remains to be definitively determined.

scholarly journals Passive leg movement and nitric oxide-mediated vascular function: the impact of age

2015 ◽  
Vol 308 (6) ◽  
pp. H672-H679 ◽  
Author(s):  
Joel D. Trinity ◽  
H. Jonathan Groot ◽  
Gwenael Layec ◽  
Matthew J. Rossman ◽  
Stephen J. Ives ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Vascular Function ◽  
Area Under The Curve ◽  
The Elderly ◽  
Novel Approach ◽  
Leg Movement ◽  
The Impact ◽  
Male Subjects ◽  
Peak Increase

In young healthy men, passive leg movement (PLM) elicits a robust nitric oxide (NO)-dependent increase in leg blood flow (LBF), thus providing a novel approach to assess NO-mediated vascular function. While the magnitude of the LBF response to PLM is markedly reduced with age, the role of NO in this attenuated response in the elderly is unknown. Therefore, this study sought to determine the contribution of NO in the PLM-induced LBF with age. Fourteen male subjects (7 young, 24 ± 1 yr; and 7 old, 75 ± 3 yr) underwent PLM with and without NO synthase (NOS) inhibition achieved by intra-arterial infusion of NG-monomethyl-l-arginine (l-NMMA). LBF was determined second-by-second by Doppler ultrasound, and central hemodynamics were measured by finger photoplethysmography. NOS inhibition blunted the PLM-induced peak increase in LBF in the young (control: 668 ± 106; l-NMMA: 431 ± 95 Δml/min; P = 0.03) but had no effect in the old (control: 266 ± 98; l-NMMA: 251 ± 92 Δml/min; P = 0.59). Likewise, the magnitude of the reduction in the overall (i.e., area under the curve) PLM-induced LBF response to NOS inhibition was less in the old (LBF: −31 ± 18 ml) than the young (LBF: −129 ± 21 ml; P < 0.01). These findings suggest that the age-associated reduction in PLM-induced LBF in the elderly is primarily due to a reduced contribution to vasodilation from NO and therefore support the use of PLM as a novel approach to assess NO-mediated vascular function across the lifespan.

scholarly journals Nitric oxide-mediated vascular function in sepsis using passive leg movement as a novel assessment: a cross-sectional study

2016 ◽  
Vol 120 (9) ◽  
pp. 991-999 ◽  
Author(s):  
Ashley D. Nelson ◽  
Matthew J. Rossman ◽  
Melissa A. Witman ◽  
Zachary Barrett-O'Keefe ◽  
H. Jonathan Groot ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Vascular Function ◽  
Area Under The Curve ◽  
Organ Damage ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
No Bioavailability ◽  
Leg Movement ◽  
Hyperemic Response

Post-cuff occlusion flow-mediated dilation (FMD) is a proposed indicator of nitric oxide (NO) bioavailability and vascular function. FMD is reduced in patients with sepsis and may be a marker of end organ damage and mortality. However, FMD likely does not solely reflect NO-mediated vasodilation, is technically challenging, and often demonstrates poor reproducibility. In contrast, passive leg movement (PLM), a novel methodology to assess vascular function, yields a hyperemic response that is predominately NO-dependent, reproducible, and easily measured. This study evaluated PLM as an approach to assess NO-mediated vascular function in patients with sepsis. We hypothesized that PLM-induced hyperemia, quantified by the increase in leg blood flow (LBF), would be attenuated in sepsis. In a cross-sectional study, 17 subjects in severe sepsis or septic shock were compared with 16 matched healthy controls. Doppler ultrasound was used to assess brachial artery FMD and the hyperemic response to PLM in the femoral artery. FMD was attenuated in septic compared with control subjects (1.1 ± 1.7% vs. 6.8 ± 1.3%; values are means ± SD). In terms of PLM, baseline LBF (196 ± 33 ml/min vs. 328 ± 20 ml/min), peak change in LBF from baseline (133 ± 28 ml/min vs. 483 ± 86 ml/min), and the LBF area under the curve (16 ± 8.3 vs. 143 ± 33) were all significantly attenuated in septic subjects. Vascular function, as assessed by both FMD and PLM, is attenuated in septic subjects compared with controls. These data support the concept that NO bioavailability is attenuated in septic subjects, and PLM appears to be a novel and feasible approach to assess NO-mediated vascular function in sepsis.

scholarly journals Contribution of nitric oxide to brachial artery vasodilation during progressive handgrip exercise in the elderly

2013 ◽  
Vol 305 (8) ◽  
pp. R893-R899 ◽  
Author(s):  
Joel D. Trinity ◽  
D. Walter Wray ◽  
Melissa A. H. Witman ◽  
Gwenael Layec ◽  
Zachary Barrett-O'Keefe ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Shear Rate ◽  
Brachial Artery ◽  
Vascular Function ◽  
The Elderly ◽  
Flow Mediated Dilation ◽  
Handgrip Exercise ◽  
Modest Contribution ◽  
Older Subjects ◽  
The Relationship

The reduction in nitric oxide (NO)-mediated vascular function with age has largely been determined by flow-mediated dilation (FMD). However, in light of recent uncertainty surrounding the NO dependency of FMD and the recognition that brachial artery (BA) vasodilation during handgrip exercise is predominantly NO-mediated in the young, we sought to determine the contribution of NO to BA vasodilation in the elderly using the handgrip paradigm. BA vasodilation during progressive dynamic (1 Hz) handgrip exercise performed at 3, 6, 9, and 12 kg was assessed with and without NO synthase (NOS) inhibition [intra-arterial NG-monomethyl-l-arginine (l-NMMA)] in seven healthy older subjects (69 ± 2 yr). Handgrip exercise in the control condition evoked significant BA vasodilation at 6 (4.7 ± 1.4%), 9 (6.5 ± 2.2%), and 12 kg (9.5 ± 2.7%). NOS inhibition attenuated BA vasodilation, as the first measurable increase in BA diameter did not occur until 9 kg (4.0 ± 1.8%), and the change in BA diameter at 12 kg was reduced by ∼30% (5.1 ± 2.2%), with unaltered shear rate (Control: 407 ± 57, l-NMMA: 427 ± 67 s−1). Although shifted downward, the slope of the relationship between BA diameter and shear rate during handgrip exercise was unchanged (Control: 0.0013 ± 0.0004, l-NMMA: 0.0011 ± 0.007, P = 0.6) as a consequence of NOS inhibition. Thus, progressive handgrip exercise in the elderly evokes a robust BA vasodilation, the magnitude of which was only minimally attenuated following NOS inhibition. This modest contribution of NO to BA vasodilation in the elderly supports the use of the handgrip exercise paradigm to assess NO-dependent vasodilation across the life span.

scholarly journals Vascular function assessed by passive leg movement and flow-mediated dilation: initial evidence of construct validity

2016 ◽  
Vol 311 (5) ◽  
pp. H1277-H1286 ◽  
Author(s):  
Matthew J. Rossman ◽  
H. Jonathan Groot ◽  
Ryan S. Garten ◽  
Melissa A. H. Witman ◽  
Russell S. Richardson
Keyword(s):  
Construct Validity ◽  
Vascular Function ◽  
Health Assessment ◽  
Flow Mediated Dilation ◽  
Vascular Health ◽  
Vascular Conductance ◽  
Significant Relationships ◽  
Vasodilatory Response ◽  
Leg Movement ◽  
Noninvasive Assessment

The vasodilatory response to passive leg movement (PLM) appears to provide a novel, noninvasive assessment of vascular function. However, PLM has yet to be compared with the established noninvasive assessment of vascular health, flow-mediated dilation (FMD). Therefore, as an initial evaluation of the construct validity of PLM and upright seated and supine PLM as well as brachial (BA) and superficial femoral (SFA) artery FMDs were performed in 10 young (22 ± 1) and 30 old (73 ± 2) subjects. During upright seated PLM, the peak change in leg blood flow (ΔLBF) and leg vascular conductance (ΔLVC) was significantly correlated with BA ( r = 0.57 and r = 0.66) and SFA ( r = 0.44 and r = 0.41, ΔLBF and ΔLVC, respectively) FMD. Furthermore, although the relationships were not as strong, the supine PLM response was also significantly correlated with BA ( r = 0.38 and r = 0.35) and SFA ( r = 0.39 and r = 0.35, ΔLBF and ΔLVC, respectively) FMD. Examination of the young and old separately, however, revealed that significant relationships persisted in both groups only for the upright seated PLM response and BA FMD (young: r = 0.73 and r = 0.77; old: r = 0.35 and r = 0.45, ΔLBF and ΔLVC, respectively). Normalizing FMD for shear rate during PLM abrogated all significant relationships between the PLM and FMD response, suggesting a role for nitric oxide (NO) in these associations. Collectively, these data indicate that PLM, particularly upright seated PLM, likely provides an index of vascular health analogous to the traditional FMD test. Given the relative ease of PLM implementation, these data have important positive implications for PLM as a clinical vascular health assessment.

scholarly journals Understanding exercise-induced hyperemia: central and peripheral hemodynamic responses to passive limb movement in heart transplant recipients

2010 ◽  
Vol 299 (5) ◽  
pp. H1653-H1659 ◽  
Author(s):  
Melissa A. Hayman ◽  
Jose N. Nativi ◽  
Josef Stehlik ◽  
John McDaniel ◽  
Anette S. Fjeldstad ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Vascular Function ◽  
Knee Extension ◽  
Limb Movement ◽  
Passive Movement ◽  
Peripheral Vascular ◽  
Femoral Artery Blood Flow ◽  
Femoral Blood ◽  
Exercise Induced ◽  
Artery Flow

To better characterize the contribution of both central and peripheral mechanisms to passive limb movement-induced hyperemia, we studied nine recent (<2 yr) heart transplant (HTx) recipients (56 ± 4 yr) and nine healthy controls (58 ± 5 yr). Measurements of heart rate (HR), stroke volume (SV), cardiac output (CO), and femoral artery blood flow were recorded during passive knee extension. Peripheral vascular function was assessed using brachial artery flow-mediated dilation (FMD). During passive limb movement, the HTx recipients lacked an HR response (0 ± 0 beats/min, Δ0%) but displayed a significant increase in CO (0.4 ± 0.1 l/min, Δ5%) although attenuated compared with controls (1.0 ± 0.2 l/min, Δ18%). Therefore, the rise in CO in the HTx recipients was solely dependent on increased SV (5 ± 1 ml, Δ5%) in contrast with the controls who displayed significant increases in both HR (6 ± 2 beats/min, Δ11%) and SV (5 ± 2 ml, Δ7%). The transient increase in femoral blood volume entering the leg during the first 40 s of passive movement was attenuated in the HTx recipients (24 ± 8 ml) compared with controls (93 ± 7 ml), whereas peripheral vascular function (FMD) appeared similar between HTx recipients (8 ± 2%) and controls (6 ± 1%). These data reveal that the absence of an HR increase in HTx recipients significantly impacts the peripheral vascular response to passive movement in this population and supports the concept that an increase in CO is a major contributor to exercise-induced hyperemia.

Pengaruh Peningkatan Pengetahuan Penyakit Hipertensi Terhadap Nilai Tekanan Darah pada Lansia di Posyandu Lansia Desa Pakisrejo Tulungagung

2021 ◽  
Vol 4 (6) ◽  
pp. 1349-1357
Author(s):  
Ana Amalia
Keyword(s):  
Blood Pressure ◽  
Community Service ◽  
Vascular System ◽  
The Elderly ◽  
P Value ◽  
Test Design ◽  
Peripheral Vascular ◽  
Hypertensive Patients ◽  
Functional Changes ◽  
Post Test

 ABSTRAK Hipertensi sering terjadi pada lansia karena terjadi perubahan struktural dan fungsional pada sistem pembuluh perifer yang mengakibatkan penuruan distensi dan daya regang pembuluh darah. Kurangnya pengetahuan pasien tentang penyakit hipertensi menyebabkan target terapi pengobatan sulit untuk dicapai. Pada pengabdian masyarakat ini bertujuan untuk meningkatkan pengetahuan pasien lansia yang menderita hipertensi dengan cara pemberian informasi melalui leaflet. Metode pengabdian masyarakat ini menggunakan rancangan pre-eksperimental dengan cara pre test – post test design yaitu dengan melakukan intervensi berupa penyuluhan menggunakan leaflet. Hasil pengabdian masyarakat ini menunjukkan terdapat pengaruh yang signifikan terhadap pemberian leaflet dan edukasi terhadap peningkatan pengetahuan pasien hipertensi dengan nilai p-value 0,001. Terdapat pengaruh yang signifikan terhadap pemberian leaflet dan edukasi terhadap penurunan tekanan darah sistolik pasien hipertensi dengan nilai p-value 0,006 dan tidak terdapat pengaruh yang signifikan terhadap pemberian leaflet dan edukasi terhadap peningkatan pengetahuan pasien hipertensi dengan nilai p-value 0,414. Kata kunci: Hipertensi, Lansia, Leaflet, Pengetahuan  ABSTRACT Hypertension often occurs in the elderly due to structural and functional changes in the peripheral vascular system which results in decreased distension and stretching of blood vessels. The patient's lack of knowledge about hypertension causes the target of treatment therapy to be difficult to achieve. This community service aims to increase the knowledge of elderly patients suffering from hypertension by providing information through leaflets. This community service method uses a pre-experimental design by means of pre-test - post-test design, namely by intervening in the form of counseling using leaflets. The results of this community service show that there is a significant effect on the provision of leaflets and education on increasing the knowledge of hypertensive patients with a p-value of 0.001. There is a significant effect on the provision of leaflets and education on the reduction of systolic blood pressure in hypertensive patients with a p-value of 0.006 and there is no significant effect on leaflet provision and education on increasing knowledge of hypertensive patients with a p-value of 0.414. Keywords: Hypertension, Elderly, Leaflet, Knowledge

Abstract P355: Comparable Impairment Of Vascular Endothelial Function By A Wide Range Of Electronic Nicotine Delivery Devices

2021 ◽  
Vol 129 (Suppl_1) ◽  
Author(s):  
Poonam Rao ◽  
Kelly Tan ◽  
Daniel D Han ◽  
Ronak Derakhshandeh ◽  
Matthew L Springer
Keyword(s):  
Endothelial Function ◽  
Vascular Function ◽  
Cardiovascular Health ◽  
Tobacco Product ◽  
Flow Mediated Dilation ◽  
Single Session ◽  
Previous Generation ◽  
Nicotine Delivery ◽  
Wide Range ◽  
Anaesthetized Rats

Introduction: Electronic nicotine delivery systems (ENDS; i.e., vaping devices) such as e-cigarettes, heated tobacco products, and newer coil-less ultrasonic vaping devices are promoted as less harmful alternatives to combustible cigarettes. However, the cardiovascular health effects of these devices are understudied. We investigated whether exposure to aerosol from a wide range of ENDS devices with and without nicotine, including a new ultrasonic vaping device, impairs endothelial function. Hypothesis: ENDS aerosols irrespective of nicotine, flavors, and heating coil impair endothelial function comparably to smoke from cigarettes. Methods: We exposed 11 groups (n=8), of anaesthetized rats to aerosol from propylene glycol (PG), vegetable glycerin (VG), PG+VG without nicotine, a USONICIG Zip ultrasonic vaping device, previous generation e-cigarettes (tank style with freebase nicotine), 5% nicotine JUUL pods of three flavors (Virginia tobacco, Mango, and Menthol), and an IQOS heated tobacco product; with Marlboro Red cigarette smoke and clean air as controls, to a single session of 10 cycles of pulsatile 5s exposure over 5 minutes. Endothelial function was quantified as arterial flow-mediated dilation (FMD) using micro-ultrasound. Results: Aerosol/smoke from all conditions except air significantly impaired FMD (Figure: each colored line denotes one rat, black horizontal bars denote means). The extent of impairment ranged from 40%-67% although there were no significant differences between groups. Nicotine absorption into the blood varied widely from these undiluted aerosols (those containing nicotine), with IQOS being the highest, and USONICIG and previous generation e-cig being the lowest. Conclusions: A single session of exposure to aerosol from a wide range of ENDS, including multiple types of e-cigarettes, a heated tobacco product, and an ultrasonic vaping device, all impair endothelial vascular function comparably to combusted cigarettes. Key words: JUUL, IQOS, ultrasonic vaping device, e-liquids, flow-mediated dilation

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