Examination of Possible Flow Turbulence during Flow-Mediated Dilation Testing

The validity of the flow-mediated dilation (FMD) test has been doubted due to the lack of normalization to the primary stimulus, shear stress. Shear stress can be calculated using a simplified mathematical model based on Poiseuille’s law. Poiseuille’s law assumes that the blood velocity profile is parabolic. The presence of turbulence will violate this assumption. The Reynolds number (RE) is used to define critical values for the transition from laminar to turbulent flow. Between RE values of 2000 and 4000, flow enters a transitional phase where turbulence is possible. Purpose: To determine whether brachial artery blood flow becomes turbulent during reactive hyperemia following forearm ischemia. Methods: Eleven healthy male subjects (25 ± 5 years) were tested. Brachial artery diameters and blood velocities were measured continuously following 2, 4, 6 and 10 minutes ischemia. The peak post-ischemic RE (REpeak) and RE integrated over 40 seconds (RE40) post-ischemia were calculated. Results: There was a significant change in REpeak (F4,7 = 98.573, p = ≤ 0.001) and RE40) (F4,7) = 50.613, p = ≤ 0.001) in response to ischemia. Within-subjects contrasts revealed a significant increase in REpeak and RE40 for each duration of ischemia versus baseline (p = ≤ 0.001). Following 4 minutes of ischemia there was approximately 12 seconds of potentially turbulent flow. Conclusion: Blood flow transitions between laminar and turbulent flow during ischemia-induced reactive hyperemia. This may limit the efficacy of estimating shear stress when using the standard FMD test protocol.