Response to Noninvasive Assessment of Subclinical Atherosclerosis in Children and Adolescents
The writing group thanks Thijssen et al1 for their comments. Their observations on the need for impeccable technique in the assessment of brachial flow-mediated dilation must be acknowledged. The review of shear stress and flow-mediated dilation by Pyke and Tschakovsky2 is an excellent article outlining the physiology responsible for producing the dilation of the brachial artery after ischemia. Although our published statement was not designed to include extensive background on the technique, we were remiss in not including this article in our references. We also agree that edge detection and wall tracking significantly improve diameter measurements. Investigators should make every effort to obtain these operator-independent types of software. Referencing the scientific basis for choice of distal cuff placement (that proximal cuff placement results in dilation that may not be NO dependent) is also an important addition that strengthens the recommendations. We again thank this group of investigators with extensive experience in the physiology of endothelial function testing for their critical review of the statement.