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Dynamic Vessel Analyzer (DVA) – a new method to detect endothelial dysfunction in chronic heart failure: correlation between DVA and asymmetric dimethyl arginine (ADMA)

  • Markus Schwefer1Email author,
  • Aleksandra Mandecka2,
  • Helen Schmicker-Helf1,
  • Andreas Brückmann3,
  • Thomas Lehmann4,
  • Ingeburg Schauer5,
  • Frank Kramer6,
  • Marcus Blum7 and
  • Harald Lapp8
BMC Pharmacology201111(Suppl 1):P66

Published: 1 August 2011


Nitric OxideEndothelial DysfunctionChronic Heart FailureRetinal VesselChronic Heart Failure Patient


Chronic heart failure (CHF) is the leading cause of hospitalization and death in industrialized countries. CHF is frequently associated with humoral and metabolic disturbances, including reduced bioavailability of the important signalling molecule nitric oxide (NO), which has vasodilating properties. Several studies reported high plasma levels of asymmetrical NG, NG-dimethyl-L-arginine (ADMA), an endogenous inhibitor of NO production, in CHF, contributing to endothelial dysfunction. The Dynamic Vessel Analyzer (DVA) enables dynamic analyses of retinal vessels. NO is a mediator of retinal vasodilator response to flicker light. Reduced response of retinal arterioles to flicker light may be an attractive technique to non-invasively assess endothelial dysfunction. The aim of the study was to test the hypothesis that retinal vessel response to flicker light is reduced in patients with CHF and correlates inversely with serum ADMA levels.

Methods and results

16 patients with non-ischemic cardiomyopathy and 22 healthy volunteers were included. Retinal arteriolar flicker response as percent change from baseline and serum ADMA level were measured.

Retinal arteriolar flicker response was significantly reduced in CHF patients compared to the healthy control group (Median: 0.60 vs. 4.60%; p<0.001). ADMA levels tended to be higher in CHF patients (median: 0.66 vs. 0.62 μmol/L; p=0.099). Noteworthy, we observed a highly significant inverse correlation between retinal arteriolar flicker response and ADMA levels (r = -0.531, p=0.001).


Our findings suggest that analysis of retinal vessels could be an attractive non-invasive method to quantify endothelial dysfunction in CHF.

Authors’ Affiliations

Department of Cardiology, Helios Klinikum Erfurt, Erfurt, Germany
Department of Internal Medicine III, University of Jena, Jena, Germany
Department of Obstetrics, University of Jena, Jena, Germany
University of Jena, Institute of Medical Statistics, Information Sciences and Documentation, Jena, Germany
Helios Klinikum Erfurt, Dia-Solution GmbH, Erfurt, Germany
Bayer Schering Pharma AG, Global Biomarker Research, Pharma Research Center, Wuppertal, Germany
Department of Ophthalmology, Helios Klinikum Erfurt, Erfurt, Germany
University of Witten Herdecke, Medical Faculty, Witten Herdecke, Germany


© Schwefer et al; licensee BioMed Central Ltd. 2011

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.