ENDOTHELIAL DYSFUNCTION: PROBLEMATIC ISSUES OF DEFINITION AND CLASSIFICATION
DOI:
https://doi.org/10.11603/1811-2471.2025.v.i3.15567Keywords:
endothelial dysfunction, definition, classification, pathophysiology, vascular homeostasisAbstract
SUMMARY. Endothelial dysfunction (ED) is a multifaceted pathophysiological condition underlying a wide range of cardiovascular and systemic diseases.
The aim – to systematically analyze the evolution of approaches to defining endothelial dysfunction, identify their limitations, formulate a generalized functional definition that would reflect the modern understanding of the endothelium's role in pathology, and propose a new classification of ED capable of adapting to various clinical contexts and research objectives.
Material and Methods. The study involved a systematic analysis of modern scientific literature concerning the definitions and classifications of endothelial dysfunction. Ten of the most influential definitions of ED found in peer-reviewed sources over the last two decades, as well as existing classifications, were analyzed.
Results. Analysis of existing ED definitions revealed that most are based on reduced nitric oxide (NO) production and impaired vasodilation but have several limitations, including being focused on specific aspects or being highly specialized. A new, universal functional definition of ED was formulated: "a state in which the endothelium loses its ability to adequately respond to the physiological needs of the body by impairing the regulation of vascular tone, permeability, thromboreactivity, immune response, and metabolic activity". A generalized matrix classification of ED was also proposed, based on etiology, primary functional impairment, potential reversibility, stage of endothelial damage, and nature of response to functional tests.
Conclusions. Endothelial dysfunction is a fundamental pathophysiological mechanism underlying many common diseases, yet the issues of its unified definition and comprehensive classification remain relevant. The proposed new functional definition and updated multi-level classification of ED have the potential to improve the understanding of its diverse manifestations, contribute to the standardization of scientific research, and optimize clinical practice.
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