Perspective Chapter: Mechanisms and Quantification of Endothelial Function – Physiology to Pathology

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Abstract
The vascular endothelium, once considered an inert barrier, is now recognized as a dynamic, multifunctional organ central to cardiovascular homeostasis. It regulates vascular tone, blood pressure, coagulation, inflammation, and angiogenesis through a repertoire of biochemical mediators and mechanosensitive responses. Endothelial dysfunction (ED), a state of impaired vasodilatory, anti-inflammatory, and anti-thrombotic capacity, is a critical early event in the pathogenesis of cardiovascular, metabolic, and inflammatory diseases. This chapter reviews the structural and molecular foundations of endothelial biology, its physiological integration into cardiovascular function, and the pathophysiological basis of ED. We critically evaluate biochemical, invasive, and non-invasive approaches for endothelial function quantification, highlighting methodological challenges and the urgent need for standardization. Finally, we present recent advances, including novel local pulse wave velocity-based endothelial reactivity assessment techniques, and discuss future prospects for clinical translation, precision medicine, and therapeutic monitoring.

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