An open discussion about endothelial dysfunction: is it timely to propose a classification?

This text proposes a classification for endothelial dysfunction including e tiological, functional and evolutionary aspects: (I) Etiological classifica tion: (a) primary or 'genotypic' (homozygote children hemocystinuria carrie rs, normotensive patients with familial antecedents of essential arterial h ypertension); (b) secondary or 'phenotypic' (atherosclerosis, coronary arte ry disease, hypertension, diabetes and others). (II) Functional classificat ion: (a) 'vasotonic' (cardiovascular diseases, vasospasm and thrombosis); ( b) 'vasoplegic' (distributive shock: sepsis, anaphylaxis, anaphylactoid rea ctions and vasoplegias related to cardiopulmonary bypass). (III) Evolutiona ry or prognostic classification: (a) 'reversible endothelial dysfunction' ( more probable of happening in the initial phases of the 'vasoplegic' dysfun ctions); (b) 'partially reversible endothelium dysfunction' (to include the idea of improvement or modification without complete reversion as in 'vaso tonic' dysfunctions associated with the cardiovascular diseases); (c) 'irre versible endothelial dysfunction' (advanced evolution of the cardiovascular diseases and sepsis). (C) 2000 Elsevier Science Ireland Ltd. All rights re served.