Arterial Wall Stiffness Research Articles

4 days in dry immersion increases arterial wall response to ultrasound wave as measured using radio-frequency signal, comparison with spaceflight data.

Recent studies have reported a significant increase in common carotid artery (CCA) intima media thickness, wall stiffness and reflectivity to ultrasound, in astronauts, after six months of spaceflight. The hypothesis was that 4 days in dry immersion (subjects under bags of water) will be sufficient to change the CCA wall reflectivity to ultrasound similar to what observed after spaceflight. Such response would be quantified using the amplitude of the ultrasound signal returned to the probe by the target concerned. [coefficient of signal return (Rs)]. The Rs for anterior and posterior CCA wall, sternocleidomastoid muscle, intima layer and CCA lumen were calculated from the ultrasound radio frequency (RF) data displayed along each echographic line. After four days of DI, Rs increased in the CCA posterior wall (+15% +/- 10 from pre DI, p < 0.05), while no significant change was observed in the other targets. The observed increase in Rs with DI was approximately half compared to what was observed after six months of space flight (+34% +/- 14). This difference may be explained by dose response (dry immersion only four days in duration). As a marker of tissue-level physical changes, Rs provide complimentary information alongside previously observed CCA wall thickness and stiffness.

Reference values of the carotid elastic modulus using shear wave elastography and arterial stiffness change in coronary slow flow

PurposeShear wave elastography (SWE) accurately and sensitively evaluates arterial wall stiffness by quantifying the elastic modulus (EM); however, the absence of reference values has precluded its widespread clinical application. This prospective cohort study aimed to establish reference values for the carotid EM using SWE; investigate the main determinants of the EM; and evaluate EM changes in coronary slow flow (CSF), which is characterized by delayed coronary opacification without evident obstructive lesion in epicardial coronary artery on angiography. MethodThis study enrolled 169 healthy volunteers and 30 patients with CSF. The carotid maximum EM (EMmax), mean EM, and minimum EM were measured using SWE. CSF was diagnosed by thrombolysis in the myocardial infarction frame count during coronary angiography. ResultsNo differences were found in the EM between the left and right carotid arteries and between men and women. Multiple linear regression analysis revealed that age was independently correlated with the EMmax, which progressively increased with age. Moreover, smoking had an independent influence on the EM after adjusting for age; smokers had higher EM than non-smokers. Age-specific reference values for the carotid EM were established. The EM was higher in patients with CSF than in controls after adjusting for age and smoking status. ConclusionsThis study first established the reference values for the carotid EM using SWE. Age and smoking status were the main determinants of the EM. Patients with CSF had high EM. SWE can effectively and noninvasively evaluate arterial stiffness in patients with CSF.

Pathophysiological and clinical aspects of the circadian rhythm of arterial stiffness in diabetes mellitus: A minireview.

Several cross-sectional trials have revealed increased arterial stiffness connected with the cardiac autonomic neuropathy in types 2 and 1 diabetic patients. The pathophysiological relationship between arterial stiffness and autonomic dysfunction in diabetes mellitus is still underinvestigated and the question whether the presence of cardiac autonomic neuropathy leads to arterial stiffening or increased arterial stiffness induced autonomic nervous system impairment is still open. Both arterial stiffness and dysfunction of the autonomic nervous system have common pathogenetic pathways, counting state of the chronic hyperinsulinemia and hyperglycemia, increased formation of advanced glycation end products, activation of protein kinase C, development of endothelial dysfunction, and chronic low-grade inflammation. Baroreceptor dysfunction is thought to be one of the possible reasons for the arterial wall stiffening development and progression. On the contrary, violated autonomic nervous system function can affect the vascular tone and by this way alter the large arteries walls elastic properties. Another possible mechanism of attachment and/or development of arterial stiffness is the increased heart rate and autonomic dysfunction corresponding progression. This minireview analyzes the current state of the relationship between the diabetes mellitus and the arterial stiffness. Particular attention is paid to the analysis, interpretation, and application of the results obtained in patients with type 2 diabetes mellitus and diabetic cardiac autonomic neuropathy.

Atherosclerosis Burdens in Diabetes Mellitus: Assessment by PET Imaging.

Arteriosclerosis and its sequelae are the most common cause of death in diabetic patients and one of the reasons why diabetes has entered the top 10 causes of death worldwide, fatalities having doubled since 2000. The literature in the field claims almost unanimously that arteriosclerosis is more frequent or develops more rapidly in diabetic than non-diabetic subjects, and that the disease is caused by arterial inflammation, the control of which should therefore be the goal of therapeutic efforts. These views are mostly based on indirect methodologies, including studies of artery wall thickness or stiffness, or on conventional CT-based imaging used to demonstrate tissue changes occurring late in the disease process. In contrast, imaging with positron emission tomography and computed tomography (PET/CT) applying the tracers 18F-fluorodeoxyglucose (FDG) or 18F-sodium fluoride (NaF) mirrors arterial wall inflammation and microcalcification, respectively, early in the course of the disease, potentially enabling in vivo insight into molecular processes. The present review provides an overview of the literature from the more than 20 and 10 years, respectively, that these two tracers have been used for the study of atherosclerosis, with emphasis on what new information they have provided in relation to diabetes and which questions remain insufficiently elucidated.

Automated Force-Coupled Ultrasound Method for Calibration-Free Carotid Artery Blood Pressure Estimation.

We develop, automate and evaluate a calibration-free technique to estimate human carotid artery blood pressure from force-coupled ultrasound images. After acquiring images and force, we use peak detection to align the raw force signal with an optical flow signal derived from the images. A trained convolutional neural network selects a seed point within the carotid in a single image. We then employ a region-growing algorithm to segment and track the carotid in subsequent images. A finite-element deformation model is fit to the observed segmentation and force via a two-stage iterative non-linear optimization. The first-stage optimization estimates carotid artery wall stiffness parameters along with systolic and diastolic carotid pressures. The second-stage optimization takes the output parameters from the first optimization and estimates the carotid blood pressure waveform. Diastolic and systolic measurements are compared with those of an oscillometric brachial blood pressure cuff. In 20 participants, average absolute diastolic and systolic errors are 6.2 and 5.6 mm Hg, respectively, and correlation coefficients are r = 0.7 and r = 0.8, respectively. Force-coupled ultrasound imaging represents an automated, standalone ultrasound-based technique for carotid blood pressure estimation, which motivates its further development and expansion of its applications.

Differential Roles of Life-Course Cumulative Burden of Cardiovascular Risk Factors in Arterial Stiffness and Thickness.

Data are limited regarding differential and common effects of cardiovascular risk factors on subclinical changes in vascular structure and function. We aimed to examine the relationships of life-course cumulative burdens of cardiovascular risk factors with adult arterial pulse wave velocity (PWV) and carotid intima-media thickness (CIMT) in a longitudinal cohort of the Bogalusa Heart Study. The cohort consisted of 900 subjects who had aortic-femoral PWV and CIMT measurements. These participants were examined 5-16 times for body mass index (BMI), blood pressure, atherogenic index of plasma (AIP), and low-density lipoprotein cholesterol (LDLC) from childhood to adulthood. The area under the curve (AUC) was calculated as a measure of long-term burden of the risk factors. Adjusting for covariates, adult PWV was associated with AUCs of BMI, systolic blood pressure (SBP) and AIP (standardized regression coefficient [β]= 0.191, 0.321, 0.153, respectively; P < 0.001 for all). Adult CIMT was associated with AUCs of BMI, SBP, AIP and LDLC (β= 0.115, 0.202, 0.141, 0.152, respectively; P < 0.001 for all). Moreover, childhood BMI was associated with adult PWV and CIMT (β= 0.088 and 0.075, respectively; false discovery rate q values < 0.05 for both), and childhood LDLC with adult CIMT (β= 0.079; false discovery rate q value < 0.05). These associations did not differ significantly among race and sex groups. The life-course cumulative burden of BMI, SBP, and AIP has common effects on arterial wall stiffening and thickening, whereas LDLC is specifically associated with arterial wall thickness, and this effect starts in early life.

Correlations between vessel stiffness and biomarkers of senescent cell in elderly patients

Aim To study the association between vascular wall stiffness and known markers for accumulation of senescent cells in blood, cells, and tissues of old patients.Material and methods This study included male and female patients aged 65 years and older who were referred to an elective surgical intervention, that included a surgical incision in the area of the anterior abdominal wall or large joints and met the inclusion and exclusion criteria. For all patients, traditional cardiovascular (CV) risk factors and arterial wall stiffness (pulse wave velocity, PWV) were evaluated. Also, biomaterials (peripheral blood, skin, subcutaneous adipose tissue) were collected during the surgery and were used for isolation of several cell types and subsequent histological analysis to determine various markers of senescent cells.Results The study included 80 patients aged 65 to 90 years. The correlation analysis identified the most significant indexes that reflected the accumulation of senescent cells at the systemic, tissue, and cellular levels (r&gt;0.3, р&lt;0.05) and showed positive and negative correlations with PWV. The following blood plasma factors were selected as the markers of ageing: insulin-like growth factor 1 (IGF-1), fibroblast growth factor 21 (FGF-21), and vascular endothelium adhesion molecule 1 (VCAM-1). A significant negative correlation between PWV and IGF-1 concentration was found. Among the tissue markers, P16INK, the key marker for tissue accumulation of senescent cells, predictably showed a positive correlation (r=0.394, p&lt;0.05). A medium-strength correlation with parameters of the 96-h increment of mesenchymal stromal cells and fibroblasts and a weak correlation with IL-6 as a SASP (specific senescent-associated secretory phenotype) were noted. Results of the multifactorial linear regression analysis showed that the blood plasma marker, VCAM-1, and the cell marker, 96-h increment of fibroblasts, were associated with PWV regardless of the patient's age.Conclusion Stiffness of great arteries as measured by PWV significantly correlates with a number of plasma, tissue, and cellular markers for accumulation of senescent cells. This fact suggests PWV as a candidate for inclusion in the panel of parameters for evaluation and monitoring of the biological age during the senolytic therapy.

RELATIONSHIP BETWEEN PERIVASCULAR ADIPOSE TISSUE AND VASCULAR REMODELING

Objective: To study the relationship between the volume of perivascular adipose tissue (PVAT) and the vascular emodelling. Design and method: We examined 318 patients without manifested cardiovascular diseases (average age 63.5 ± 13.7 years). Anthropometric indicators were measured, body mass index (BMI) was calculated. Lipid profile was evaluated. Arterial wall stiffness was assessed by calculation of the cardio-ankle index (CAVI) using VaSera (VS-1000) (Fucuda Denshi, Japan). Thickness of the intima-media complex and vasomotor function of the endothelium of the brachial artery were evaluated by ultrasound using LOGIQ F6 (GE Healthcare, USA). All patients underwent multi-detector chest computed tomography in spiral mode on Toshiba Aquilion Prime scanner using standardized protocol. PVAT was detected using specialized semi-automatic software Tissue Composition Module QCTPro (Mindways Software, Inc., USA) after scanner calibration with special phantom. Statistical analysis was performed using Statistica 10.0 software (StatSoft Inc., USA). Results: Male to female ratio in the cohort was shifted towards males, however this difference was statistically insignificant (p = 0.066). Prevalence of hypertension in the study group was high – 268 (84.3%) patients. The majority (74.2%) of study participants had elevated BMI. Average PVAT volume was 0.3[0.2;0.4] cm³. The PVAT volume was significantly higher in obese patients vs patients with normal body mass: 0.4 [0.3;0.5] cm³ vs 0.25[0.2;0.4] cm³ (p = 0.0007). The PVAT volume was significantly higher in patients with elevated CAVI vs patients with normal CAVI: 0.4[0.3;0.5] cm³ vs 0.3[0.25;0.3] cm³ (p = 0.02). Correlation analysis revealed significant correlation between the PVAT volume and BMI (r = 0.27; p &lt; 0.005), waist circumference (r = 0.41; p &lt; 0.005), CAVI (r = 0.49; p &lt; 0.05), endothelial dysfunction of the brachial arteries (r = 0.38; p &lt; 0.05). Multiple regression analysis demonstrated significant association of CAVI with age (±SE, 0.51 ± 0.15; p = 0.002) and the volume of PVAT (±SE,0.41 ± 0.13; p = 0.005). Conclusions: This study demonstrated an association of PVAT volume with visceral obesity and indicators of vascular wall stiffness.

COMPARISON BETWEEN TWO NONINVASIVE METHODS USED TO ESTIMATE BIOMECHANICAL PROPERTIES OF THE INTERNAL CAROTID ARTERY

Background: Many cardiovascular diseases modified the arterial wall stiffness. Objectives: This work focuses on the quantification of the elastic biomechanical properties of the internal carotid (ICA) wall by applying the cepstral analysis on healthy volunteers aged from 22 to 86 years old. The purpose of this study is to compare two methods of measurement of arterial compliance ([Formula: see text], arterial distensibility ([Formula: see text], arterial elastance (Eh), and Young’s modulus ([Formula: see text]. Material and methods: First, arterial compliance and arterial distensibility were measured in function of wave speed ([Formula: see text], which is measured in our previous works by using two methods. Second, elastance Eh was estimated through the ratio between diastolic radius ([Formula: see text] and [Formula: see text]. Finally, [Formula: see text] was estimated from a statistical study from the literature on h due to the difficulty of measuring wall thickness ([Formula: see text]. Results: The Student test demonstrated that there is a very significant difference between young and old subjects in terms of elastance, compliance, and Young’s modulus ([Formula: see text]). These findings are in agreement with the reference values reported in the literature. They are very satisfying for distinguishing a pathological change in parietal elasticity. Conclusion: The in vivo application of these methods presents their potential for clinical measurement of arterial stiffness.

Cytokines, insulin resistance and arterial wall stiffness in assessing the course of non-alcoholic fatty liver disease

The progression of non-alcoholic fatty liver disease is associated with an increased prevalence of cardiovascular disease. Aim: to assess the level of cytokines, insulin resistance, arterial wall stiffness during the progression of hepatic steatosis in patients with non-alcoholic fatty liver disease. Material and methods. 87 patients with non-alcoholic fatty liver disease were examined. Group I consisted of 14 patients without steatosis, group II – 32 patients with steatosis grade 1; III – 30 patients with steatosis grade 2, IV group – 11 patients with steatosis grade 3. The control group consisted of 30 apparently healthy individuals. Steatometry with a quantitative assessment of the grade of hepatic steatosis was performed using a Soneus P7 ultrasound machine. The content of cytokines (interleukin-6, interleukin-10, TNF-α) was determined using an enzyme-linked immunosorbent assay using a Stat Fax 303 Plus analyzer. The level of insulin resistance was determined using the HOMA-IR index. Results. The content of interleukin-6 in the blood serum of patients of group IV was significantly increased relative to the level in the control group (by 1.8 times, P &lt; 0.05), patients of group I (by 3.2 times, P &lt; 0.05), II group (by 3.0 times, P &lt; 0.05) and group III (2.3 times, P &lt; 0.05). The level of TNF-α increased with the progression of structural changes in the liver and at grade 4 of steatosis its content was increased by 6.4 times (P &lt; 0.05) relative to the level in the control group, by 8.0 times (P &lt; 0.05) relative to group I patients, by 3.4 times (P &lt; 0.05) – group II patients and by 1.8 times (P &lt; 0.05) – group III patients. An increase in the HOMA-IR index by 3.2 times (P &lt; 0.05) was found in patients with moderate steatosis and 3.9 times (P &lt; 0.05) in patients with severe steatosis compared to controls. A correlation was established between the intima-media thickness of the left common carotid artery and the level of TNF-α (r = 0.438; P = 0.006) and the HOMA-IR index (r = 0.557; P = 0.0008). Conclusions. In patients with non-alcoholic fatty liver disease with progression of the grade of hepatic steatosis, a significant increase in proinflammatory cytokines, insulin resistance and intima-media thickness of the left common carotid artery was found.

Effects of Oral Bicarbonate Supplementation on the Cardiovascular Risk Factors and Serum Nutritional Markers in Non-Dialysed Chronic Kidney Disease Patients.

Background and Objectives: Kidneys play a key role in maintaining the acid–base balance. The aim of this study was to evaluate the effect of a 3-month oral sodium bicarbonate administration on arterial wall stiffness, arterial pressure and serum nutritional markers in non-dialysed patients with chronic kidney disease (CKD) stages 3–5 and metabolic acidosis. Methods: Eighteen CKD patients with eGFR < 45 mL/min/1.73 m2 and capillary blood bicarbonate (HCO3) < 22 mmol/L were enrolled in this single-centre, prospective study. Anthropometric parameters, pulse wave velocity, 24-h ambulatory blood pressure measurements, blood and urine parameters were assessed at the beginning and at the end of the study. The patients received supplementation with 2 g of sodium bicarbonate daily for three months. Results: A significant increase of pH: 7.32 ± 0.06 to 7.36 ± 0.06; p = 0.025, HCO3 from 18.7 mmol/L (17.7–21.3) to 22.2 mmol/L (20.2–23.9); p < 0.001 and a decrease in base excess from −6.0 ± 2.4 to −1.9 ± 3.1 mmol/L; p < 0.001 were found. An increase in serum total protein from 62.7 ± 6.9 to 65.8 ± 6.2; p < 0.013 and albumin from 37.3 ± 5.4 to 39.4 ± 4.8; p < 0.037 but, also, NT-pro-BNP (N-Terminal Pro-B-Type Natriuretic Peptide) from 794.7 (291.2–1819.0) to 1247.10 (384.7–4545.0); p < 0.006, CRP(C Reactive Protein) from 1.3 (0.7–2.9) to 2.8 (1.1–3.1); p < 0.025 and PTH (parathyroid hormone) from 21.5 ± 13.7 to 27.01 ± 16.3; p < 0.006 were observed, as well as an increase in erythrocyte count from 3.4 ± 0.6 to 3.6 ± 0.6; p < 0.004, haemoglobin from 10.2 ± 2.0 to 11.00 ± 1.7; p < 0.006 and haematocrit from 31.6 ± 6.00 to 33.6 ± 4.8; p < 0.009. The mean eGFR during sodium bicarbonate administration did not change significantly: There were no significant differences in pulse wave velocity or in the systolic and diastolic BP values. Conclusion: The administration of sodium bicarbonate in non-dialysed CKD patients in stages 3–5 improves the parameters of metabolic acidosis and serum nutritional markers; however, it does not affect the blood pressure and vascular stiffness.

Effect of Amlodipine/Nebivolol combination therapy on central BP and PWV compared to Amlodipine/Valsartan combination therapy

BackgroundPulse wave velocity (PWV) and central blood pressure (CBP) have been intoduced into managment of hypertensive patients. PWV is positively correlated with arterial wall stiffness while central aortic pressure becomes better predictor of cardiovascular outcome than peripheral pressure. Reduction in CBP provides protective properties against subclinical organ damage. This work aims to investigate the effect of a new combination therapy of Amlodipine/Nebivolol (A/N) on central BP, peripheral BP and PWV. The results of using this combination will be compared to the well-established fixed-dose combination of Amlodipine/Valsartan (A/V). The study conducted between October 2018 and August 2020. One hundred and two hypertensive patients were assigned for Amlodipine 10 mg/Valsartan 160 mg combination therapy (A/V, n = 52) or Amlodipine 10 mg/Nebivolol 5 mg combination therapy (A/N, n = 50) by simple 1:1 randomization. Office, central blood pressure and PWV were measured on first (0 week), second (4–8 weeks) and third visit (10–12). Difference in BP (in each arm and between arms) was calculated along all visits.ResultsNo statistical significant difference was found between A/V and A/N regarding age, gender, BMI and CV history. OBP, CBP and PWV were significantly reduced in each arm, but no differences were found when comparing both arm results to each other. Recorded side effects were insignificant.ConclusionsThe new combination therapy Amlodipine/Nebivolol (A/N) affords a significant reduction in CBP, PBP and PWV with minor and tolerable side effects. It has provided comparable results to Amlodipine/Valsartan (A/V) combination therapy.

Швидкість розповсюдження пульсової хвилі у хворих на гіпертонічну хворобу залежно від категорії кардіоваскулярного ризику

У роботі доведено доцільність індивідуальної оцінки швидкості розповсюдження пульсової хвилі з урахуванням віку і рівня артеріального тиску для своєчасного виявлення раннього судинного старіння. У чоловіків, хворих на ГХ, вже при І стадії із помірним серцево-судинним ризиком спостерігається погіршення пружно-еластичних властивостей артеріальної стінки. Із збільшенням стадії захворювання та категорії серцево-судинного ризику встановлено прогресуюче підвищення ШРПХ.

Assessment of the structural and functional state of blood vessels in patients with hypertrophic cardiomyopathy

Aim To evaluate the structural and functional condition of the vasculature using fingertip photoplethysmography and computerized videocapillaroscopy in patients with hypertrophic cardiomyopathy (HCMP).Material and methods The study included patients with HCMP (n=48; 28 (57 %) men; age, 54.3±13.6 years) and healthy volunteers (control group, n=33, 15 (45 %) men; age, 58.2±8.8 years). Standard laboratory and instrumental examination (blood count and biochemistry, electrocardiography, echocardiography, Holter electrocardiogram monitoring) were performed for all HCMP patients. The condition of vascular wall at various levels of the vasculature was evaluated by fingertip photoplethysmography (apparatus Angioscan-01) and computerized nail-fold videocapillaroscopy (apparatus Capillaroscan-01). The photoplethysmography study analyzed structural parameters, including the arterial wall stiffness index (aSI) of large blood vessels and the resistance index (RI) of small muscular arteries. Endothelial dysfunction was evaluated by the occlusion index (OI) and phase shift (PS). The capillaroscopy study assessed structural parameters, including the resting capillary density (rCD) and the capillary density following venous occlusion (voCD), and functional parameters, including the percentage of perfused capillaries (PPC), the percentage of restored capillaries (PRC), and the capillary density after the reactive hyperemia test (rhCD).Results The study showed increases in aSI (8.8 [6.8; 12.2] and RI (32.5 [17.4; 47.9] in the HCMP group. The OI was significantly lower in the HCMP group (1.3 [1.1; 1.5]) than in the control group (1.8 [1.5; 2.7], р&lt;0.001). Also, PS values were significantly decreased in the HCMP group (4.4 [2.3; 8.6]) compared to the control group (8.4 [5.1; 12.1]. p=0.018). Disorders of structural and functional capillary indexes were observed in HCMP patients compared to the control group; rCD and voCD were decreased in the HCMP group (60 [52.6; 68] and 88 [75; 90], respectively) compared to the control group (75.8 [60; 87] and 90 [73; 101]), however, no intergroup difference reached a statistical significance. The rhCD, PPC, and PRC values were decreased in the HCMP group (66.3 [55; 72], 86.7 [70.9; 104.2] and 1.7 [-6.95; 20.3], respectively) compared to the control group (86 [68.6; 100], 103 [96; 114] and 18.4 [8.1; 27.4], respectively); PPC and PRC values were significantly different (р&lt;0.005 and p&lt;0.004, respectively).Conclusion In patients with HCMP, fingertip photoplethysmography and computerized videocapillaroscopy showed increased wall stiffness in both large blood vessels and microvasculature, pronounced endothelial dysfunction, and decreases in capillary density and percentage of restored capillaries following respective tests.

Links of Autoimmune Thyroid Disorders to Alzheimer’s Disease for Medicare Beneficiaries Ages 65+

To explore racial disparities in the interaction between Hashimoto thyroiditis (HT), Graves disease (GD), and Alzheimer’s disease (AD)we used age-adjusted rates for Medicare beneficiaries aged 65+. We investigated race/ethnicity/gender-specific trends of age-adjusted prevalence of HT and GD over 1991-2017 and used the Cox proportional hazards model with propensity score matching to explore the associations between AD and these thyroid disorders. The total age-adjusted prevalence of GD was increasing over the study period reaching a maximum of 0.35% in 2014 followed by a gradual decline. Except for relatively high prevalence rates in Native American Males, no statistically significant sex/race-related differences were identified. GD was found to be associated with an increased risk of AD onset [HR: 1.129; CI: 1.050-1.215]. The mechanism of interaction between thyroiditis and AD could follow several alternative pathways. The primary mechanism involves changes in blood vessel function, mostly arterial wall stiffness, which leads to increased pulse wave velocity and consequently to the higher amplitude of oscillation of the peripheral microcapillary system in the brain leading to cerebral leukoaraiosis and damage in kidney tissue. This, in turn, leads to kidney diseases (themselves associated with AD/ADRD), increased for HT and decreased for GD LDL cholesterol levels and an increased for HT and decreased for GD total/HDL cholesterol ratio, which has an important role in increased common carotid intima‐media thickness (CIMT) in hypothyroid patients and is linked to arteriosclerosis. Additionally, both, endothelial dysfunction and arterial stiffness are risk factors for coronary or artery disease and consequently increase risks for AD/ADRD.

The Association of Blood Glucose Levels and Arterial Stiffness (Cardio-Ankle Vascular Index) in Patients With Type 2 Diabetes Mellitus.

Introduction: Diabetes mellitus causes a major burden on healthcare systems all around the world. It has been documented that type 2 diabetes mellitus (T2DM) is associated with long-term vascular complications including micro-vascular, macro-vascular, and mixed-vascular disorders. Several studies have concluded that the increment of arterial wall stiffness is correlated with an increase in the risk of cardiovascular adverse events and the mortality associated with it.Aims: This study purposed to evaluate the arterial stiffness measurements, using Cardio-Ankle Vascular Index (CAVI), in T2DM patients, and the relationship with the fasting blood glucose (FBG), hemoglobin A1c (HbA1c), and other factors that may increase the risk of elevated arterial stiffness in T2DM patients.Methodology: A total of 200 patients were recruited from the outpatient setting at King Fahd Hospital of the University, Al Khobar. A total of 181 patients fit the inclusion criteria. The charts of the patients who fit the inclusion criteria were reviewed and data related to age, gender, body mass index, smoking history, FBG, HbA1c levels, blood pressure (mmHg) measurements, and CAVI scores were collected.Results: The elevation in CAVI readings was noted to be more prominent in the senior age group. Hypertensive patients also showed a significant increase in CAVI readings. In addition, higher CAVI readings were more associated with the male gender rather than females. All of which showed a significant correlation. Furthermore, although it was not significant, higher FBG levels and HbA1c readings were correlated with higher CAVI readings.Conclusion: The results of the study suggest that factors like age, smoking status, gender, and the increase in blood pressure as well as the increase in blood glucose levels are correlated with higher CAVI readings in T2DM patients. This demonstrates their important effect on arterial wall stiffness while showing that CAVI can be used in predicting the prognosis of arterial wall health in patients with diabetes.

Cardio-ankle vascular index of increased arterial wall stiffness is associated with neurocognitive impairment in well-controlled HIV.

HIV-associated neurocognitive disorders (HAND) remain prevalent in people living with HIV (PLWH) despite widespread use of combined antiretroviral therapy (ART). Vascular disease contributes to the pathogenesis of HAND, but traditional vascular risk factors do not fully explain the relation between vascular disease and HAND. A more direct measure of vascular dysfunction is needed. This cross-sectional study tested whether the cardio-ankle vascular index (CAVI), a novel method to assess arterial stiffness, is associated with HAND among PLWH. Participants included 75 non-diabetic adults with well-controlled HIV from an outpatient HIV clinic. We assessed the relation between CAVI and neurocognitive impairment (NCI). The latter was primarily characterized by the Frascati criteria and secondarily (posthoc) using the Global Deficit Score (GDS). Logistic regression models tested whether high CAVI (≥8) was independently associated with NCI when controlling for potential confounders. Participants (Mage =45.6±8.3years; 30.1% male) had few traditional cardiovascular disease (CVD) risk factors (hypertension, n=7; dyslipidaemia, n=34; body mass index ≥25 kg/m2 , n=12; smoking history, n=13; 2.2% mean 10-year risk of CVD or stroke). Twelve (16%) participants had high CAVI, which was independently associated with meeting Frascati criteria for NCI [n=39, odds ratio (OR) =7.6, p=0.04], accounting for age, education, gender, income, CD4 nadir, recent CD4 and traditional CVD risk factors. High CAVI was also associated with NCI as reflected by higher GDS (OR =17.4, p=0.02). Cardio-ankle vascular index is a promising measure of vascular dysfunction that may be independently associated with NCI in relatively healthy PLWH. Larger studies should test the utility of CAVI in predicting NCI/decline in PLWH.

Вплив фіксованої комбінації метформіну SR та глімепіриду на показники вуглеводного, ліпідного обміну та жорсткість артеріальної стінки у хворих на цукровий діабет 2-го типу

З метою вивчення впливу цукрознижувальної терапії за допомогою комбінації глімепіриду й метформіну SR упродовж 12 тижнів на показники вуглеводного й ліпідного обміну, динаміку рівня адипокінів у плазмі крові та показники жорсткості артеріальної стінки великих артерій (аорти та її гілок) спостерігали 30 пацієнтів (з них 18 — жінки) з цукровим діабетом 2-го типу віком 60,10 ± 1,08 року із серед-ньою тривалістю основного захворювання 5,7 ± 0,9 року. Результати. Порівняно з початковими значеннями відзначено покращення показників вуглеводного обміну. Так, рівень HbA1c знизився на 1,7 % (р &lt; 0,001), глікемії натще — на 22 % (р &lt; 0,001), постпрандіальної глікемії — на 44 % (р &lt; 0,001). Крім того, на тлі терапії спостерігалося покращення ліпідного обміну: зниження загального холестерину на 13,2 % (р &lt; 0,01), холестерину ліпопротеїнів низької щільності — на 19,3 % (р &lt; 0,01), тригліцеридів — на 30,6 % (р &lt; 0,05). Спостерігалися зміни рівня адипокінів у плазмі крові: зниження рівня адипонектину з 5,98 ± 0,52 мг/мл до 4,45 ± 0,29 мг/мл (р &lt; 0,01), а також тенденція до збільшення рівня лептину в плазмі крові з 14,6 ± 2,3 нг/мл до 18,12 ± 2,90 нг/мл (р &gt; 0,05). Зміни швидкості пульсової хвилі в аорті та аортального індексу аугментації були статистично незначущими (р &gt; 0,05). Зміни антропометричних показників (ваги, індексу маси тіла, окружності талії і стегон), а також загальної кількості жирової тканини, визначеної методом імпедансометрії, були статистично незначущими (р &gt; 0,05).Висновки. Комбінована цукрознижувальна терапія глімепіридом і метформіном SR упродовж 12 тижнів призвела до статистично значущого покращення вуглеводного та ліпідного обміну, не впливала на антропометричні показники й загальну кількість жирової тканини, запобігала прогресуванню артеріосклерозу великих судин за даними показників жорсткості артеріальної стінки.

Relationship between the volume of perivascular adipose tissue and the vascular wall lesion

Aim. To study the relationship between the volume of perivascular adipose tissue (PVAT) and the vascular wall lesion.Material and methods. The study included 318 patients without cardiovascular disease (mean age, 63,5±13,7 years). Hypertension was detected in 268 (84,3%) patients. All patients underwent assessment of anthropometric characteristics, lipid profile, arterial wall stiffness with the estimation of cardio-ankle vascular index, intima-media thickness, brachial artery endothelial vasomotor function. Chest computed tomography was performed with the estimation of the volumes of PVAT and pericardial adipose tissue (PAT).Results. The volume of PVAT, on average, was 0,3 [0,2; 0,4] cm3 . The VAT volume was significantly higher in obese individuals when compared with patients with normal body weight: 0,4 [0,3; 0,5] vs 0,25 [0,2; 0,4] cm3 (p=0,0007). The VAT volume was higher in individuals with an increased CAVI level when compared with patients with normal CAVI values: 0,4 [0,3; 0,5] vs 0,3 [0,25; 0,3] (p=0,02). A significant correlation was found between the VAT volume and body mass index (r=0,27, p&lt;0,005), waist circumference (r=0,41, p&lt;0,005), CAVI (r=0,49, p&lt;0,05), impaired endothelium-dependent brachial artery vasodilation (r=0,38, p&lt;0,05). When performing multiple linear regression, a significant relationship of CAVI was found with age (β±SE, 0,51±0,15; p=0,002) and volume of PVAT (β±SE, 0,41±0,13; p=0,005).Conclusion. The results indicate the relationship of PVAT with visceral obesity and vascular wall stiffness parameters.

Pulse wave velocity and its diagnostic value in cardiovascular diseases. Literature review and results of own observations

Over the past decade, in connection with the continuous increase of mortality from cardiovascular diseases, attention of scientists was tied down to the early reveal of vascular lesions and search for new biomarkers. Generally known, that an adequate hemodynamics is determined by damping properties of the great vessels, therefore their viscoelasticity properties are of particular interest. It is important to identify the changes in the arteries’ structure prior to onset of clinical symptoms of vascular disease. The measurement of pulse wave velocity (PWV) is one of main investigational methods for arteries’ properties; based on experts’ data it serves as an independent predictor of cardiovascular complications. The methods of estimation of elasticity or stiffness of arteries wall acquire all greater popularity, so as they allow to estimate not only structure but function of vessels. For the estimation of the structural‑functional state of major vessels, direct visualizing (USI, МRT) and indirect technique (contour analysis of pulse wave, plethysmography, sphygmography etc.) are used. In clinical and outpatient practice, the most popular are non‑invasive, affordable and easily reproducible techniques. The authors presented methods for determining the increased local and regional stiffness of the arterial wall using such devices as Complior, SphygmoCor, PulsePen, PolySpectr SPV, VaSera‑1000 and other. However, a demand exists today for novel methods for estimation of vascular stiffness. To simplify and improve the determination of the pulse wave velocity, the authors have proposed a method based on photoplethysmography and elucidated the main advantages and shortcomings, reveled during investigation. The aim of this publication was to inform the physicians about the importance of researches of arterial wall stiffness, the most widespread and demanded in clinical practice methods of its determination, about conditions, where vascular stiffness should be assessed, the existing limitations, as well as issues, still unsolved in this area.