Brachial Artery Diameter Research Articles

A clinical randomized controlled trial: moxibustion at Laogong interval with Panax notoginseng promoted the maturation of arteriovenous fistulae

BackgroundWe aim to study the clinical effect of moxibustion at Laogong interval with Panax notoginseng on the short-term maturation and long-term patency of arteriovenous fistula.MethodsSeventy-four pre-dialysis uremic patients who received distal forearm radial-cephalic fistula creations were enrolled in this study and randomly assigned to the control group and experimental group. After arteriovenous fistula creations, the control group underwent handgrip exercise, and the experimental group received moxibustion at Laogong acupoint interval with Panax notoginseng. Both groups received a 12-week treatment and were followed up for 24 weeks in all at the following time points: before creations and 2, 4, 8, 12, 24 weeks after creations. The diameter of anastomosis, the diameter and outflow of draining-veins 5 cm above anastomosis, the diameter and outflow of brachial arteries evaluated the maturation and patency of arteriovenous fistula. Enzyme linked immunosorbent assay determined serum levels of endothelin and nitric oxide.ResultsThe maturity rate in the experimental group was significantly higher than that in the control group at 4 weeks after arteriovenous fistula creations (P = 0.048). The diameter of anastomosis, the diameter of draining veins, and the blood flow of draining veins increased in both groups during the whole 24 weeks. The diameter and blood flow of brachial arteries ascended in both groups during the previous 12 weeks. Compared with the control group, moxibustion at Laogong interval with Panax notoginseng significantly improved the value of the diameter of draining-veins (P = 0.016), the blood flow of draining-veins (P = 0.015), the diameter of brachial arteries (P < 0.001), and the blood flow of brachial arteries (P = 0. 012) at 2 weeks, and enhanced the blood flow of draining-veins (P = 0.029) and brachial arteries (P < 0.001) at 12 weeks. Serum levels of endothelin were significantly lower (P = 0.047), and serum levels of nitric oxide were markedly higher (P < 0.001) in the experimental group than that in the control group at 2 weeks after creations.ConclusionsMoxibustion at Laogong interval with Panax notoginseng was non-invasive and promoted the maturation of arteriovenous fistula at 4 weeks after creations. However, its long-term beneficial effect on patency at 24 weeks after creations was not significant.Trial registration Chinese Clinical Trial Registry, No. ChiCTR1900024042. Registered, http://www.chictr.org.cn/index.aspx

Effect of watermelon supplementation on exercise performance, muscle oxygenation, and vessel diameter in resistance-trained men.

Watermelon shows promise as an ergogenic aid due to its high concentration of L-citrulline, vitamins, minerals, and antioxidants. The purpose of this study was to examine the effect of watermelon supplementation on exercise performance, muscle oxygenation, and vessel diameter. In a crossover design fashion, 15 resistance-trained men (22.4 ± 2.9 years; 177.5 ± 7.1cm; 82.7 ± 11.2kg) were randomly assigned to supplement with either watermelon juice concentrate (WM; 2.2g·day-1 L-citrulline) or placebo (PL) for 7days prior to completing an experimental trial consisting of an isometric mid-thigh pull test and acute bench press protocol. Participants completed two sets of two repetitions at 75% 1 repetition maximum (1-RM) with maximum ballistic intent followed by five repetition-maximum (RM) sets at the same load. Barbell velocity and power were measured via linear position transducer during the first two sets, while volume load and muscle oxygenation were quantified during RM sets. Brachial artery diameter and subjective perception measures were assessed at baseline and immediately pre- and post-exercise. Except for a greater percent change in skeletal muscle oxygenation during WM compared to PL on average and across sets (mean difference = + 4.1%, p = 0.033, BF10 = 2.2-54.5), separate traditional and Bayesian analyses of variance with repeated measures, as well as paired-samples t tests for calculated summary measures, revealed no evidence favoring conditional differences in any measure of performance, perception, or muscle oxygenation. Short-term watermelon supplementation does not appear to enhance isometric force production, bench press performance, blood vessel diameter, or muscle oxygenation parameters compared to PL in resistance-trained men.

Effects of Antidiabetic Drugs on Endothelial Function in Patients With Type 2 Diabetes Mellitus: A Bayesian Network Meta-Analysis.

BackgroundThe changes of endothelial function in type 2 diabetes mellitus (T2DM) patients are closely associated with the development of cardiovascular disease (CVD). However, it is still unclear whether commonly used antidiabetic drugs can improve endothelial function. Flow-mediated dilation (FMD) is a noninvasive tool for evaluating endothelial function, which typically examines changes in the brachial artery diameter in response to ischemia using ultrasound. We performed a network meta-analysis (NMA) to explore the associations between changes in endothelial function and antidiabetic drugs by evaluating FMD in T2DM patients.MethodsWe systematically searched several electronic databases for randomized controlled trials (RCTs) published from inception until January 25, 2022 with no language restriction. The primary outcome was FMD change in all studies, and we performed subgroup analysis in T2DM patients without CVD. NMA was performed to calculate the mean differences (MDs) with 95% confidence intervals (CIs).ResultsFrom the 1,987 candidate articles identified in the initial search, 30 RCTs were eventually included in the analysis. In all studies, glucagon-like peptide-1 receptor (GLP-1R) agonists [MD = 3.70 (1.39–5.97)], TZD [MD = 1.96 (0.006–3.89)] produced improvement of FMD change compared to lifestyle intervention. GLP-1R agonists [MD = 3.33 (1.36–5.34) and MD = 3.30 (1.21–5.43)] showed significantly greater improvements in FMD change in pairwise comparisons with sulfonylureas and placebo. SGLT-2i also showed efficacy compared to sulfonylureas (MD = 1.89, 95% CI, 0.10, 3.75). In studies of T2DM patients without CVD, GLP-1R agonists [MD = 3.53 (1.24–5.76)], and TZD [MD = 2.30 (0.27–3.24)] produced improvements in FMD change compared to lifestyle treatment. GLP-1R agonists [MD = 3.25 (1.13–5.40), and MD = 3.85 (1.68–6.13)] showed significantly greater improvements in pairwise comparisons with sulfonylureas, and placebo.ConclusionIn T2DM patients, both GLP-1R agonists, SGLT-2i and TZD have favorable effects to improve endothelial function in T2DM patients. In T2DM patients without CVD, GLP-1R agonists had a greater effect to improve endothelial function than sulfonylureas. These suggested that GLP-1R agonists are associated with significantly improved endothelial function in T2DM patients.

Abstract WP14: Association Of Vascular Properties With The Periventricular And Deep White Matter Hyperintensity In Middle-age Population

Introduction: The periventricular white matter is more sensitive to alterations in the hemodynamics of the systemic circulation than the deep white matter due to differences in its vascular supply and relationship to systemic circulation. We hypothesize that periventricular white matter hyperintensity volume (PVWMH) shows greater association than deep white matter hyperintensity (DWMH) volume with vascular property measures of arterial stiffness (AS) and cardiovascular remodeling, important indicators of the systemic circulation. Methods: Participants in the Genetic Study of Atherosclerosis Risk ≥ 50 years of age with brain MRI were selected. Vascular property measures included pulse pressure (PP), hypertension response to exercise (HRE), diastolic brachial artery (BA) diameter, diastolic common carotid artery (CCA) diameter, CCA distensibility coefficient, and left ventricular function. PVWMH and DWMH were measured using semi-automated segmentation approach. The relative associations of these parameters with PVWMH and DWMH volumes as multiple measures within the same individual further nested within families were determined using multilevel linear models. We also determined if differences between PVWMH and DWMH associations were modified by age. Results: 426 participants (age 59.0±6.1 years, 57.5% females, and 39.7% African American) were included. Within the same subject, PVWMH volume showed greater association than DWMH volume with PP (P=0.002), HRE (p=0.04), diastolic BA diameter (p=0.012), and diastolic CCA diameter (p=0.04) independent of age and cardiovascular risk factors. This difference in PVWMH versus DWMH association with vascular properties did not differ at any age threshold. Conclusions: We show for the first time that PVWMH volume has greater association than DWMH volume, independent of age, with vascular property measurements of AS and cardiovascular remodeling. Our findings suggest that changes in the systemic circulation may affect PVWMH and DWMH differently adding to a growing body of literature that PVWMH and DWMH may represent different phenotypes of cerebral small vessel disease.

A Single Center Experience With Forearm Arteriovenous Loop Grafts For Hemodialysis

<h3>OBJECTIVES</h3> Autogenous arteriovenous fistula (AVF) remains the standard of care for hemodialysis (HD) access, however, it cannot be reasonably obtained in all patients. For patients with contraindications to AVFs, prosthetic arteriovenous graft (AVG) remains an alternative. AVGs are plagued by high failure rates, however, there is a paucity of literature examining this. This study aims to examine a single-center review of outcomes of forearm loop AVGs in patients requiring HD access. <h3>METHODS</h3> A single institution, retrospective chart review was completed from 2012-2019, including patient demographics, end-stage renal disease (ESRD) etiology, brachial artery and vein diameters, and comorbidities. Logistic regression and cox proportional hazard models were evaluated. Outcomes were defined as length of primary patency (time from graft placement to intervention to maintain patency) and secondary patency (time from graft placement until graft failure despite intervention). <h3>RESULTS</h3> 98 patients [mean age 61.8(13.9) years, 42.9% female] were identified as having brachial artery to brachial vein AVG creation during the study period. Primary patency was 0.36 (SE 0.07) at six months, 0.12 (0.05) at one year. Secondary patency was 0.75 (0.07) at six months and 0.43 (0.09) at one year (see figure 1 below). No association between preoperative vessel diameters and primary or secondary patency was observed. <h3>CONCLUSION</h3> Prosthetic forearm loop AVGs remain hindered in their utility as they show high rates of graft failure within a year of creation. A significant patient-specific factor leading to this was not clearly demonstrated. As guidelines change regarding the nature of dialysis access for patients on HD, these results draw into question the utility of prosthetic forearm loop grafts in patients requiring long-term HD access.

Вплив терапії внутрішньовенним інгібітором 5-ліпоксигенази кверцетином на функцію ендотелію, вираженість системного запалення та прооксидантного стресу при гострому інфаркті міокарда з елевацією ST

Метою роботи була оцінка антиоксидатної та протизапальної активності інгібітору 5-ліпоксигенази кверцетину, а також вливу препарату на функцію ендотелію у пацієнтів із гострим коронарним синдромом (ГКС) з елевацією сегмента ST на електрокардіограмі на фоні сучасного лікування. Обстежені 94 пацієнти, які надійшли у перші 12 годин від розвитку симптоматики захворювання та отримали реперфузійну терапію методом первинної ангіопластики. Пацієнти були розподілені на дві групи у співвідношенні 2 : 1. Додатково до базисної терапії ГКС 60 хворих отримували інгібітор 5-ліпоксигенази кверцетин, 34 пацієнти становили контрольну групу. Пацієнти обох груп не відрізнялися за основними клініко-анамнестичними показниками, характеристиками інфаркту міокарда та проведеним базисним лікуванням. Результати проби з потікзалежною вазодилатацією (ППЗВ) на 1-шу добу в обох групах не відрізнялися (р = 0,654). У динаміці госпітального періоду відзначено суттєве збільшення приросту діаметра плечової артерії при ППЗВ у групі кверцетину (6,45 ± 1,02 % на 1-шу добу проти 9,96 ± 0,94 % на 7-му добу відповідно, р = 0,004) за відсутності змін у контрольній групі (р = 0,324). Терапія кверцетином суттєво не впливала на динаміку рівнів фактора Віллебранда, розчинного E-селектину, розчинного CD40 ліганду та С-реактивного білка. Відзначено суттєве підвищення вмісту VEGF на 7-му добу у групі кверцетину (149,3 ± 47,2 пкг/мл на 1-шу добу проти 396,0 ± 64,7 пкг/мл на 7-му добу відповідно, р = 0,002) на відміну від контрольної групи (p = 0,373). Рівень мієлопероксидази (МПО) у плазмі крові хворих із гострим інфарктом міокарда (ГІМ) на 1-шу добу в обох виділених групах суттєво не відрізнявся (p = 0,603). Виявлені тісний обернений кореляційний зв’язок (r = –0,46; p = 0,006) між умістом МПО в плазмі крові та результатами ППЗВ на 1-шу добу, а також обернена кореляція між змінами рівня МПО та змінами результатів ППЗВ у динаміці госпітального періоду (r = –0,40; p = 0,01). Терапія кверцетином сприяла значному зниженню рівня МПО в плазмі крові хворих із ГІМ (611,7 ± 83,3 нг/мл на 1-шу добу проти 382,4 ± 65,4 нг/мл на 7-му добу, р = 0,013), чого не спостерігалося в контрольній групі (525,9 ± 122,3 нг/мл на 1-шу добу проти 437,6 ± 104,8 нг/мл на 7-му добу, р = 0,210). За результатами клінічного спостереження, хворі, яким додатково до базисної терапії призначався кверцетин, характеризувалися зменшенням проявів гострої лівошлуночкової недостатності протягом госпітального періоду спостереження. Отже, інгібітор 5-ліпоксигенази кверцетин у хворих на ГІМ з елевацією сегмента ST не справляє додаткового протизапального ефекту, але позитивно впливає на функцію ендотелію та має антиоксидатні властивості (зниження рівня МПО), що обумовлює тенденцію до зменшення внутрішньогоспітальних ускладнень на фоні кверцетину навіть в умовах сучасної терапії ГКС.

PECULIARITIES OF VASOR-REGULATING FUNCTIONS OF THE VASCULAR ENDOTHELIUM IN ADAPTATION OF THE YOUTH BODY TO SYSTEMATIC PHYSICAL LOADS.

The aim: To analyze the features of changes in the functional state of the vascular endothelium of handball players in the dynamics of the training process, at different levels of the body's hypoxic state. Materials and methods: Theoretical methods, the method of Corretti et al. with the use of high-resolution ultrasound, Fisher test with the calculation of the Fisher criterion and the Bland-Altman method. The study of the vasomotor function of the vascular endothelium was carried out of young men 18-20 y.o., who did not go in for sports and which were systematically played handball. The brachial artery diameter, maximum linear blood flow velocity, volumetric blood flow velocity were registered in the state of relative rest after artificially created reactive hyperemia. Results: The primary results obtained showed that in the process of long-term adaptation to systematic muscular work, a pronounced vasodilation effect was observed. Subsequent analyze of changes in the functional state of the vascular endothelium of young sportsmen during the macrocycle preparation different levels of the body's hypoxic state manifested the following. The young men-athletes had more pronounced vasodilation effect, the values of the linear and volumetric blood flow velocity both in the state of relative rest and at the peak of the artificially created hyperemia were significantly higher than in the young men, who did not go in for sports. Conclusions: Suggested that the systematic muscular work contributes to a significant intensification of the oxidation pathway of nitric oxide formation from L-arginine with the participation of endothelial NO-synthase.

ENDOTHELIUM DYSFUNCTION IN PATIENTS WITH LIVER CIRRHOSIS

Aim: To assess endothelial dysfunction in patients with liver cirrhosis. Material and methods: The study involved 95 patients with alcoholic liver cirrhosis. The data were subjected to analysis of variance involving the calculation of arithmetic mean value and variance (М±m), estimating the values validity according to Student’s t-test and measuring Pearson correlation coefficient for binary variables. Results: The brachial artery diameter was 0.4±0.02 mm narrower, with its blood velocity flow being 25.8±3.4 cm/s slower in the mean, in the patients with liver cirrhosis with signs of hepatic encephalopathy as compared to the control group. The maximum EDV values were recorded in the patients in Group I (7.5±1.9 %), while Group III patients displayed the lowest EDV value (5.6±1.9 %). The LC patients were found to exhibit a significant increase in the concentration of ET-1 up to 1.14±0.07 fmol/ml as opposed to 0.34±0.05 fmol/ml in the control group (р&lt;0.01), an increase in the level of VWF by 139.4±24,8 % as compared to the control group (р&lt;0.01) and D-dimer by a factor of 6.8. Conclusions: The patients with liver cirrhosis were found to have endothelial damage, namely the dysfunction of the vasoregulating activity of vascular wall against the background of portal hypertension. Changes in the vasoactive BAS values are indicative of the damage to the vascular endothelium in LC patients with signs of HE. A steady and gradual increase or decrease in the levels of ЕТ-1, VWF, АТ ІІІ, and D-dimer may suggest the progressive character of ED in the LC patients.

A randomized controlled trial of the effect of postoperative hand exercise training on arteriovenous fistula maturation in patients with chronic kidney disease

Immature arteriovenous fistula (AVF) is a critical problem in patients with chronic kidney disease (CKD) after creation. Exercise with 30% maximum voluntary contraction (MVC) encourages vascular functions in other populations. It is unknown which exercise type is superior on maturation in the CKD population. We compare effects of isometric (ISM) and isotonic (IST) hand exercise training, both at 30% MVC, on AVF maturation and grip strength in patients with CKD. Fifty patients with CKD were randomized into the ISM program or IST program (25 per group). Each group performed exercise program at intensity of 30% MVC every day for 10 weeks. Cephalic vein (CV) and brachial artery diameters, brachial blood flows, and grip strength were measured at weeks 0, 2, 6, and 10 of the program. The number of patients meeting clinical and ultrasound maturation were evaluated at weeks 2, 6, and 10. At weeks 6 and 10 of the programs, the ISM group had greater CV diameters (week 6, 7.1 ± 1.2 vs 6.2 ± 1.0 mm; week 10, 7.1 ± 1.0 vs 6.2 ± 1.1 mm) than the IST group. Compared with the IST group, the ISM group had a higher number of patients meeting ultrasound maturation at weeks 2 (IST/ISM, 8/2), 6 (IST/ISM, 16/8), and 10 (IST/ISM, 21/12), and clinical maturation at week 10 (IST/ISM, 25/18). No adverse events were observed throughout the study. At 30% MVC, ISM is more effective at promoting increases in CV diameter and maturation than IST. Both exercise types are feasible and safe for patients with CKD after AVF creation.

Is atherosklerosi̇s developing risk in patients with asthma?

Asthma is an inflammatory disease of the airways and is characterized by attacks of bronchospasm. Atherosclerosis develops as a result of a series of systemic inflammatory processes that begin with arterial endothelial dysfunction. Arteries tend to dilate in hypoxemic conditions Flow-Mediated Dilation (FMD) is a non-invasive, low-cost, straightforward and effective method that was described some 20 years ago, showing endothelial function and therefore a predisposition to atherosclerosis, according to the reflex vasodilation response of the artery after occlusion. In this study, we aimed to evaluate the susceptibility of these patients to atherosclerosis by performing the FMD test in controlled and uncontrolled asthma groups. We included 61 asthma patients in this study and 30 healthy people enrolled thi study as control group. Thirty-two of the patients were uncontrolled, did not receive regular treatment and were not followed up regularly, whereas 29 patients were full symptom control. Pulmonary function tests were performed on all subjects who met the inclusion criteria of the study and gave informed consent. After the pulmonary function test, the right brachial artery diameters of all cases were measured from intima to intima by Doppler USG. FEV1 values were 67.28±9.89% in in patients with uncontrolled astma, and 79±7 in symptom free group of astma patients. The initial brachial artery diameter was 4.40±0.33 and The measurement made after 5 minutes was 4.69±0.296 (p&lt;0.001) in patients with uncontrolled astmatic patents. The difference between these two measurements was 0.29±0.16. FMD tet results in Symptom free patients values were 4.45±03 and 4.81±0.4 respectively (p&lt;0.001). Initial and after measurements difference between symptom free and uncontrolled patients were 0.36±0.16 and 0.29±0.11 p&lt;0.01. There was not statistically significant difference between symptom free patients and healthy group. We have shown that vascular disfunction in symptomatic astma patients with FMD test. Atherosclerosis developing might be higher in asthma patients and this patients should be encourage to regular medicine usage.

An observational study of the endothelial dysfunction in type 2 diabetes mellitus and its association with risk factors

Background: Cardiovascular diseases (CVDs) are the major culprit to cause morbidity in type 2 diabetes mellitus (T2DM) patients. Endothelial dysfunction (ED) precedes the progressed stage of CVD presentation. This study aimed to study the risk factors for ED and identify the modifiable factors for risk reduction and provide caution measures. Materials and Methods: This cross-sectional observational study included 100 adult patients with T2DM on oral hypoglycemic drugs or insulin therapy. Based on glycemic control, type 2 diabetic patients were divided into four groups: Group 1 (poor glycemic control and hemoglobin A1C (HbA1c) >9%), Group 2 (fair glycemic control and HbA1c 8%–8.9%), Group 3 (good glycemic control and HbA1C 7–7.9%), and Group 4 (excellent glycemic control, HbA1C <7%). P < 0.05 was considered statistically significant. Results: Overall, significantly higher glycemic levels (fasting blood glucose, postprandial blood glucose, and HbA1c) and lipid derangements (cholesterol, low-density lipoprotein, and triglyceride) were found in patients with ED as compared to those without ED (P < 0.05). Baseline brachial artery diameter (D1) was into three groups, one group with D1 (≤3.6 mm) with mean flow-mediated dilatation (FMD) of 9.07%, Another group of D1 (3.61 mm to ≤4.30 mm) with mean FMD of 5.26%, and the third group with D1 (>4.41 mm) with mean FMD of 4.58%. There was a statistically significant association seen between baseline brachial artery diameter and FMD (P < 0.05). Multivariate linear regression showed that HbA1c and treatment of both Oral hypoglycemic agents (OHA) and insulin were the significant independent factors affecting the ED with OR of 7.566 (P = 0.0003) and 0.013 (P = 0.011), respectively. Conclusion: In diabetics, the risk of ED is increased with worsening levels of lipid profile and glycemia irrespective of the age and duration of the disease.

Center-To-Periphery Arterial Stiffness Gradient Is Attenuated and/or Reversed in Pregnancy-Associated Hypertension.

Background: Non-pregnant (NP) women have a progressive increase in arterial stiffness from central-to-peripheral arteries [“stiffness gradient” (SG)], which is of physiologic importance since excessive pulsatility is filtered by the creation of wave reflections. If the aorta gets stiff with minimal or no change in the periphery, the SG is dissipated transmitting pressure disturbances to the microcirculation. It remains unknown the status of the SG in both women with healthy pregnancies (HP) and complicated by pregnancy-associated hypertension (PAH).Objective: To determine whether HP and PAH are associated with changes in SG. Secondarily, we aim at identifying potential differences between the subgroups of PAH (pre-eclampsia and gestational hypertension).Methods: HP (n = 10), PAH (n = 16), and healthy NP women (n = 401, to be matched for age, and cardiovascular risk with the pregnant women) were included. Carotid-to-femoral (cfPWV) and carotid-to-radial pulse wave velocity (crPWV), common carotid artery (CCA) and brachial artery (BA) diameters and elastic modulus (EM), and regional (cfPWV/crPWV or “PWV ratio”) and local (CCA EM/BA EM or “EM ratio”) SG were quantified.Results: HP showed no changes in PWV ratio compared with NP, in the presence of significantly lower cfPWV and crPWV. HP exhibited higher arterial diameters and lower CCA EM/BA EM compared to NP, without differences with PAH. PAH was associated with a significant increase in the PWV ratio that exceeded the levels of both NP and HP, explained by a lower (although significant) reduction of cfPWV with respect to that observed in HP with respect to NP, and a higher reduction in crPWV with respect to that observed between HP and NP. The blunted reduction in cfPWV observed in PAH coincided with an increase in the CCA EM.Conclusions: Compared with NP, HP was associated with unchanged PWV ratio but with a reduction in CCA EM/BA EM, in the setting of a generalized drop in arterial stiffness. Compared with NP and HP, PAH was associated with an “exaggerated rise” in the PWV ratio without changes in CCA EM/BA EM, in the setting of a blunt reduction in cfPWV but exaggerated crPWV drop. The SG attenuation/reversal in PAH was mainly driven by pre-eclampsia.

603 Endothelial dysfunction is associated with hypertensive disorder during pregnancy

Abstract Aims Arterial hypertension (AH) is one of the main determinants of clinical disorders during pregnancy affecting 2% to 10% of pregnancies with a substantial public health impact. Both endothelial injury and increased vascular reactivity have been reported to be involved in the pathogenesis of pre-eclampsia syndrome. Abnormal patterns in brachial artery Doppler velocities have been shown to be predictive of pre-eclampsia in first trimester. The aim of this study is to investigate whether flow-mediated dilation (FMD) and Doppler flow derived-parameters can predict the occurrence of AH. Methods and results The study population consisted of pregnant women (mean age 32 years) who had been referred to the IRCCS Fondazione Ca’ Granda Policlinico of Milan. None of them had any medical issues and was taking any medications at the time of pregnancy. FMD was performed on left brachial artery according to expert recommendation. Measurements of brachial artery diameter and flow have been collected at rest, shortly before cuff release and then 5-, 15-, 30-, 60-, and 90-s during hyperaemia phase. Among Doppler measurements, systolic and diastolic velocity (Vs and Vd, respectively) as well as mean velocity (mean V) were considered. In addition, the pulsatility index (PI) and resistance index (RI) were calculated. A 3-months follow-up was planned in order to detect the presence of AH. All data were expressed as the median. U-test (Mann–Whitney analysis) was performed to test difference among hypertensives and non-hypertensives We recruited 48 women (median age 32 yeas) whose 4 (8.5%) developed AH during pregnancy. These latter had statistically significant higher systolic velocity measured at 5 s after the release of distal occlusion (126 cm/s vs. 173 cm/s; P &amp;lt; 0.05). No other velocity Doppler data [diastolic velocity (Vd), mean velocity (mean V), PI, RI, TAMAX, and TAMEAN] showed a statistical significant association with AH development. Conclusions The present study suggests that the vascular assessment through Doppler during FMD procedure may foresee the development of hypertensive disorder in pregnancy. Our result provides the first evidence that the peak systolic velocity of brachial artery may represent a marker of early endothelial activation or damage, that can be directly involved in the pathophysiological mechanisms of the hypertensive disorders in pregnancy.

Safety and effectiveness of enhanced external counterpulsation (EECP) in refractory angina patients: A systematic reviews and meta-analysis.

Enhanced external counterpulsation (EECP) is believed to be a non-invasive treatment for coronary artery disease and angina. The aim of this study was to determine the safety and effectiveness of EECP in refractory angina patients through a systematic reviews and meta-analysis. We conducted a comprehensive search of the literature published on PubMed, Cochrane library, Scopus, ScienceDirect, Trip Database and Google Scholar databases using appropriate keywords and specific strategy with no time limit. Having selected and screened the studies based on the defined inclusion and exclusion criteria and evaluating their quality based on the Cochrane checklist. For the meta-analysis,the Mantel-Haenszel method or the generic Inverse Variance was used. Analyses were done with Review Manager 5.2 software. A number of 299 studies were initially reviewed and finally, seventeen studies were included in the meta-analysis based on the inclusion and exclusion criteria. Also, thirteen outcomes were analyzed and the results of meta-analysis in twelve outcomes including (Systolic Blood Pressure (7 studies), Diastolic Blood Pressure (7 studies), Pulse Pressure (4 studies), Mean Arterial Pressures (4 studies), Heart Rate (6 studies), Angina episodes (7 studies), Walking distance (2 studies),Canadian Cardiovascular Society classification (6 studies), Flow-Mediated Dilation (3 studies), Daily Nitrate Usage (4 studies), Exercise Treadmill Test-Time (2 studies), ST-segment depression (2 studies)demonstrated a significant clinical advantage in the EECP treatment effectiveness in patients with angina. No significant difference was observed regarding EECP usefulness (P = 0.18) in the outcome of brachial artery diameter (2 studies). Based on the meta-analysis, the results indicate the safety and effectiveness of EECP in patients with angina pectoris and indicate the usefulness of this treatment in these patients. In general, the authors believe that the general conclusion in this regard requires some studies with a large sample size and a control group assignment.

Brachial artery aneurysm as a late complication of arteriovenous fistula.

Brachial artery aneurysm (BAA) is a rare late complication of arteriovenous fistula (AVF). It brings the risk of peripheral embolism and hand ischemia and is defined by brachial artery diameter above 10 mm or by regional dilatation by >50%. BAA is described in the literature in closed radiocephalic arteriovenous fistulas after kidney transplantation. The aim of the study was to analyze the prevalence of BAA and of their more dangerous forms. A observational one center study performed on patients after kidney transplantation with AVF or arteriovenous graft (AVG). We invited all patients followed up for kidney transplantation in our center. Arterial diameter greater than 10 mm was considered as a brachial artery aneurysm to simplify the detection and evaluation of aneurysms. About 162 patients with AVF after kidney transplantation were examined between 4/2018 and 4/2020. Brachial artery aneurysm was detected in 34 patients (21%) with AVF or AVG, of them 7 had confirmed wall thrombi. AVF flow volume of more than 1500 ml/min increased the risk of BAA development by 4.54x. Eight aneurysms were treated surgically. After this surgery, the primary patency was 87.5% in 12 months. Brachial artery aneurysm was relatively frequent in our study compare to the literature. Aneurysm or dilatation of the brachial artery is more frequent in functional AVFs. Surgical correction is necessary in cases of complicated aneurysms to prevent distal embolization.

Short stature is associated with low flow-mediated vasodilation in Japanese men.

An inverse association between height and the risk of cardiovascular disease has been reported. The objective of this study was to examine the association between height and endothelial function assessed by flow-mediated vasodilation (FMD). We evaluated cross-sectional associations of height with FMD in 7682 Japanese men. All participants were divided into four groups based on height: <155.0 cm, 155.0-164.9 cm, 165.0-174.9 cm, and ≥175.0 cm. Subjects in a lower quartile of FMD were defined as subjects having low FMD values. Univariate regression analysis revealed that height was significantly correlated with FMD (r = 0.14, p < 0.001). FMD values were 4.6 ± 3.1% in the <155.0 cm group, 5.2 ± 3.1% in the 155.0-164.9 cm group, 5.7 ± 3.1% in the 165.0-174.9 cm group and 6.1 ± 3.2% in the ≥175.0 cm group. FMD significantly increased in relation to an increase in height. Multiple logistic regression analysis revealed that higher height groups were significantly associated with a decreased risk of low FMD value compared with the <155.0 cm group after adjustments for age, presence of hypertension, dyslipidemia, diabetes, current smoking, and brachial artery diameter. FMD was low in subjects with a short stature compared with that in subjects with tall stature. Individuals with a short stature may require intensive interventions to reduce the risk of cardiovascular events.Clinical Trial Registration Information: URL for Clinical Trials: http://www.umin.ac.jp Registration Number for Clinical Trials: UMIN000012952.

Effect of HIV-1 Infection on Angiopoietin 1 and 2 Levels and Measures of Microvascular and Macrovascular Endothelial Dysfunction.

BackgroundIndividuals infected with HIV have an increased risk of developing cardiovascular disease; yet, the underlying mechanisms remain unknown. Recent evidence has implicated the Tie‐2 tyrosine kinase receptor system and its associated ligands ANG1 (angiopoietin 1) and ANG2 (angiopoietin 2) in maintaining vascular homeostasis. In the general population, lower ANG1 levels and higher ANG2 levels are strongly correlated with the development of cardiovascular disease. In this study, we aim to investigate the associations of HIV infection with angiopoietin levels and endothelial dysfunction.Methods and ResultsIn this cross‐sectional study, we compared measures of ANG1, ANG2, and endothelial dysfunction using flow‐mediated vasodilation of the brachial artery in 39 untreated subjects infected with HIV, 47 treated subjects infected with HIV, and 46 uninfected subjects from the SCOPE (Observational Study of the Consequences of the Protease Inhibitor Era) cohort. Compared with uninfected controls, treated individuals infected with HIV had 53.1% lower mean ANG1 levels (P<0.01) and similar ANG2 levels. On the other hand, untreated individuals infected with HIV had similar ANG1 levels, and 29.2% had higher ANG2 levels (P<0.01) compared with uninfected controls. When compared with individuals with untreated HIV infection, those with treated HIV infection had 56% lower ANG1 levels (P<0.01) and 22% lower ANG2 levels (P<0.01).Both treated and untreated HIV infection were associated with significant impairment in hyperemic velocity, a key measure of microvascular dysfunction (median 61 versus 72 cm/s, P<0.01), compared with uninfected controls (median 73 cm/s). This difference persisted after adjustment for ANG1 and ANG2 levels. Interestingly, when compared with untreated individuals infected with HIV, treated individuals infected with HIV had worse hyperemic velocity (−12.35 cm/s, P=0.05). In contrast, HIV status, ANG1 levels, and ANG2 levels were not associated with macrovascular dysfunction as measured by flow‐mediated dilatation and brachial artery diameter, 2 other measures of vascular homeostasis.ConclusionsHIV infection affects the balance between levels of ANG1 and ANG2 and may disturb endothelial homeostasis through disruption of vascular homeostasis. Individuals with treated HIV had decreased ANG1 levels and similar ANG2 levels, whereas individuals with untreated HIV had similar ANG1 levels and increased ANG2 levels, suggesting that treatment status may alter the balance between ANG1 and ANG2. HIV also promotes endothelial dysfunction via impairment of microvascular dysfunction, independent of the Tie‐2 receptor system; the finding of worse microvascular dysfunction in the setting of treated HIV infection may reflect the impact of viral persistence on the microvasculature or toxicities of specific antiretroviral regimens. Further research to clarify the mechanism of HIV‐mediated endothelial dysfunction is necessary to advance treatment of cardiovascular complications of HIV infection.

Can Overnight Sleep Efficiency Impact Cardiovascular Risk in the Morning? [Response to Letter

Response to Letter in regards to Sleep Efficiency is Inversely Associated with Brachial Artery Diameter and Morning Blood Pressure in Midlife Adults, with a Potential Sex-Effect: A Short Comment [Letter]

Peripheral vascular access from the arms for invasive cardiac investigation using ultrasound guidance

Abstract Introduction Vascular access for invasive cardiac investigations has traditionally been gained from the femoral vessels, however, a “radial-first” approach has become increasingly popular for coronary interventions [1]. Transradial access has shown lower complication rates, shorter admission times, and reduced healthcare costs for coronary interventions [4]. A “superior” approach via the jugular and subclavian veins have been reported for electrophysiology (EP) studies and radiofrequency catheter ablation (RFCA) but is associated with an increased risk of complications such as pneumo- and haemothorax [9]. Purpose EP procedures often require the use of both venous and arterial catheters, and the potential advantage of non-femoral peripheral access is yet to be investigated. This study was performed to provide comprehensive anatomical evidence that the vessels of the arms are suitable for use during EP procedures, as assessed by vascular ultrasound. Methods A portable ultrasound device was used to measure the diameter of the brachial artery, brachial vein, basilic vein &amp; cephalic vein on the left and right upper limbs of 63 healthy adult volunteers. Measurements were also taken of the circumference at the elbow and at the mid-bicep level on both arms. A subgroup of 15 volunteers had additional measurements taken of the same veins and artery on both arms with a tourniquet at the upper bicep level. Results The basilic vein was found to have the largest diameter with a median of 4.6 mm and 4.5 mm (right and left diameter, respectively), followed by the cephalic (median of 3.1 and 3.0 mm) and the brachial vein (median of 2.8 mm for both arms). 100% of volunteers had at least one vein that was equal to a 3 mm diameter (which would allow for a 8F sheath insertion), with 98% having 2 suitable veins and &amp;gt;80% having 3 suitable venous vessels. More than 90% had a suitable diameter of more than 3 mm for both the right and left brachial artery. There was significant correlation between gender, and basilic vein and brachial artery diameters. There was no correlation between BMI, height, weight and elbow or bicep circumference. Conclusion To our knowledge, this is the first study to investigate the feasibility of adopting peripheral access in the electrophysiology lab. 100% of volunteers examined had one vein which was at least 3mm in size and would be suitable for 8F sheath insertion. We demonstrate the anatomic evidence that the vessels in the arm are capable of housing the size of sheath and catheters commonly used in the EP lab. Funding Acknowledgement Type of funding sources: None. Figure 2. measurementsFigure 3. Vessel diameters

Association between atrial high rate episode burden and autonomic and vascular function in patients with implanted cardiac device

Abstract Background Patients who experience frequent atrial high rate episodes (AHREs), recorded on implantable cardiac devices, are at an increased risk of stroke and systemic embolism. Increased duration of AHRE is related to higher risk of thromboembolic event. The underlying pathophysiology is unclear; however, autonomic and/or endothelial dysfunction may contribute. Purpose We tested the hypothesis that patients with high AHRE burden have worse autonomic and vascular function compared to patients with low AHRE burden. Design We studied 44 patients split in two groups: high AHRE burden (longest AHRE ≥24 hours; n=22) and low AHRE burden (longest AHRE &amp;lt;24 hours; n=22). Resting time- and frequency-domain measures of HRV were determined to index cardiac autonomic function. High-resolution ultrasound was used to measure brachial artery diameter at rest and during reactive hyperaemia (endothelium-dependent flow mediated dilation (FMD)). Results FMD was higher in the low AHRE burden group compared to high AHRE group (5.5% [95% confidence interval (CI):3.4–7.6] vs 3.1% [95% CI: 1.9–6.2]; p=0.04) (table 1). Mean heart rate (p&amp;lt;0.001) and AHRE burden (p=0.02) were independent predictors of FMD on multivariate analysis. Time-domain, frequency-domain and non-linear indices of HRV were not significantly different between the groups. A slower heart rate (Spearman's rho 0.369; p=0.01) and high AHRE burden (Spearman's rho −0.315; p=0.04) were independently associated with changes seen on FMD following adjustment for multiple variables (p=0.001 and p=0.03 respectively). Conclusion Endothelium-dependent FMD is impaired in patients with high AHRE burden, while HRV derived indices of autonomic function were not affected by AHRE burden. Endothelial dysfunction may play an important role in the adverse outcomes seen in patients who experience frequent AHRE. Funding Acknowledgement Type of funding sources: None.