Dilation Of Brachial Artery Research Articles

Revision using distal inflow for high flow hemodialysis access alters arterial flow characteristics in the dialysis arm

ObjectiveRevision using distal inflow (RUDI) is currently proposed in patients on hemodialysis having a high flow access (HFA; >2 L/min) or hemodialysis access-induced distal ischemia (HAIDI). However, a recurrence of high flow or hand ischemia is not unusual in the years after RUDI. The aim of the present study was to describe changes in flow characteristics and arterial diameters in the dialysis arm after RUDI for HFA. MethodsVolume flow, diameter, peak systolic velocity and end diastolic velocity of the brachial artery (BA) were studied 2 and 12 months after RUDI using duplex imaging. In a portion of patients, these characteristics were also assessed at proximal and distal portions of radial and ulnar arteries (proximal forearm radial artery, distal radial artery, ulnar artery, and distal ulnar artery), and in the greater saphenous venous interponate. HFA patients were grouped according to presence of concomitant hand ischemia (HFA-HAIDI) or absence (HFA). ResultsFifteen patients (54 ± 16 year old; 10 males; HFA-HAIDI, n = 6; HFA, n = 9) with a BA HFA (flow volume, 2740 ± 322 mL/min) undergoing RUDI were studied between March 2011 and October 2016 in two Dutch hospitals. After 2 months, flow volume had decreased (1180 ± 189 mL/min), but again increased at 12 months (1520 ± 217 mL/min; P < .001). BA diameters did not change (7.4 ± 0.5 mm), but proximal forearm radial diameters doubled (overall 2.6 ± 0.2 mm to 5.4 ±1.0 mm; P < .001), albeit less prominent in HFA-HAIDI (+80%) than in HFA (+130%; P = .019). During follow-up, the distal ulnar artery peak systolic velocity in HFA-HAIDI (83 ± 10 cm/s) was higher compared with the HFA group (54 ± 5 cm/s; P < .01). Dilatation was not present in the greater saphenous venous interponate. ConclusionsRUDI for HFA reduction does not reverse BA dilatation, suggesting irreversible structural arterial wall damage possibly contributing to recurrent high flow. Radial artery remodeling is attenuated in HFA patients previously reporting concurrent hand ischemia diminishing the likelihood of high flow recurrence in this subgroup.

Ultrasound investigation of the brachial artery diameter as a non-invasive method for exposure of endothelial dysfunction in patients with ischemic heart disease and concomitant gastroesophageal reflux disease

Objective — to assess endothelial dysfunction in patients with ischemic heart disease (IHD) with concomitant gastroesophageal reflux disease (GERD) with the use of high-quality ultrasound imaging of the brachial artery.Materials and methods. The study involved 100 patients, who were divided into two groups. The first group included 60 patients (43 male (71.7 %), 17 female (28.3 %)) aged 42 to 60 years (the mean age 53.79 ± 3.9 years) with IHD and concomitant nonerosive form of GERD. Second group included 40 patients (28 (70 %) male, 12 (30 %) female) aged 39 to 60 years (the mean age 53.0 ± 4.6 years) with IHD without comorbidites. The control group consisted of 20 healthy participants with matching age (mean 47 ± 6.1 years old) and gender (7 (35 %) male, 13 (65 %) female). The IHD diagnosis was established according to ICD-10, Unified clinical protocol for primary, secondary and tertiary care «Stable ischemic heart disease», 2013 European Society of Cardiology guidelines on the management of stable coronary artery disease. The GERD diagnosis was made according to ICD-10 and The Montreal definition and classification of gastroesophageal reflux disease (2006). BP was measured by the Scipione Riva-Rocci/Korotkoff method using Microlife BP AG1 — 20 sphygmomanometer (Switzerland) after 10 minutes rest in sitting and supine positions to measure systolic BP. Measurements of endothelial dysfunction were conducted using reactive hyperemia test and nitroglycerine test. Brachial artery (BA) diameter measurement was conducted on Aloka-SSD-650 ultrasound scanner (Japan) using high-definition linear probe. All collected data were entered into the electronic database. Statistical processing was performed with variation and nonparametric biomedical statistics using Excel for Windows, Statistica 6.0 and SPSS Statistics statistical software. Statistical significance was determined using Student’s t-test and Wilcoxon signed-rank test. The difference in results was considered statistically significant with p-value &lt; 0.05.Results. The obtained results showed a significant difference in BA diameter measurements between both groups of patients and control group. At the same time, the difference in BA diameter measurements between first and second study groups was not significant, while difference in BA diameter measurements between second study group and control group was significant. After conducting reactive hyperemia tests, the significantly decreased rate of BA diameter increase (p &lt; 0.001) was noted in patients with IHD with concomitant GERD, both compared to control group and patients with IHD without comorbidities. After sublingual nitroglycerine, the significantly (p &lt; 0.001) increased rate of BA diameter increase was defined in all study groups, evidencing the probe adequacy.Conclusions. The non-invasive high-quality ultrasound Doppler scan method to determine brachial artery dilatation during occlusion test can be used to evaluate degree of endothelial dysfunction both in people with cardiovascular diseases and people with other pathologies with underlying abnormal endothelial function.

Aerobic training and vascular protection: Insight from altered blood flow patterns.

What is the central question of this study? This study sought to determine whether prior upper limb aerobic training can attenuate the vascular dysfunction resulting from negative alteration of blood flow patterns. What is the main finding and its importance? We demonstrated that the microvasculature of young men with prior upper limb aerobic training (rowing) was equally susceptible to negatively altered blood flow patterns when compared with untrained control subjects. This finding reveals that aerobic training does not provide adequate protection against this type of vascular insult, highlighting the importance of reducing known vascular insults regardless of training status. Acute alteration of blood flow patterns can substantially reduce blood vessel function and, if consistently repeated, may chronically reduce vascular health. Aerobic exercise training is associated with improved vascular health, but it is not well understood whether aerobic training-induced vascular adaptations provide protection against acute vascular insults. This study sought to determine whether prior upper limb aerobic training can attenuate the vascular dysfunction resulting from an acute vascular insult (increased retrograde/oscillatory shear). Ten young arm-trained (AT) men (rowers; 22±1 years of age) and 10 untrained (UT) male control subjects (21±3 years of age) were recruited for this study. Subjects completed two brachial artery (BA) flow-mediated dilatation (FMD) tests separated by an acute bout of subdiastolic cuff inflation (SDCI) of the distal forearm. Brachial artery dilatation (normalized for the shear stimulus) and reactive hyperaemia evaluated during the BA FMD test were used to determine conduit artery and microvascular function, respectively. Data were presented as mean values±SD. The AT group reported significantly greater whole body (peak oxygen uptake; P=0.01) and forearm aerobic capacity (P<0.001). The SDCI intervention significantly increased retrograde (P<0.001) and oscillatory shear (P<0.001) in both groups. After the SDCI, microvascular function (post-cuff release hyperaemia), but not conduit artery function (shear-induced BA dilatation), was significantly reduced from pre-SDCI values (P=0.001) independent of group. This study revealed that young men with prior upper limb aerobic training, when compared with untrained control subjects, were equally susceptible to the microvascular dysfunction associated with an acute increase in retrograde/oscillatory shear.

Aerobic Training And Vascular Protection: Insight From Altering Blood Flow Patterns

Adequate blood flow patterns are essential in maintaining vascular homeostasis. Exercise-induced increases in antegrade, or forward, blood flow is a major modulator of vascular health; however, as vascular function in the conduit arteries is normalized as aerobic training progresses it is unknown if aerobically-trained vessels can adequately counteract vascular insults. PURPOSE: The study sought to determine the ability of aerobically-trained individuals to counteract an acute vascular insult (increased retrograde shear). METHODS: Ten young male trained rowers (20±1 yrs) and ten male recreationally active controls (24±1 yrs) were recruited for this study. Subjects completed two brachial artery (BA) flow mediated dilation (FMD) tests separated by a 30 minutes of sub-diastolic cuff inflation (60 mmHg) of the forearm. BA diameter, blood flow, and shear rate were evaluated prior to and throughout both FMD tests. RESULTS: The sub-diastolic cuff inflation intervention resulted in significant increases in retrograde shear rate (p < 0.001) and oscillatory shear index (p < 0.001) over time (pre- to post-FMD measures). Significant reductions across time were revealed in brachial artery (BA) dilation (absolute: p = 0.008; relative change: p = 0.011) and the post-cuff release hyperemic response (BA blood flow AUC: p < 0.001; BA shear rate AUC: p = 0.001), but no group differences were observed in these variables. CONCLUSIONS: This study revealed that individuals with prior upper limb training were unable to attenuate the vascular dysfunction associated with acute increases in retrograde shear.

Effects of Resistance Training with Blood Restriction on Flow-Mediated Dilatation of Braquial Artery in Elderly

Endothelial function is one of the early markers of atherosclerosis and thus consecutively of cardiovascular disease risks. Brachial Artery Flow-Mediated Dilatation (DILA) is an indicator of endothelial function that can be obtained by a non-invasive technique. Physical exercise is a non-pharmacological therapy that has the benefit of homeostasis of endothelial function. PURPOSE: To evaluate the effects of resistance training with restriction of blood flow on endothelial function and total occlusion pressure in elderly. METHODS: The elderly were invited to participate of the study in the written informed consent term. We selected 37 elderly women who were divided into 3 groups (placebo control (C), 60% restriction of blood flow (R60) and 80% restriction of blood flow (R80)), and were submitted to the DILA protocol, which is a test that verifies the total artery occlusion pressure through an ultrasound and an inflatable cuff, with endothelial control function and the total vascular occlusion pressure, so that the training pressure restriction is determined. All were submitted to a maximum load protocol (1RM), to determine the training load (20% of 1RM) with blood flow with duration of 8 weeks. Comparison of data was done through two-way ANOVA. RESULTS: Significant differences were found only in the group that trained with 60% blood flow restriction when compared to all groups in the post-training (C: 0.0213±0.0160 cm vs. R60: 0.0503±0.0180*cm vs. R80: 0.0306±0.0200 cm, *p≤0.05) and and with pre-training of group R60 (0.0190±0.0135 cm vs. 0.0503±0.0180* cm *p≤0.05). In occlusion pressure, the group which trained with 60% of flow restriction had a difference significant before and after the training R60 (186.67±10.33 mmHg vs. 156.66±16.32* mmHg, *p≤0.05). CONCLUSION: Resistance training with blood flow restriction is able to increase brachial artery dilatation and reduce the pressure of occlusion in elderly women who trained with 60% blood flow restriction.

Examining Arm Vascular Function and Blood Flow Regulation in Row-trained Males.

This study sought to determine whether vascular function and blood flow regulation during handgrip exercise are altered in row-trained males. Nine young row-trained males (ROW, 20 ± 1 yr; V˙O2peak = 51 ± 2 mL·kg·min) and 14 recreationally active male controls (C: 22 ± 1 yr; V˙O2peak = 37 ± 2 mL·kg·min) were recruited for this study. Subjects performed multiple bouts of progressive rhythmic handgrip exercise. Brachial artery (BA) diameter, blood flow, shear rate, and mean arterial pressure were measured at rest and during the last minute of each exercise workload. Resting values for BA diameter, blood flow, shear rate, and mean arterial pressure were not different between groups. During handgrip exercise, the ROW group reported significantly lower BA blood flow (ROW vs C: 4 kg [146 ± 21 vs 243 ± 13 mL·min], 8 kg [248 ± 29 vs 375 ± 17 mL·min], 12 kg [352 ± 43 vs 490 ± 22 mL·min]) across all workloads when compared with controls. The examination of BA dilation, when controlled for the shear rate stimulus and evaluated across all workloads, was revealed to be significantly greater in ROW group versus controls. This study revealed that vascular function and blood flow regulation were significantly different in row-trained males when compared with untrained controls evidenced by greater shear-induced BA dilation and lower arm blood flow during progressive handgrip exercise.

Effects of a short-term interval aerobic training program with recovery bouts on vascular function in sedentary aged 70 or over: A randomized controlled trial

Background: Interval aerobic training programs with active recovery bouts (IATP-R) are reported as being more adapted to seniors while improving cardiorespiratory and endurance parameters. Report of benefits on vascular function is still limited.Purpose: To measure the impact of IATP-R on vascular function among seniors.Methods: Sedentary volunteers (≥70 years of age) were randomly assigned to either IATP-R (n = 30) or control group (n = 30). The IATP-R consisted of 2 weekly sessions of 30-min (6 × 4-min at first ventilatory threshold (VT1) intensity + 1-min at 40% of VT1) cycling exercise over 9.5-week. Controls remained their sedentary life over the same period. In all participants, the endothelial function was measured by flow-mediated dilation (FMD) in brachial artery and arterial stiffness through the carotid/radial and carotid/femoral pulse wave velocity (PWV). Systolic (SBP) and diastolic blood pressure (DBP) were measured at baseline and 9.5 weeks later.Results: Resulting from a planned interim analysis, IATP-R improved SBP (IATP-R: from 133.7 ± 9.8 to 122.6 ± 9.4 mmHg vs. Controls: from 128.9 ± 12.5 to 132.6 ± 14.7 mmHg), DBP (IATP-R: from 80.2 ± 7.0 to 74.1 ± 6.7 mmHg vs. Controls: from 77.1 ± 6.8 to 80.3 ± 7.5 mmHg), and FMD (IATP-R: from 6.7 ± 2.0 to 7.5 ± 2.7% vs. Controls: from 7.9 ± 2.7 to 7.5 ± 2.5%). No significant impact on PWV was measured.Conclusion: Although these findings resulted from an interim analysis, IATP-R might be effective in regulating BP and improving endothelial function among sedentary seniors.

Assessment of ultrasound flow-mediated dilation of brachial artery in regular blood donors in a Nigerian Tertiary Hospital

Background: Iron is a pro-oxidant cofactor that may be linked to cardiovascular disease (CVD) progression and reduction of body iron stores have been hypothesized to reduce the risk of CV disease. Aim: The aim of this study is to assess reduction in CVD risk susceptibility among regular blood donors compared with nondonors using ultrasound brachial artery flow-mediated dilation (BAFMD). Settings and Design: A prospective comparative study designed to establish the difference between mean flow-mediated dilatation (FMD) in the patients who are regular blood donors compared with nondonors recruited from a Teaching Hospital donor clinic. Materials and Methods: Data were collected over 7 months from December 2014 to June 2015. 100 eligible regular male blood donors, aged 21–50 years, were selected from a Teaching Hospital blood donor records and their BAFMD assessed. 50 nondonors/ first time donors, of equivalent age group, consecutively were assessed for comparison. Serum markers of iron stores, markers of oxidative stress and other related cardiac risk factors were also assessed in all patients. Results: BAFMD was significantly greater in regular blood donors when compared with nondonors (13.95% ± 7.02% vs. 8.20% ± 4.19%, P = 0.000). Serum ferritin was significantly decreased in regular blood donors when compared with nondonors (mean value 41.92 ng/ml ± 23.12 ng/ml vs. 61.97 ± 30.19 ng/ml, P = 0.000), but Hb did not differ between the groups. High FMD was significantly associated with high C-high-density lipoprotein and low C-LDL (r = −0.215*, P = 0.032, r = 0.188, P = 0.031, r = 0.193, P = 0.027, r = 0.0279, P = 0.002, r = 0.139, P = 0.084). LDL was decreased in regular blood donors compared with nondonors. Conclusion: The study provides prognostic information for assessing ultrasound BAFMD as a cardiac risk marker. Regular blood donors have enhanced cardiovascular function with increased flow-mediated dilation, decreased body iron stores, and decreased oxidative stress compared with nondonors.

Brachial artery intima-media thickness and grayscale texture changes in patients with peripheral artery disease receiving supervised exercise training in the PROPEL randomized clinical trial.

We performed an exploratory analysis to evaluate the effects of a treadmill exercise program on brachial artery (BA) intima-media thickness (IMT) and three BA grayscale ultrasound measures that may indicate subclinical arterial injury. Data were from a clinical trial in individuals with peripheral artery disease who were randomly assigned to treadmill exercise training or attention control. B-mode ultrasonography was performed at baseline and after 26 weeks. BA IMT, grayscale median (GSM), entropy, and gray-level difference statistic-contrast (GLDS-CON) were measured by a single reader. The 184 participants were (mean (SD)) 66.7 (8.2) years old and had an ankle-brachial index of 0.70 (0.18). Exercise training was associated with a 0.01 (0.06) mm ( p = 0.025) reduction in BA IMT compared to 0.00 (0.05) mm ( p = 0.807) in the control group (between-group p = 0.061). BA GSM, entropy, and GLDS-CON did not change significantly with exercise. Improvements in the 6-minute walk distance correlated with increases in resting BA blood flow ( r = 0.23, p = 0.032), flow-mediated dilation ( r = 0.24, p = 0.022), diameter ( r = 0.29, p = 0.005), entropy ( r = 0.21, p = 0.047), and GLDS-CON ( r = 0.22, p = 0.041). In a post hoc analysis, BA IMT improved significantly with treadmill exercise training but did not change with attention control; however, the between-group difference did not reach statistical significance. With exercise, improvements in the 6-minute walk distance were associated with improved endothelial function, increased resting blood flow, and BA dilation, as well as higher grayscale entropy and GLDS-CON, indicating that lower extremity exercise is associated with salutary changes in upper-extremity arterial wall structure and function. ClinicalTrials.gov Identifier: NCT01408901.

The relationship between autophagy, increased neutrophil extracellular traps formation and endothelial dysfunction in chronic kidney disease

In chronic kidney disease (CKD), the number of circulating neutrophils are increased, and this is usually accompanied by an increased basal activation state. However, the possible association between neutrophil extracellular traps (NETs) with vascular complications has not been evaluated. We assessed the relationship between NETs, autophagy and endothelial dysfunction in maintenance hemodialysis (MHD) patients. NET formation, neutrophil elastase (NE) activities, and serum nucleosome levels were measured in MHD (n = 60) and controls (n = 20). Basal NET formation were markedly increased in MHD patient compared to controls. After PMA stimulation, MHD neutrophils showed significantly increased NETs formation response than controls. The degree of NETs was strongly associated with lower flow-mediated dilatation(%) of brachial artery even after adjustment for cardiovascular risk factors and uremic toxins. Moreover, MHD neutrophils showed increased basal autophagy activity. Interestingly, the levels of NETs were markedly augmented after autophagy inhibition, suggesting a protective role of autophagy in excessive NET formation.

Investigation of vascular endothelial dysfunction in the patients with age-related macular degeneration

Purpose This study aims to evaluate the association between age-related macular degeneration (AMD) and cardiovascular disease by using the noninvasive flow-mediated dilation (FMD) test to show endothelial dysfunction as an indicator of subclinical atherosclerosis. Method Participants in this study included 30 dry AMD patients, 30 wet AMD patients, and 30 healthy controls without any systemic disease, including AMD. FMD and the intima media thickness (IMT) of the carotid artery were compared between the groups. Results Comparison of FMD between the groups showed a 10.96% brachial artery dilation in the healthy controls, 3.99% in the dry AMD group, and 5.03% in the wet AMD group. While a significant difference was not observed between the wet and dry AMD groups, comparison of the control group to the wet and dry AMD groups yielded a significant difference. When brachial artery dilation below 7% was accepted as an abnormal FMD, 26.7% of the healthy controls, 66.7% of the dry AMD patients and 76.7% of the wet AMD patients were found to be abnormal. Similarly, while no significant difference was observed between the wet and dry AMD groups, comparison of the control group with the wet and dry AMD patients yielded a significant difference. When an IMT below 0.7 mm was accepted as abnormal, 26.7% of the healthy controls, 33.3% of the dry AMD, and 43.3% of the wet AMD were found to have an abnormal IMT. However, differences between the groups did not reach statistical significance. Conclusions In this study, use of the FMD test showed endothelial dysfunction among AMD patients. No significant differences were found between the dry and wet AMD patient groups.

Aortic elasticity and the influence of valve morphology in children with bicuspid aortic valve.

The study group included 44 patients and 42 controls. Patients were divided into groups according to the type of valve opening as horizontal - fusion between right and left coronary cusps - and vertical - fusion between right-non-coronary cusps; according to age they were divided into younger (5-10 years) and older patients (11-16 years). Our study did not include valve phenotype with fusion between left and non-coronary cusps. Systolic-diastolic diameters of aortic annulus, sinus valsalva, sinutubular junction, arcus, and ascending-descending and abdominal aorta were measured and z-scores were obtained. Aortic strain, distensibility, and stiffness index were calculated. Flow-mediated dilatation of brachial artery was studied. z-Scores at annulus, sinus valsalva, sinutubular junction, and ascending aorta were higher in study patients (p=0.001, p=0.0001, p=0.0001, p=0.0001, respectively). z-Scores of sinus valsalva and sinotubular junction were higher in the horizontal group than in the vertical group (p=0.006, p=0.023, respectively). z-Score was over +2 in 51% of patients with horizontal morphology and 33% of patients with vertical morphology (p=0.0001). Ascending aorta was more distensible and less stiff in the study group (11.3±5.63 versus 7.91±4.5, p=0.002; 4.76±3.60 versus 6.19±3.44 cm2.dyn-1.10-6, p=0.033, respectively). Stiffness index of ascending, arcus, and abdominal aorta were higher in the horizontal group (p=0.004, p=0.038, p=0.006, respectively). Ascending aorta was more distensible and less stiff in the younger group (p=0.007, p=0.027, respectively) but did not differ in the older group compared with the control group. Aortic dimensions are enlarged in patients with bicuspid aortic valve starting from childhood, suggesting the presence of generalised aortopathy. Aortic elasticity is increased at young age and decreased with age.

Albuminuria Is More Closely Associated with Vascular Endothelial Function than eGFR in Type 2 Diabetes with Diabetic Kidney Disease

Diabetic kidney disease (DKD), defined by decreased estimated glomerular filtration rate (eGFR) and/or existence of albuminuria, is an important issue for the prevention of cardiovascular disease (CVD) as well as end-stage renal disease. Recently, attention has been focused on the discordance between albuminuria and decreased eGFR in DKD in various clinical situations. However, clinical implication of albuminuria and/or eGFR on subclinical atherosclerosis does not fully remain clear as yet. The present study aims to investigate the association of albuminuria (ACR, mg/gCre) or decreased eGFR (mL/min/1.73m2) with endothelial dysfunction as an early surrogate marker of CVD in type 2 diabetic patients (T2D) with DKD. Six-hundred thirty-three patients (male, 363; median age 64 years, duration 10 years, HbA1c 8.4%) were enrolled. Flow-mediated dilatation (FMD, %) of brachial artery was measured by novel ultrasound equipment (UNEX EF®, Nagoya). All subjects were distributed in each stage of ACR or eGFR as follows; ACR, 425 (67.1%) subjects in A1 stage (&amp;lt;30), 101 (16.0%) in A2 (30-300), 107 (16.9%) in A3(&amp;gt;300); eGFR, 392 (61.9%) subjects in G1/2 stage (&amp;gt;60), 118 (18.6%) in G3a (45-60), 63 (10.0%) in G3b (30-45), 60 (9.5%) in G4/5 (&amp;lt;30). FMD was found to be significant lower in order of advanced stage of albuminuria or eGFR, respectively; 7.1±4.3 (A1), 6.3±3.5 (A2), 5.4±4.0 (A3), p =0.001; 7.3±4.2 (G1/2), 5.5±3.0 (G3a), 6.7±4.7 (G3b), 5.0±4.3 (G4/5), p &amp;lt;0.001. In multivariate analyses, only log-transformed ACR (β= -0.136, p=0.005) contributed to FMD independently even after adjustment for known classical risk factors such as age, BMI, HbA1c, and LDL-c, but eGFR did not. In conclusion, albuminuria is stronger independent determinant to endothelial function than eGFR in T2D patients with DKD. Our finding suggest that albuminuria may be more important than eGFR as a risk factor and/or potential therapeutic target for CVD in these high risk population. Disclosure Y. Kakutani: Speaker's Bureau; Self; Astellas Pharma US, Inc., Novo Nordisk Inc., Novartis Pharma K.K., Takeda Pharmaceuticals U.S.A., Inc. M. Emoto: Speaker's Bureau; Self; Eli Lilly and Company, Boehringer Ingelheim Pharmaceuticals, Inc., Sumitomo Dainippon Pharma Co., Ltd.. Research Support; Self; Astellas Pharma Inc, Ono Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., Kowa Pharmaceutical Company Ltd., Taisho Toyama Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation. Y. Yamazaki: None. K. Motoyama: None. T. Morioka: Consultant; Self; Ono Pharmaceutical Co., Ltd.. Research Support; Self; Novartis Pharma K.K., MSD K.K., Eli Lilly and Company, Sanofi K.K., Mitsubishi Tanabe Pharma Corporation. Speaker's Bureau; Self; Takeda Pharmaceuticals U.S.A., Inc., Novo Nordisk Inc., Kowa Pharmaceuticals America, Inc., Astellas Pharma US, Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Sumitomo Dainippon Pharma Co., Ltd. K. Mori: Speaker's Bureau; Self; Boehringer Ingelheim GmbH, Eli Lilly and Company, Mitsubishi Tanabe Pharma Corporation, MSD K.K., Sanofi, AstraZeneca, Daiichi Sankyo Company, Limited. S. Fukumoto: Speaker's Bureau; Self; Astellas Pharma US, Inc.. Research Support; Self; Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation. Speaker's Bureau; Self; Novo Nordisk Inc., Sanofi K.K.. Research Support; Self; Takeda Pharmaceuticals U.S.A., Inc., Taisho Toyama Pharmaceutical Co., Ltd.. A. Shioi: None. T. Shoji: Speaker's Bureau; Self; Astellas Pharma Inc, Bayer Yakuhin Ltd. Research Support; Self; Bayer Yakuhin Ltd. Speaker's Bureau; Self; Kowa Pharamaceutical Co Ltd, Daiichi Sankyo Company, Limited, MSD K.K., Chugai Pharmaceutical Co., Ltd.. Research Support; Self; Chugai Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Kyowa Hakko Kirin Co., Ltd., Kissei Pharmaceutical Co., Ltd.. M. Inaba: None.

Assessment of endothelial function among patients with type 2 diabetes mellitus

Background: Endothelial dysfunction is an initial key step in the pathogenesis of atherosclerosis. Many tests developed to measure endothelial function, most of which are either invasive or semi-invasive. The unique nature of brachial artery reactivity test of being a noninvasive, quantitative, and repeatable procedure is gaining increasing interest as an index in assessing endothelial cell function. Aim of Study: The aim is to study the assessment of endothelial function among a group of patients with type 2 diabetes mellitus (DM), using brachial artery reactivity test. Patients and Methods: In a case control study enrolling 35 patients with type 2 DM matched against a similar number of nondiabetic participants of related genders and age groups to trace the brachial artery diameter both at rest and in response to reactive hyperemia using a commercially available U/S machine equipped with a high-resolution linear probe (7.5 MHz) following an already defined U/S protocol. Results: The diabetic participants revealed a statistically significant attenuation in brachial artery dilatation in response reactive hyperemia when compared with nondiabetic group (mean ± standard deviation) (4.63 ± 0.4 mm vs. 5.61 ± 0.47 mm). Comparing the two groups, a statistically significant impairment of the brachial artery dilatation is traced in relation to the atherosclerotic risk factors both in isolation and in clusters. Moreover, strict glycemic control (HbA1c ≤6%) significantly altered the response to vasodilatation (0.74 ± 0.17 mm vs. 0.43 ± 0.14 mm, P = 0.0001). Age, gender difference, and duration of diabetes did not significantly alter the results. Conclusions: Endothelial dysfunction is not uncommon among patients with type 2 DM. Brachial artery reactivity test is a well-accepted, noninvasive, repeatable, and a quantitatively reproducible index to trace endothelial function.

Impact of exposure to biomass on the vascular function of Senegalese women

Background: In rural Senegal, biomass fuels are the main and often the only source of domestic energy for cooking. Their combustion is a source of particles and many other chemical contaminants that could alter cardiovascular function. Aims and Objectives: The aim of our study was to assess the effects of exposure to biomass fumes on vascular function in non-smoking women in rural Senegal. Materials and Methods: We conducted a cross-sectional 8-month study of 64 women (32 exposed to biomass smoke and 32 unexposed controls) who were active or housewives and involved in cooking. The subjects were aged 33.56 ± 9.34 years and 30.22 ± 6 years, respectively. All the women received a questionnaire with questions on sociodemographic characteristics, habitat characteristics, cooking habits, and biomass exposure conditions. Flow-mediated brachial arterial vasodilation flow-mediated dilatation (FMD) expressed as a percentage of the diameter was measured basally at rest and post-compression at 5, 30, 60, 90, and 120 s and 10 min after deflation. Results: All participants were non-smokers. 12.5% of subjects used gas in addition to biomass. Seniority was 18. 90 ± 10 years, with a mean daily biomass exposure of 4 ± 1 h. The analysis of cardiovascular parameters and blood sugar found no significant difference between the two groups. Kinetic FMD comparisons between the two groups showed significant differences at points 60 and 90 s 10 min post-occlusion. A negative correlation was found between FMD at 90 s after deflation and the duration of exposure in exposed women (r = 0.44 P < 0.05). Conclusion: Our results showed that exposure to biomass is implicated in the appearance of vascular dysfunction in non-smoking women.

Two-stage forearm brachio-basilic loop arteriovenous graft for hemodialysis

Introduction. The autologous radio-cephalic arteriovenous fistula (AVF) is the best vascular access for patients on chronic hemodialysis. In some patients with inadequate blood vessels, it is necessary to create proximal AVF, or arteriovenous grafts. High percentage of primary graft failure is noted in cases where diameters of the brachial artery and the basilic vein are insufficient. The aim of this work was to introduce a new surgical technique for arteriovenous creation in patients with inadequate blood diameter. Case outline. The authors have proposed implantation of brachio-basilic polytetrafluoroethylene AV forearm loop graft in two acts. In the first act, the native brachio-basilic AVF was created in the distal region of the arm by side-to-end anastomosis. Three to four weeks after the first act, significant dilatation of brachial artery and basilic vein was noted (confirmed by the use of color duplex sonography technique). During the second act, polytetrafluourethylene graft was implanted by end-to-end anastomosis on the dilated basilica vein. Conclusion. AV graft that was created in two acts has sufficient blood flow without early or late complications. Primary patency was 30 months and secondary patency was 50 months. As an original method in the current literature, we recommend it in different clinical settings when there are no better alternatives for vascular access.

Applied Machine Learning for the Prediction of Growth of Abdominal Aortic Aneurysm in Humans

ObjectiveAccurate prediction of abdominal aortic aneurysm (AAA) growth in an individual can allow personalised stratification of surveillance intervals and better inform the timing for surgery. The authors recently described the novel significant association between flow mediated dilatation (FMD) and future AAA growth. The feasibility of predicting future AAA growth was explored in individual patients using a set of benchmark machine learning techniques.MethodsThe Oxford Abdominal Aortic Aneurysm Study (OxAAA) prospectively recruited AAA patients undergoing the routine NHS management pathway. In addition to the AAA diameter, FMD was systemically measured in these patients. A benchmark machine learning technique (non-linear Kernel support vector regression) was applied to predict future AAA growth in individual patients, using their baseline FMD and AAA diameter as input variables.ResultsProspective growth data were recorded at 12 months (360 ± 49 days) in 94 patients. Of these, growth data were further recorded at 24 months (718 ± 81 days) in 79 patients. The average growth in AAA diameter was 3.4% at 12 months, and 2.8% per year at 24 months. The algorithm predicted the individual's AAA diameter to within 2 mm error in 85% and 71% of patients at 12 and 24 months.ConclusionsThe data highlight the utility of FMD as a biomarker for AAA and the value of machine learning techniques for AAA research in the new era of precision medicine.

Serial assessment of endothelial vasomotor function using optimal medical therapy predicts clinical outcomes in patients after complete coronary revascularization.

ObjectivePrevious studies have demonstrated the importance of intensive optimal medical therapy (OMT) in patients with coronary artery disease (CAD). To investigate our hypothesis that patients with and without OMT achievement differed with respect to the risk of future cardiac events, we investigated the endothelial function in patients with CAD who underwent percutaneous coronary intervention (PCI) and contemporary medical therapy.MethodsWe conducted a prospective longitudinal cohort study to evaluate the endothelial function in 96 consecutive patients at 12 h after admission and 3 months at <12 h after admission and at 3 months after discharge by measuring the brachial artery dilatation after 5 min of forearm ischemia flow-mediated dilation (FMD). OMT achievement was defined as systolic blood pressure of ≤130 mm Hg, low-density lipoprotein cholesterol of ≤100 mg/dl, and hemoglobin A1c level of ≤7.0%. The primary endpoint was the incidence of composite major adverse cardiac or cerebrovascular events (MACCE) at 36 months.ResultsForty-nine (51%) patients achieved all three risk factor targets at 3 months. Although baseline FMD values did not differ between the OMT achievement and non-achievement groups, the 3-month FMD significantly improved in the OMT achievement group (6.6±3.5 vs. 5.2±2.9, p=0.03). Patients with improved FMD at 3 months had a lower rate of 36-month MACCE than those with persistently impaired FMD. A multiple Cox hazards analysis showed that OMT was a protective predictor of MACCE (hazard ratio, 0.19; 95% confidence interval, 0.04–0.88, p=0.03).ConclusionThis study demonstrated a significant association between the serial measurement of endothelial function with OMT and the clinical outcome in patients after PCI.

Endothelial Function and Flow-Mediated Dilation of Brachial Artery in Pre-Eclampsia : Color Doppler Ultrasound Study

Endothelial Function and Flow-Mediated Dilation of Brachial Artery in Pre-Eclampsia : Color Doppler Ultrasound Study

Correlation between endothelial dysfunction and myocardial damage in acute phase of Tako-Tsubo cardiomyopathy: brachial flow mediated dilation as a potential marker for assessment of patient with Tako-Tsubo.

Takotsubo cardiomyopathy (TTC) is characterized by transient systolic ventricular dysfunction. It is supposed to be caused by a cathecolaminergic wave which leads to myocardial stunning through a massive action on beta2-adrenoreceptor. Moreover, beta2-receptor hyperactivity negatively influences endothelial function. It can be detected by brachial flow mediated dilation (b-FMD) which assesses endothelium regulated vasomotility. The study aim is to analyze the b-FMD variability during hospitalization in 50 patients admitted with TTC. In addition, we investigated a possible correlation between b-FMD at admission and both length of hospital stay (LOHS) and troponin I peak. We detected b-FMD by measuring the hypoxic induced vasoreactivity through assessing brachial artery dilation after 5min of iatrogenic ischemia obtained by inflating a sphygmomanometer cuff. Artery diameter modifications were assessed by high-resolution ultrasound, and a dedicated software calculated accurately the percentage of dilation after ischemia by comparing it to the basal. These values were measured at admission and on discharge. The obtained values were compared for each patient to explore their variability during hospitalization. Moreover, the correlation between the b-FMD at admission and both the troponin I peak and the LOHS was investigated. There was a statistical significant difference between mean FMD measured at admission and at discharge (respectively 1.54±0.34 and 8.92±2.48%; p<0.001). Moreover, we found a significant negative correlation between troponin I peak and FMD values at admission (r=-0.7645; p<0.001) and a significant inverse correlation between FMD at admission and LOHS (r=-0.7543; p<0.001). There is a significant improvement of b-FMD during hospitalization in patients admitted for Tako-Tsubo Cardiomyopathy. Moreover, for the first time, a direct correlation among b-FMD, troponin I peak and LOHS has been detected.