Increase In Brachial Artery Diameter Research Articles

Relationship of Warfarin and Apixaban with Vascular Function in Patients with Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is associated with endothelial damage/dysfunction. Herein, we tested the hypothesis that brachial artery flow-mediated dilation (FMD) is superior in AF patients taking apixaban compared to warfarin. Methods: AF patients on apixaban (n = 46; 67 [7] years; mean [standard deviation]; 15 women) and warfarin (n = 27; 73 [9] years (p < 0.01); 11 women) were recruited. Duplex Doppler ultrasound imaging was undertaken during baseline (2 min), cuff inflation (5 min), and following cuff deflation (3 min). FMD was defined as peak increase in brachial artery diameter following cuff deflation and analysed as percentage change in diameter, as a ratio of FMD, shear rate area under the curve (SR_AUC; FMD-to-SR_AUC), and using SR_AUC as a covariate (FMD_SR). Results: Baseline artery diameter (4.96 [1.14] vs. 4.89 [0.88] mm), peak diameter (5.12 [1.17] vs. 5.14 [0.93] mm), and FMD_SR (3.89 [3.62] vs. 4.80 [3.60] %) were not different between warfarin and apixaban (p > 0.05; analysis of covariance with age, CHA₂DS₂-VASc, years since AF diagnosis, number of diabetics, alcohol drinkers, and units of alcohol consumed per week as covariates). Stepwise multiple regression identified independent association of fibrillation, hypertension, and increased age with FMD. Conclusion: AF patients on warfarin and apixaban exhibit similar endothelium-dependent vasodilation. Increased blood pressure negatively impacts vasodilator capacity in AF patients.

Upper-body Rowing Increases Cardiorespiratory Fitness But Not Flow-mediated Dilation In Individuals With Spinal Cord Injury

Spinal cord injury (SCI) is often associated with low cardiorespiratory fitness (VO2peak). Traditional upper-body exercise training for individuals with SCI (e.g. arm crank exercise and wheelchair propulsion) elicits positive effects on VO2peak, while the effects on vascular health are less clear. Upper-body rowing may prove to be an effective exercise modality for improving VO2peak and vascular health, as it involves repeated contractions of a relatively large muscle mass. PURPOSE: To determine the effects of exercise training performed on a rowing ergometer modified for wheelchair users on VO2peak, resting diameter of brachial artery and flow-mediated dilation (FMD). METHODS: Fifteen participants with SCI (8 males, 7 females; level of injury: C4-L3; ASIA Impairment Scale (AIS): A-C) were randomized to a control (CON, n = 7) or exercise (EXR, n = 8) group. VO2peak, resting brachial artery lumen diameter (mm) and FMD (%) were assessed before, and after six (6 W) and 12 weeks (12 W) of three weekly sessions of moderate-to-vigorous intensity exercise. VO2peak (ml/kg/min) was determined using an incremental arm crank test until exhaustion. FMD (%) was calculated as the relative increase in brachial artery diameter (determined by high-resolution ultrasound) after five minutes of cuff occlusion. Changes in diameter were analyzed off-line using semi-automated edge-detecting software. Main effects of group and time and group-by-time interactions were examined using linear-mixed models. RESULTS: There was an interaction effect for VO2peak and resting brachial artery diameter (p < .001 and p = .016, respectively). VO2peak increased from baseline (15.1 ± 5.0 ml/kg/min) to 6 W (16.6 ± 5.3 ml/kg/min, p = .007) and 12 W (17.8 ± 6.1 ml/kg/min, p < .001) in EXR, but not in CON. Resting brachial artery diameter increased from baseline (4.8 ± 0.7 mm) to 12 W (5.1 ± 0.9 mm, p = .005) in EXR, with no changes at 6 W (5.0 ± 0.9 mm), and no changes in CON. There were no main effects or interaction effect observed for FMD. CONCLUSION: These data indicate that rowing is efficient for improving VO2peak in individuals with SCI. While resting lumen diameter increases with training, 12 weeks of rowing does not increase brachial artery endothelial function.

No accelerated arterial aging in relatively young women after preeclampsia as compared to normotensive pregnancy.

IntroductionPreeclampsia, an endothelial disorder of pregnancy, predisposes to remote cardiovascular diseases (CVD). Whether there is an accelerated effect of aging on endothelial decline in former preeclamptic women is unknown. We investigated if the arterial aging regarding endothelial-dependent and -independent vascular function is more pronounced in women with a history of preeclampsia as compared to women with a history of solely normotensive gestation(s).MethodsData was used from the Queen of Hearts study (ClinicalTrials.gov Identifier NCT02347540); a large cross-sectional study on early detection of cardiovascular disease among young women (≥18 years) with a history of preeclampsia and a control group of low-risk healthy women with a history of uncomplicated pregnancies. Brachial artery flow-mediated dilation (FMD; absolute, relative and allometric) and sublingually administered nitroglycerine-mediated dilation (NGMD; absolute and relative) were measured using ultrasound. Cross-sectional associations of age with FMD and NGMD were investigated by linear regression. Models were adjusted for body mass index, smoking, antihypertensive drug use, mean arterial pressure, fasting glucose, menopausal state, family history of CVD and stress stimulus during measurement. Effect modification by preeclampsia was investigated by including an interaction term between preeclampsia and age in regression models.ResultsOf the 1,217 included women (age range 22–62 years), 66.0% had a history of preeclampsia and 34.0% of normotensive pregnancy. Advancing age was associated with a decrease in relative FMD and NGMD (unadjusted regression coefficient: FMD: −0.48%/10 years (95% CI:−0.65 to −0.30%/10 years), NGMD: −1.13%/10 years (−1.49 to −0.77%/10 years)) and increase in brachial artery diameter [regression coefficient = 0.16 mm/10 years (95% CI 0.13 to 0.19 mm/10 years)]. Similar results were found when evaluating FMD and NGMD as absolute increase or allometrically, and after confounder adjustments. These age-related change were comparable in former preeclamptic women and controls (p-values interaction ≥0.372). Preeclampsia itself was independently associated with consistently smaller brachial artery diameter, but not with FMD and NGMD.ConclusionIn young- to middle-aged women, vascular aging in terms of FMD and NGMD was not accelerated in women after preeclampsia compared to normotensive pregnancies, even though former preeclamptic women consistently have smaller brachial arteries.

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.

The association between S1P and vascular disease markers in the general population

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Sphingosine-1-phosphate (S1P) is a lipid mediator of the immune system and vascular bed. However, cross-sectional analyses of S1P and parameters of vascular health in the population are sparse. Purpose We explored the relation between S1P concentrations and several parameters of vascular health, i.e. ankle-brachial index (ABI), carotid intima-media thickness (cIMT), presence of carotid atherosclerotic plaques/stenosis, brachial artery flow-mediated dilation (FMD) as well as aortic wall thickness (AWT). Methods S1P was measured by liquid chromatography-tandem mass spectrometry in the population-based Study of Health in Pomerania (SHIP-TREND-0). ABI was calculated as the ratio of systolic blood pressure in arms and ankles. For cIMT, the distance between the lumen-intima and media-adventitia interfaces in longitudinal scans were measured. Carotid plaques were defined as a focal protrusion of the carotid vessel wall. Carotid stenosis was assessed with Doppler ultrasonography. FMD was evaluated by measuring the increase in brachial artery diameter after transient forearm ischemia. AWT was assessed by Magnetic Resonance Imaging. Subjects with cancer, severe renal insufficiency, previous myocardial infarction and extreme values for S1P (&amp;lt; 1st and &amp;gt; 99th percentile) were excluded. Sex stratified linear regression models adjusted for age, smoking, waist-to-hip ratio and platelets were used to assess the relation between S1P and vascular disease parameters. Results A total of n = 3,643 participants (48% male, median age 51, 25th and 75th percentile 39 and 63 years) could be included in the analyses. The median S1P concentration was 0.788 µM (25th and 75th percentile 0.679 and 0.906, respectively). In men a 1 standard deviation higher S1P was associated with a significantly greater cIMT (β: 0.0057 95% confidence interval [CI]: 0.00027 to 0.0112 mm; p = 0.0396) and a lower ABI (β: -0.0090 (95% confidence interval [CI]: -0.0153 to -0.0029; p = 0.0038. In women S1P was significantly associated with cIMT (β: 0.0044 95% confidence interval [CI]: 0.0001 to 0.0086 mm; p = 0.0445) while no significant association was found for the relation of S1P with ABI. For both men and women S1P was not associated with FMD, the presence of carotid plaques/stenosis and AWT. Conclusions We found that S1P concentrations were positively related to a thicker cIMT in both sexes and lower ABI values in men. There was no association of S1P with any of the other vascular markers of interest. Future studies need to validate our results in other populations.

Прогнозирование состояния пациенток с преэклампсией на основании показателей эндотелийзависимой вазодилатации

Aim: to determine prognostic criteria of severe preeclampsia based on the assessment of endothelium-dependent (ED) flow-mediated dilation (FMD) of the brachial artery (BA). Patients and Methods: 97 pregnant women (&gt;28 weeks of pregnancy) with moderate preeclampsia were enrolled. These women were retrospectively divided into two groups. Group 1 included 42 pregnant women (mean age 30.0±0.5 years) in whom the severity of preeclampsia increased after treatment. Group 2 included 55 pregnant women (mean age 31.0±0.7 years) whose severity of preeclampsia did not increase after treatment. Group 3 (control group) included 20 women with a healthy pregnancy. ED FMD of BA was assessed by vascular ultrasound using a reactive hyperemia test. In addition, BA diameter and peak systolic velocity (PSV) 15 sec and 1 min after cuff deflation were measured. These measurements were performed at enrollment and after one week (or in feeling worse). Results: healthy pregnancy was characterized by a gradual increase in BA diameter in response to cuff inflation (by 15.7% and 23.9% after 15 sec and 1 min, respectively, at baseline and by 17.8% and 21.3% after 15 sec and 1 min, respectively, after one week). In pregnant women with preeclampsia, baseline changes in BA diameter were less significant. Meanwhile, after one week, a reduction in BA diameter was reported in group 1, and close-to-normal BA diameter was reported in group 2. In group 3, BA PSV increased by 5.2% and 16% in 15 sec and 1 min, respectively, after cuff inflation. In pregnant women with preeclampsia, BA PSV, in contrast, was reduced (more significant after 1 min). Conclusion: increased BA diameter and PSV by less than 10% 15 sec and 1 min after cuff inflation indicate endothelial dysfunction. A negative pattern of changes in these parameters suggests an unfavorable course of preeclampsia and its transition to severe disease. KEYWORDS: preeclampsia, endothelial dysfunction, vasodilation, brachial artery, peak systolic velocity, prognosis. FOR CITATION: Shavaeva R.Kh., Murashko A.V., Zuev V.M. et al. Predicting preeclampsia course based on endothelium-dependent dilation. Russian Journal of Woman and Child Health. 2021;4(4):317–321 (in Russ.). DOI: 10.32364/2618-8430-2021-4-4-317-321.

The Effect Of A High-fat Meal On Sympathetic Vasoconstrictor Responsiveness In Men And Women

Consumption of a high-fat (HF) meal has been shown to reduce flow-mediated dilation (FMD) in men, but not women. This decline in FMD may be a result of decreased nitric oxide (NO) bioavailability. NO inhibits sympathetic vasoconstriction and a HF meal may, therefore, heighten sympathetic vasoconstrictor responsiveness. However, the effect of a HF meal on sympathetic vasoconstriction in men and women has not been investigated. PURPOSE: The purpose of this study was to investigate the hypothesis that consumption of a HF meal would heighten sympathetic vasoconstrictor responsiveness in men, but have no effect in women. METHODS: In a randomized cross-over design, young males (n=15) and females (n=15) consumed a HF or an isocaloric low-fat (LF) meal on separate days. Two hours post-meal, subjects underwent a cold pressor test (CPT) and measurement of brachial artery FMD to determine sympathetic vasoconstrictor responsiveness and endothelial function, respectively. Beat-by-beat blood pressure was measured by Finometer and mean arterial pressure (MAP) was calculated. Forearm blood flow (FBF) was measured by Doppler ultrasound at the brachial artery and forearm vascular conductance (FVC) was calculated as FBF/MAP. Sympathetic vasoconstrictor responsiveness was calculated as the percentage decrease in FVC (%∆FVC) in response to CPT. FMD was calculated as the percentage increase in brachial artery diameter from baseline and normalized for cumulative shear rate. RESULTS: Sympathetic vasoconstrictor responsiveness was not different (p>0.05) between meal conditions or between females (LF: -27±14%: HF: -30±15%) and males (LF: -29±23%: HF: -24±16%) in either meal condition. FMD was higher (main effect of sex; p<0.05) in females (LF: 8.1±2.1%: HF: 7.4±1.4%) compared to males (LF: 6.2±1.5%: HF: 5.1±1.1%) and FMD was lower (main effect of meal; p<0.05) in the HF compared to the LF meal condition. No interaction (p>0.05) was observed between meal condition and sex for FMD. FMD normalized for shear rate was not different (p>0.05) between meal conditions or between females and males in either meal condition. CONCLUSION: These data suggest that, despite evidence of a post-prandial decrease in endothelial function, a HF meal does not alter sympathetic vasoconstrictor responsiveness in men or women.

The effect of ivabradine as part of standard therapy on vascular endothelial function and cardiac electrical instability in patients with post-infarction cardiosclerosis and heart failure

Aim. To reveal the equivalence of nebivolol replacement with ivabradine in the prevention of endothelial dysfunction and cardiac electrical instability in patients with heart failure with reduced ejection fraction (HFrEF).Material and methods. In current observational study, 126 patients with HFrEF in the postinfarction period were randomized into two groups for six-month treatment: group 1 (n=62) — standard therapy (acetylsalicylic acid 0,1 g/day, clopidogrel 75 mg/day, veroshpiron 50 mg/day, nebivolol 5 mg/day, perindopril 5 mg/day and rosuvastatin 20 mg/day; group 2 (n=66) — the same therapy with nebivolol replacement with ivabradine 10 mg/day. Initially and after 6 months, 24-hour Holter monitoring was performed, heart rate variability was determined. We also investigated endothelial dysfunction using the photoplethysmographic technique with post-occlusive reactive hyperemia (PORH) test.Results. The heart rate, the number of episodes and the duration of symptomatic and silent myocardial ischemia, total myocardial ischemia were significantly decreased in both groups (p&lt;0,001). The decrease of supraventricular extrasystole frequency in both groups had not statistical significance (p&gt;0,05). In both groups, after therapy, parameters of heart rate variability were improved with the parasympathetic predominance (p&lt;0,01). In both groups, the PORH test revealed the increase of brachial artery diameter (group 1 — 5,90Ѓ}3,15% and group 2 — 5,88Ѓ}1,82%) and pulse wave amplitude (group 1 — 1,81Ѓ}0,78 and group 2 — 1,73Ѓ}0,90 times), which indicates a trend towards an improvement in endothelial function. Intergroup comparisons did not reveal significant differences.Conclusion. Ivabradine is equivalent to nebivolol in preventing ventricular extrasystole and reducing heart rate, number of episodes of symptomatic and silent ischemia and the duration of total myocardial ischemia in patients with HFrEF. Ivabradine equivalently to nebivolol improves endothelial function and heart rate variability with reducing the sympathetic activity.

Endothelial dysfunction in workers in underground mining of chrome ores

Introduction. Currently, endothelial dysfunction is considered as one of the initial stages of the pathogenesis of cardiovascular diseases. By isolating a number of biologically active compounds, the endothelium helps to maintain vascular tone and physiological rheology of the blood. Modern production of chrome ore is characterized by a variety of harmful occupational factors (chromium, dust, noise, vibration, severity and intensity of work, cooling microclimate), which can disrupt the normal functioning of the vascular endothelium and lead to the development of cardiovascular diseases.The aim of the study was to study the features of endothelial function in workers engaged in underground mining of chrome ore in harmful working conditions.Materials and methods. The study included 98 miners of the enterprise for the extraction of chrome ore. The comparison group (working in conditions outside the influence of the studied production factors) consisted of 75 employees-managers and specialists of administrative and managerial personnel of the enterprise, comparable in age and experience with the observation group. To assess the vasomotor function of the endothelium, a flow-dependent (endothelium-dependent) vasodilation test was performed using the D. S. Celermajer technique. Post-occlusive increase in brachial artery diameter, brachial artery sensitivity coefficient to endothelial shift change were evaluated.Results. The endothelial function of mine workers did not differ significantly from the comparison group with work experience up to 10 years (the values of the relative increase in the diameter of the brachial artery 12.2% in the observation group and in the comparison group 12.6%, p=0.74). With experience of more than 10 years, the value of the relative increase in the diameter of the brachial artery in the observation group with experience of more than 10 years corresponded to the signs of endothelial dysfunction and amounted to 8.6%, while in the comparison group this figure was 12.4%, which corresponded to normal endothelial function (p=0.019). Endothelial function progressively deteriorated with increasing seniority in mine workers. Conclusions. For workers engaged in underground mining of chrome ore for more than 10 years, a reduced vasodilation reaction to reperfusion after an occlusion test and a low coefficient of sensitivity of the endothelium to shear stress are characteristic. There was no statistically significant decrease in increase in brachial artery diameter and the coefficient of sensitivity of endothelium to shear stress relative to the comparison group was selected only from persons with experience more than 10 years. The comparative analysis of the results of the evaluation of the functional activity of the endothelium in workers of the compared groups indicates that the change in the functional state of the endothelium in miners is associated not only with age, but also with working conditions. The revealed changes predispose to the development of cardiovascular pathology associated with atherosclerosis in workers of underground chrome ore mining.

Endothelial dysfunction in children with pyelonephritis

Aim. To study the characteristics of vascular endothelium system functioning as a marker of the balance between endothelium-dependent vasodilation and endothelium-dependent vasoconstriction in children with acute and chronic pyelonephritis.Materials and methods. 39 children with acute and 37 with chronic pyelonephritis aged 11–17 years, without exacerbation of the inflammatory process were examined. The control group consisted of 30 apparently healthy children. Endothelium-dependent vasodilatation test adapted to children was used.Results. In children with acute pyelonephritis, the initial index of the brachial artery diameter did not differ significantly from the norm (3.40 ± 0.19 mm, P &gt; 0.05), while it was significantly less in patients with chronic pyelonephritis (2.20 ± 0.12 mm, P &lt; 0.05). In the phase of maximal vasodilation, the brachial artery diameter index was significantly higher (4.10 ± 0.15 mm, P &lt; 0.05) in patients with acute pyelonephritis, and in patients with chronic pyelonephritis – significantly less than the norm (2.60 ± 0.17 mm, P &lt; 0.05). As a result, the brachial artery diameter increase was significantly less in children with chronic pyelonephritis than in healthy children (8.2 ± 0.2 %, P &lt; 0.05), while it was significantly higher (24.10 ± 0.53 %, P &lt; 0.05) in children with acute pyelonephritis. Linear blood flow velocity at rest was significantly lower than normal (111.80 ± 0.17, P &lt; 0.05) in children with acute pyelonephritis and it was significantly increased (148.70 ± 0.14 cm/s, P &lt; 0.05) in children with chronic pyelonephritis. In the phase of reactive hyperemia, the linear flow velocity was decreased in both groups of patients.Conclusions. Endothelial dysfunction is registered in 17.9 % of acute pyelonephritis and in 64.9 % of chronic pyelonephritis cases in children. Diverging paths are observed: in patients with acute pyelonephritis, activity of vasodilatory agents predominates, and in chronic pyelonephritis - vasoconstrictor agents. Endothelial dysfunction associated with chronic pyelonephritis has the risk of unfavorable course of the disease and requires differential management.

Positive Effects of Tomato Paste on Vascular Function After a Fat Meal in Male Healthy Subjects.

Tomato consumption has been recently associated with a reduced incidence of cardiovascular disease (CVD). The aim of this study was to test whether a seven-day period of tomato paste purèe (tomato paste, TP) supplementation could improve some haemodynamic parameters in healthy volunteers before and after a standardized fat meal (FM). Methods and results: Nineteen healthy male volunteers participated in a randomized, single-blind (operator) crossover study. Participants maintained low fiber diets (LFD) during the study periods. They were randomized either to a LFD and TP arm (80 g of TP/day) for seven-days, or to a control arm (LFD-only) with a two-week washout period. Flow Mediated Dilatation and other morpho-functional vascular indices were measured by ultrasound. Stiffness Index and Reflection Index were estimated by digital photo-plethysmography. All these parameters were measured one h before and two and 3.5 h after the FM. The difference in Stiffness Index was increased in the LFD and TP + FM-arm, as compared to the LFD-only + FM arm at both two and 3.5 h points. After the FM, in both arms, at two h, we observed a reduction in the Reflection Index and an increase in heart rate. Interestingly, only in the LFD and TP + FM-arm, some haemodynamic changes were detectable at two h; notably, there was an increase in brachial artery diameter and a reduction in diastolic blood pressure (BP). Conclusions: TP has no effect on Flow Mediated Dilatation but acutely modifies some haemodynamic parameters triggered by FM, suggesting possible haemodynamic beneficial effects in people consuming tomatoes.

Vasodilation and Reduction of Systolic Blood Pressure after One Session of High-Intensity Interval Training in Patients With Heart Failure with Preserved Ejection Fraction

BackgroundHeart failure with preserved ejection fraction (HFpEF) is a multifactorial syndrome characterized by a limited exercising capacity. High-intensity interval training (HIIT) is an emerging strategy for exercise rehabilitation in different settings. In patients with HFpEF, HIIT subacute effects on endothelial function and blood pressure are still unknown.ObjectiveTo evaluate the subacute effect of one HIIT session on endothelial function and blood pressure in patients with HFpEF.MethodsSixteen patients with HFpEF underwent a 36-minute session of HIIT on a treadmill, alternating four minutes of high-intensity intervals with three minutes of active recovery. Brachial artery diameter, flow-mediated dilation, and blood pressure were assessed immediately before and 30 minutes after the HIIT session. In all analyses, p <0.05 was considered statistically significant.ResultsThere was an increase in brachial artery diameter (pre-exercise: 3.96 ± 0.57 mm; post-exercise: 4.33 ± 0.69 mm; p < 0.01) and a decrease in systolic blood pressure (pre-exercise: 138 ± 21 mmHg; post-exercise: 125 ± 20 mmHg; p < 0.01). Flow-mediated dilation (pre-exercise: 5.91 ± 5.20%; post-exercise: 3.55 ± 6.59%; p = 0.162) and diastolic blood pressure (pre-exercise: 81 ± 11 mmHg; post-exercise: 77 ± 8 mmHg; p = 1.000) did not change significantly. There were no adverse events throughout the experiment.ConclusionsOne single HIIT session promoted an increase in brachial artery diameter and reduction in systolic blood pressure, but it did not change flow-mediated dilation and diastolic blood pressure.

Endothelial dysfunction assessment by flow-mediated dilation in a high-altitude population.

IntroductionEndothelial function at high altitude has been measured only in populations that are genetically adapted to chronic hypoxia. The objective of this study was to evaluate endothelial dysfunction (ED) in a nongenetically adapted high-altitude population of the Andes mountains, in Huancayo, Peru (3,250 meters above sea level).MethodsParticipants included 61 patients: 28 cases and 33 controls. The cases were subjects with hypertension, diabetes mellitus, obesity, or a history of stroke or coronary artery disease. Flow-mediated vasodilation (FMD) of the brachial artery was measured in the supine position, at noon, after 5 minutes of resting. The brachial artery was identified above the elbow. Its basal diameter was measured during diastole, and FMD was tested after 5 minutes of forearm ischemia. Intima–media complex in the right carotid artery was also determined. An increase in the artery’s baseline diameter <10% indicated a positive test. Endothelium-independent vasodilation was evaluated with sublingual nitrate administration. The intima–media complex in the right carotid artery was also measured.Results100% of diabetics had ED; ED was also found in 68.8% of obese individuals, 55% of hypertensive patients, and 46.5% of controls. Age, height, body mass index, and waist diameter were higher in the cases as compared with the controls. A total of 57.9% (n=11) of the cases and 45.2% (n=19) of the controls presented ED. Patients without ED had a mean increase in brachial artery diameter of 23.16%, while in those with ED it was only 3.84%. Individuals with diabetes or hypertension had a greater thickness of the carotid artery intima media layer (1.092 versus 0.664 cm) (p=0.037). A positive test for ED was associated with a greater basal diameter of the brachial artery (4.66±0.62 versus 4.23±0.59 cm) (p=0.02). A total of 7 patients presented paradoxical response, developing posthyperemia vasoconstriction.DiscussionThe proportion of ED was high among controls and among patients with risk factors. Controls showed better FMD profiles than subjects studied in Tibet and the Himalayas.

PP.20.01] REPRODUCIBILITY OF DIFFERENT MEASURES OF ENDOTHELIAL FUNCTION

Objective: Brachial artery flow-mediated dilatation (FMD) to determine endothelial function is an investigator-demanding method. Impaired endothelial function as measured by FMD is known to be associated with cardiovascular risk factors. Local thermal hyperaemia (LTH) of the skin measured with a laser Doppler flow imager is less demanding and may serve as an alternative. We investigated the reproducibility of LTH and its correlation with FMD. In addition, the association of FMD with post-occlusive dermal hyperaemia (PORH), a widely used measure of microvascular function, was assessed. Design and method: FMD, LTH and PORH were measured in 27 healthy men (8 smokers) on two occasions, one week apart, at the same time of the day. FMD, measured with ultra-sound, was expressed as the maximal percentage increase in brachial artery diameter during reactive hyperaemia. LTH peak was defined as the maximal dermal blood flow (DBF) response within the first ten minutes and LTH plateau as the average DBF response during the last five minutes of 35 heating in arbitrary units (a.u.), measured with a laser Doppler flow imager. PORH Peak and AUC were measured at the volar site of the left forearm just under the pressure cuff, using a laser speckle imager. Results: Coefficients of variation (n = 27) of the LTH peak and plateau response were 18% and 21%, of the PORH peak and area under the curve (AUC) response both 13% and of the FMD response 21%. The LTH peak and plateau response and FMD response were not correlated, whereas the PORH AUC was correlated with FMD (r = 0.46, p < 0.05) and PORH Peak correlated with LTH Plateau (r = 0.58, p < 0.05). Conclusions: The reproducibility of the LTH plateau response and FMD response were almost equal in this study. In addition, as LTH and FMD did not correlate, these responses appear to provide different information. PORH, however, correlated partly with both LTH and FMD and should be further investigated as a possible alternative for FMD in long-term outcome studies.

Endothelial function in primary hyperaldosteronism vs essential arterial hypertension

Objective.To estimate and compare the endothelial function in patients with essential arterial hypertension (HTN) and primary hyperaldosteronism (PHA).Design and methods.Eighty-two patients were examined. Among them, PHA was verified in 19 patients, while 36 patients had essential HTN stage II (blood pressure (BP) elevation of 1st or 2nd degree), and 27 age-matching healthy people formed control group. The HTN duration in PHA patients was 1,95 ± 0,24 years, and in patients with essential HTN — 5,5 ± 0,5 years. Both patients and healthy peoples were examined within the hospital, in compliance with the hospital regime and diet. Endothelial function was assessed by several methods: the number of circulating desquamated endothelial cells (the method by Hladovec J.), reactive hyperemia test and evaluation of endothelium-dependent vasodilation (as a percentage of the brachial artery diameter increase), total blood nitrates and nitrites level (Griss-reaction method), nitric oxide excretion in urine.Results.Endothelial dysfunction (ED) was found in all patients with high BP. We found more profound ED in PHA patients compared to patients with essential HTN, which resulted in a significantly higher number of circulating endothelial desquamated cells, lower percentage of vasodilation response in reactive hyperemia test, decreased blood levels of total nitrites/nitrates and elevated nitric oxide urine excretion. Discriminant analysis was applied to range the severity of ED. Patients with essential HTN had moderate ED, while patients with PHA had severe ED. Conclusions. The proposed classification approach can be successfully applied for monitoring changesin ED and the effectiveness of treatment in patients with various diseases associated with BP elevation.

Endothelial dysfunction in patients with hypertension and peripheral artery disease

Aim. To assess endothelial function in patients with hypertension and peripheral artery disease.Methods. The study included 100 patients with an established diagnosis of essential hypertension. Ultrasonic duplex scanning of brachiocephalic arteries and lower limb arteries was performed. The functional state of the endothelium was evaluated using postocclusive reactive hyperemia test by D.S. Celermajer.Results. Atherosclerotic plaques in the carotid arteries were found in 71% of patients, in the lower limb arteries - in 60%. The combined affection of both vascular beds was diagnosed in 51% of patients. Endothelial dysfunction was found in 64% of patients. In patients with carotid arterial system atherosclerosis, brachial artery dilation response was 6.1%, while in those with intact carotid arteries - 4.7% (p=0.041). The value of the brachial artery dilation response in patients with atherosclerotic lesions of lower extremities arteries was 5.9%. In the subgroup of patients with intact lower limbs arteries, the increase in brachial artery diameter was 9.60% an average (p=0.04). Among 51 people with affection of both vascular systems the brachial artery diameter increase was 5.4%, while in comparison, in the subgroup consisting of 49 patients without combined carotid and lower limb arteries lesions, - 9.9% (p=0.003). According to the results of the correlation analysis, the relation between endothelial dysfunction and the maximum percentage of stenosis of the carotid arteries and lower limb arteries at the level of tibial segment was revealed.Conclusion. In patients with hypertension and peripheral artery disease, decrease in dilation response in endothelium-dependent vasodilation test was registered regardless of the localization of atherosclerotic lesions; endothelial dysfunction in essential hypertension was associated with the highest percentage of stenosis of the carotid arteries and lower limb arteries at the level of tibial segment.

Study of atherosclerotic risk markers in patients with nonalcoholic fatty liver disease

Introduction: Nonalcoholic fatty liver disease (NAFLD) is described as hepatic component of metabolic syndrome as close association exists between the two. It has gained lots of importance in midst of rising epidemic of obesity worldwide in recent times as one of the predisposing risk factors of cardiovascular events. Study Design: The study design was a cross-sectional hospital-based study. Materials and Methods: Forty-eight patients diagnosed to have NAFLD were assessed for insulin resistance (IR) and noninvasive markers of subclinical atherosclerosis and compared with age, gender, and body mass index-matched controls. Results: The patients with NAFLD had significantly higher waist circumference, diastolic blood pressure, fasting insulin, homeostasis model assessment-IR, and significantly lower levels of high-density lipoprotein-cholesterol. They also had significantly higher carotid intima media thickness (CIMT) than controls. Mean CIMT was 0.76 ± 0.12 mm in patients with NAFLD and 0.54 ± 0.18 mm in controls. This difference was statistically significant (P = 0.001). The mean increase in brachial artery diameter was 0.26 ± 0.13 mm in patients and 0.48 ± 0.09 mm in controls. Conclusion: Patients with NAFLD have greater propensity to develop cardiovascular disease in view of the presence of subclinical atherosclerotic markers compared to controls.

Effects of chronic dietary nitrate supplementation on the hemodynamic response to dynamic exercise.

While acute treatment with beetroot juice (BRJ) containing nitrate (NO3 (-)) can lower systolic blood pressure (SBP), afterload, and myocardial O2 demand during submaximal exercise, effects of chronic supplementation with BRJ (containing a relatively low dose of NO3 (-), 400 mg) on cardiac output (CO), SBP, total peripheral resistance (TPR), and the work of the heart in response to dynamic exercise are not known. Thus, in 14 healthy males (22 ± 1 yr), we compared effects of 15 days of both BRJ and nitrate-depleted beetroot juice (NDBRJ) supplementation on plasma concentrations of NOx (NO3 (-)/NO2 (-)), SBP, diastolic blood pressure (DBP), mean arterial pressure (MAP), CO, TPR, and rate pressure product (RPP) at rest and during progressive cycling exercise. Endothelial function was also assessed via flow-mediated dilation (FMD). BRJ supplementation increased plasma NOx from 83.8 ± 13.8 to 167.6 ± 13.2 μM. Compared with NDBRJ, BRJ reduced SBP, DBP, MAP, and TPR at rest and during exercise (P < 0.05). In addition, RPP was decreased during exercise, while CO was increased, but only at rest and the 30% workload (P < 0.05). BRJ enhanced FMD-induced increases in brachial artery diameter (pre: 12.3 ± 1.6%; post: 17.8 ± 1.9%). We conclude that 1) chronic supplementation with BRJ lowers blood pressure and vascular resistance at rest and during exercise and attenuates RPP during exercise and 2) these effects may be due, in part, to enhanced endothelium-induced vasodilation in contracting skeletal muscle. Findings suggest that BRJ can act as a dietary nutraceutical capable of enhancing O2 delivery and reducing work of the heart, such that exercise can be performed at a given workload for a longer period of time before the onset of fatigue.

Vascular Function in Fibromuscular Dysplasia

Background: There have been no studies to date on the pathophysiologic mechanisms of how fibromuscular dysplasia (FMD) affects vascular function. Due to the perturbations in the blood vessel wall and the propensity for stenosis, dissection, and aneurysms seen in arteries with FMD, subjects with FMD may have impairment in endothelial function and abnormalities in arterial compliance. Methods: Twenty-seven subjects with documented FMD of the renal and/or carotid arteries and ten age, gender, and ethnicity matched healthy control subjects were recruited for this study. Predictors of cardiovascular disease including endothelial function, brachial-ankle pulse wave velocities (baPWVs), ankle-brachial indices (ABIs), and carotid artery intima-media thickness (IMT) were evaluated. Results: For the FMD population, endothelium dependent flow-mediated vasodilation of the brachial artery was 15.91 ± 8.69% (p<0.001). Nitroglycerin produced a significant 27.69% (p=0.04) increase in time-averaged, volumetric flow through the brachial artery and resulted in an increase in brachial artery diameter from 2.66 ± 0.42 mm to 3.37 ± 0.51 mm, p<0.01. The mean baPWV for all ages was 1324.37 ± 247.55 cm/sec, the mean ABI was 1.16 ± 0.09, and the mean distal common carotid artery far wall IMT was 0.64 ± 0.15 mm. Conclusion: This is the first study to evaluate vascular function in FMD. In this small population, FMD was not associated with endothelial dysfunction, impaired arterial compliance, increased carotid artery IMT, or decreased ABIs. A prospective larger study will be required to confirm these findings.

Effect of L-Carnitine on the Indices of endothelial Dysfunction and Inflammation Factors in Patients with Acute Myocardial Infarction Without the Q Wave

Aim: To evaluate the influence of L-carnitine on inflammatory markers and indicators of endothelial function in patients with acute myocardial infarction without the Q wave.Materials and Methods: 40 patients with verified diagnosis of AMI without Q-wave. All the patients were matched by sex, age, weight and duration of the underlying disease. The patients were randomized into 2 groups. The first group ofpatients were on a standard basic therapy and additionally administered L- carnitine at a dose 5g/day, II- group consisted of patients who did not receive drugs with metabolic action. In dynamics (on the 1st and 10th day of the treatment) the parameters of endothelium vasodilation and markers of inflammation were evaluated.Results: On the background of the basic therapy in both groups an improvement in endothelial function resulting in an increase of brachial artery diameter was observed. However, the L- carnitine vasodilator effect was more pronounced and persistent as compared to group II. In the dynamics, CRP levels and plasma fibrinogen were more pronounced in the Ist group.