Percent Flow-mediated Dilation Research Articles

The relationship of visceral adiposity with endothelial functions and subclinical atherosclerosis in obese individuals.

On the cardiovascular system, obesity accelerates atherosclerosis progression, inducing pathophysiological changes that are detectable already from young adults. Endothelial dysfunction is one of the earliest vascular alterations observed in obesity. In this study, we aimed to determine endothelial functions and carotid intima-media thickness in patients with obesity without overt cardiovascular disease. The study was conducted with 112 individuals with obesity without overt cardiovascular disease and any chronical diseases (BMI>30 kg/m2) (84 female, 28 male, mean age: 46.3±11.2 years) and 49 healthy individuals with no diseases (33 female, 16 male, mean age: 44.6±10.2 years). All patients were examined for endothelial functions by the flow-mediated dilatation (FMD) method and carotid intima-media thicknesses (CIMT). All measurements were performed by the same imaging specialist, averaging 3 different measurements. In addition to the body mass index and waist circumference visceral adiposity index (VAI) and triponderal mass index (TPI) also calculated. The percentage of FMD obtained by brachial artery ultrasound was significantly lower, visceral adipose tissue, perirenal adipose tissue thicknesses measured by abdominal ultrasound and CIMT were significantly thicker in Group 1 compared to Group 2. FMD had a negative significant correlation with body mass index, visceral adipose tissue thickness, perirenal adipose tissue thickness, and waist and hip circumferences, and carotid intima-media thickness and CIMT had a significant correlation with visceral adipose tissue thickness, perirenal adipose tissue thickness, VAI, TPI and waist, hip circumferences. Individuals with obesity have impaired endothelial functions and greater carotid intima-media thicknesses compared to healthy individuals. This impairment in endothelial functions is proportional to the amount of visceral and perirenal fat accumulation. Parameterss reflecting visceral fat distribution such as VAI and TPI are also related with these impairment.

The relationship of visceral adiposity with endothelial functions and subclinical atherosclerosis in obese individuals.

On the cardiovascular system, obesity accelerates atherosclerosis progression, inducing pathophysiological changes that are detectable already from young adults. Endothelial dysfunction is one of the earliest vascular alterations observed in obesity. In this study, we aimed to determine endothelial functions and carotid intima-media thickness in patients with obesity without overt cardiovascular disease. The study was conducted with 112 individuals with obesity without overt cardiovascular disease and any chronical diseases (BMI>30 kg/m2) (84 female, 28 male, mean age: 46.3±11.2 years) and 49 healthy individuals with no diseases (33 female, 16 male, mean age: 44.6±10.2 years). All patients were examined for endothelial functions by the flow-mediated dilatation (FMD) method and carotid intima-media thicknesses (CIMT). All measurements were performed by the same imaging specialist, averaging 3 different measurements. In addition to the body mass index and waist circumference visceral adiposity index (VAI) and triponderal mass index (TPI) also calculated. The percentage of FMD obtained by brachial artery ultrasound was significantly lower, visceral adipose tissue, perirenal adipose tissue thicknesses measured by abdominal ultrasound and CIMT were significantly thicker in Group 1 compared to Group 2. FMD had a negative significant correlation with body mass index, visceral adipose tissue thickness, perirenal adipose tissue thickness, and waist and hip circumferences, and carotid intima-media thickness and CIMT had a significant correlation with visceral adipose tissue thickness, perirenal adipose tissue thickness, VAI, TPI and waist, hip circumferences. Individuals with obesity have impaired endothelial functions and greater carotid intima-media thicknesses compared to healthy individuals. This impairment in endothelial functions is proportional to the amount of visceral and perirenal fat accumulation. Parameterss reflecting visceral fat distribution such as VAI and TPI are also related with these impairment.

Enhancing Flow Mediated Dilation Analysis by Optimizing an Open-Source Software with Automated Edge Detection.

Flow mediated dilation (FMD) is a common measure of endothelial function and an indicator of vascular health. Automated software methods exist to improve the speed and accuracy of FMD analysis. Compared to commercial software, open-source software offers similar capabilities at a much lower cost while allowing for increased customization specific to users' needs. We introduced modifications to an existing open-source software, FloWave.us to better meet FMD analysis needs. The purpose of this study was to compare the repeatability and reliability of the modified FloWave.us software to the original software and to manual measurements. To assess these outcomes, Duplex ultrasound imaging data from the popliteal artery in older adults were analyzed. The average percent FMD for the modified software was 6.98±3.68% and 7.27±3.81% for Observer 1 and 2 respectively, compared to 9.17±4.91% and 10.70±4.47% with manual measurements and 5.07±31.79% with the original software for Observer 1. The modified software and manual methods demonstrated higher intra-observer intraclass correlation coefficients (ICCs) for repeated measures for baseline diameter, peak diameter, and percent FMD compared to the original software. For percent FMD, the inter-observer ICC was 0.593 for manual measurements and 0.723 for the modified software. With the modified method an average of 97.7±2.4% of FMD videos frames were read, compared to only 17.9±15.0% frames read with the original method when analyzed by the same observer. Overall, this work further establishes open-source software as a robust and viable tool for FMD analysis and demonstrates improved reliability compared to the original software.

Prevalence and Determinants of Endothelial Dysfunction among Adults Living with HIV in Northwest Nigeria.

Endothelial dysfunction constitutes an early pathophysiological event in atherogenesis and cardiovascular disease. This study aimed to assess the prevalence, determinants, and degree of endothelial dysfunction in antiretroviral therapy (ART)-treated people living with HIV (PLWH) in northwestern Nigeria using brachial flow-mediated dilatation (FMD). This was a comparative, cross-sectional study. A total of 200 ART-treated adults living with HIV with no evidence of kidney disease were compared with 200 HIV-negative participants attending a tertiary hospital in Kano, Nigeria, between September 2020 and May 2021. Endothelial function was evaluated by measuring FMD with a high-resolution vascular ultrasound transducer. FMD was calculated as the ratio of the brachial artery diameter after reactive hyperemia to baseline diameter and expressed as a percentage of change. Blood and urine samples were obtained from participants in both arms. Urine albumin-to-creatinine ratio (uACR) was calculated using the 2021 CKD-EPI estimated glomerular filtration rate (eGFR) creatinine-cystatin C equation without the race variable, and low-density lipoprotein (LDL) cholesterol was measured using enzymatic method. The overall mean age (± standard deviation) of the study participants was 42 ± 11 years. Participants in the comparison arm were younger than PLWH (38 ± 11 versus 46 ± 10 years, respectively). The median (interquartile range) uACR was 41.6 (23.2-162.9) mg/g for the ART-treated PLWH versus 14.5 (7.4-27.0) mg/g for healthy controls. PLWH had a significantly lower mean percent FMD when compared to HIV-negative participants (9.8% ± 5.4 versus 12.1% ± 9.2, respectively). Reduced FMD was independently associated with HIV infection (β = -2.83%, 95% CI, -4.44% to -1.21%, p = 0.001), estimated glomerular filtration rate (β = -0.04%, 95% CI, -0.07% to -0.01%, p = 0.004) and LDL cholesterol (β = -1.12%, 95% CI, -2.13% to -0.11%, p = 0.029). HIV-positive status, lower estimated GFR, and higher LDL cholesterol levels were independently associated with endothelial dysfunction. Future prospective studies with larger cohorts of persons living with HIV (and age- and sex-matched HIV-negative controls) are needed to gain further insight into these important findings. In the interim, aggressive management of modifiable risk factors is warranted.

Cardiometabolic function in retired night shift workers and retired day workers

Night shift work is associated with poor cardiometabolic outcomes, even post-retirement. However, the characteristics of cardiometabolic function in retired night shift workers (RNSW) compared to retired day workers (RDW) are not well-understood. Rigorous characterization of cardiometabolic dysfunction in RNSW and RDW will inform targeted risk stratification for RNSW. This observational study evaluated whether RNSW (n = 71) had poorer cardiometabolic function than RDW (n = 83). We conducted a multimodal assessment of cardiometabolic function including metabolic syndrome prevalence, brachial artery flow-mediated dilation, and carotid intima-media thickness. Main analyses tested overall group differences. Sex-stratified follow-up analyses tested group differences separately in men and women. RNSW had 2.6-times higher odds of metabolic syndrome prevalence than RDW in unadjusted analyses (95% CI [1.1,6.3]); this association was not significant when adjusting for age, race and education. RNSW and RDW (Mage = 68.4; 55% female) did not differ in percent flow-mediated dilation or carotid intima-media thickness. In sex-stratified analyses, women RNSW had 3.3-times higher odds of having high body mass index than women RDW (95% CI [1.2,10.4]). Men RNSW had 3.9-times higher odds of having high triglycerides than men RDW (95% CI [1.1,14.2]). No other group differences were observed. We found mixed evidence that night shift work exposure was associated with cardiometabolic dysfunction in retirement, possibly in a sex-specific manner.

Abstract 14821: Effect of Single Volatile Organic Compound Metabolites and Volatile Organic Compound Mixtures on Vascular Function

Volatile organic compounds (VOCs) are ubiquitous environmental toxicants with pre-clinical evidence of decreased vascular health. Research to date has focused on single VOC metabolites and data is lacking on the effects on human vascular health. Many VOCs are strongly correlated with similar exposure sources. Though the compounding effects are poorly defined, they are likely to increase the overall toxicity. Therefore, we examined single VOC metabolites and mixtures’ association with flow mediated dilation (FMD), an index of vascular health. We recruited adult participants into a CV risk cohort, aged 25-70 years, from 2018 and 2019. A panel of urinary VOC metabolites were measured in 308 non-smoking participants who had completed brachial artery FMD. Regression analysis of 16 VOC analytes was tested for associations with %FMD and models were adjusted for covariates selected a priori including age, sex, diabetes and ACE inhibitors. We examined the joint effect of MU, 3HPMA, CEMA, CYMA, DHBMA, 2HPMA, 2MHA, and AAMA mixtures on log-transformed %FMD using quantile-based g-computation models adjusted for the covariates above and for correlated VOC metabolites that were not associated with FMD in single metabolite analyses. The mean %FMD was 7.1 % ± 4.7%. VOC metabolites that were predictors of decreased %FMD in fully adjusted models were 3HPMA (β=-1.275; 95% CI= -2.402, -0.148; p=0.027), CEMA (β= -1.204; 95% CI= -2.051; -0.357 p=0.006), AAMA (β=-1.125; 95% CI= -2.156, -0.094; p=0.033), 2HPMA (β= -1.035; 95% CI= -1.847, -0.222 p=0.013), and 2MHA (β=-0.623; 95% CI= -1.123, -0.124; p=0.015). Most VOC metabolites had fair to moderate correlations in bivariate analyses (Spearman correlation from 0.06 to 0.60). We found that a quartile increase in the VOC mixture was associated with 20% lower percent FMD (ψ -0.18; 95%CI= -0.35, -0.02; p=0.027) in adjusted models. We found the overall mixture effect was driven primarily by 3HPMA, followed by CYMA, CEMA, 2MHA, and AAMA. Therefore, the main driver of the association between the VOC mixture and decreased vascular function is acrolein and to a lesser extent acrylonitrile. Future research could focus on identifying sources of exposure to these VOCs to promote better vascular health among non-smokers.

Endothelial NO synthase 786T/T polymorphism increases hemorrhagic transformation after endovascular thrombectomy

Background and purposeThis study examined whether the 786 NOS3 polymorphism is associated with the risk of hemorrhagic transformation (HT) in stroke patients with anterior large vessel occlusion (ALVO) treated using endovascular thrombectomy (EVT). MethodsWe performed an observational cohort study that included 118 patients with ALVO who underwent EVT. HT was assessed in follow-up CT and MRI. HT and non-HT patients were compared in terms of the 786 NOS3 polymorphism, flow mediated dilation (FMD) values within 3 days after the stroke, and collateral status based on three grading scales. Demographics, vascular risk factors, additional radiological data including ASPECT score, thrombus length and infarct size, and EVT procedure and outcome variables were also included. ResultsRadiological HT occurred in 55 (46.6%) patients and the 786T/T NOS3 polymorphism was associated with HT (unadjusted OR of 2.33, 95%CI: 1.05–5.20, adjusted OR of 3.14, 95%CI: 1.16–8.54). Collateral status and systemic endothelial function assessed by FMD were not mediators of this relationship as no differences were seen in the median FMD percentage values or collateral status between NOS3 genotypes. ConclusionsOur results suggest that genetic variations affecting the NO pathway, such as the 786 NOS3 polymorphism, may contribute to individual variability in the occurrence of HT and these results support involvement of this pathway in the pathogenesis of ischemia-reperfusion injury after EVT.

A single, high-fat meal adversely affects postprandial endothelial function: a systematic review and meta-analysis

ABSTRACTBackgroundEndothelial dysfunction is a predictive risk factor for the development of atherosclerosis and is assessed by flow-mediated dilation (FMD). Although it is known that NO-dependent endothelial dysfunction occurs after consuming a high-fat meal, the magnitude of the effect and the factors that affect the response are unquantified.ObjectivesWe conducted a systematic review and meta-analysis exploring the quantitative effects of a single high-fat meal on endothelial function and determined the factors that modify the FMD response.MethodsSix databases were systematically searched for original research published up to January 2022. Eligible studies measured fasting and postprandial FMD following consumption of a high-fat meal. Meta-regression was used to analyze the effect of moderator variables.ResultsThere were 131 studies included, of which 90 were suitable for quantitative meta-analysis. A high-fat meal challenge transiently caused endothelial dysfunction, decreasing postprandial FMD at 2 hours [−1.02 percentage points (pp); 95% CI: −1.34 to −0.70 pp; P < 0.01; I2 = 93.3%], 3 hours [−1.04 pp; 95% CI: −1.48 to −0.59 pp; P < 0.001; I2 = 84.5%], and 4 hours [−1.19 pp; 95% CI: −1.53 to −0.84 pp; P < 0.01; I2 = 94.6%]. Younger, healthy-weight participants exhibited a greater postprandial reduction in the FMD percentage change than older, heavier, at-risk groups after a high-fat meal ( P < 0.05). The percentage of fat in the meals was inversely associated with the magnitude of postprandial changes in FMD at 3 hours (P < 0.01).ConclusionsA single, high-fat meal adversely impacts endothelial function, with the magnitude of the impact on postprandial FMD moderated by the fasting FMD, participant age, BMI, and fat content of the meal. Recommendations are made to standardize the design of future postprandial FMD studies and optimize interpretation of results, as high-fat meals are commonly used in clinical studies as a challenge to assess endothelial function and therapeutics. This trial was registered at PROSPERO as CRD42020187244.

Ventilatory Muscle Training for Early Cardiac Rehabilitation Improved Functional Capacity and Modulated Vascular Function of Individuals Undergoing Coronary Artery Bypass Grafting: Pilot Randomized Clinical Trial.

Background: Cardiac rehabilitation with aerobic exercises is the first strategy for nonpharmacological treatment in the postoperative period of individuals undergoing coronary artery bypass grafting (CABG) to improve functional capacity and vascular health. However, other exercise modalities remain uncertain regarding the same benefits. Objectives: Evaluation of the effect of different modalities of exercise, such as early cardiac rehabilitation on subjects submitted to CABG in the six-minute walk test (6-MWT) and on the percentage of flow-mediated dilatation (FMD) of the brachial artery. Methods: A randomized clinical trial in which 15 patients (62.7 ± 6.7 years) who underwent CABG were randomly assigned to the following groups: isometric (IG, Handgrip Jamar®), ventilatory muscle training (VG, PowerBreathe®) and control (CG, conventional respiratory and motor physiotherapy). All patients were attended to physically twice a day (20 min/session) for a consecutive week after the CABG (hospital admission). Functional capacity was assessed by 6-MWT and endothelial function was assessed through the technique of FMD, before and after (~7 days) admission to CABG. The doppler ultrasound videos were analyzed by Cardiovascular Suite® software (Quipu, Pisa, Italy) to measure %FMD. Statistics: Generalized estimation equation, followed by Bonferroni post hoc (p < 0.05). Results: Systolic, diastolic and mean arterial pressure (SBP/DBP/MAP, respectively) were 133, 76 and 95 mmHg. The groups presented walking meters (m) distance before and after intervention of: IGbasal 357.80 ± 47.15 m vs. IGpost 306.20 ± 61.63 m, p = 0.401 (+51 m); VGbasal 261.50 ± 19.91 m vs. VGpost 300.75 ± 26.29 m, p = 0.052 (+39 m); CG basal 487.83 ± 83.23 m vs. CGpost 318.00 ± 31.08, p = 0.006 (−169 m). %FMD before and after intervention was IGbasal 10.4 ± 4.8% vs. IGpost 2.8 ± 2.5%, p = 0.152; VGbasal 9.8 ± 5.1% vs. VGpost 11.0 ± 6.1%, p = 0.825; CGbasal 9.2 ± 15.8% vs. CGpost 2.7 ± 2.6%, p = 0.710 and resting mean basal blood flow was IGbasal 162.0 ± 55.0 mL/min vs. IGpost 129.9 ± 63.7 mL/min, p = 0.662; VGbasal 83.74 ± 12.4 mL/min vs. VGpost 58.7 ± 17.1 mL/min, p = 0.041; CGbasal 375.6 ± 183.7 mL/min vs. CGpost 192.8 ± 115.0 mL/min, p = 0.459. Conclusions: Ventilatory muscle training for early cardiac rehabilitation improved acute functional capacity and modulated mean flow of individuals undergoing CABG.

Improved blood pressure and flow-mediated dilatation via increased plasma adropin and nitrate/nitrite induced by high-intensity interval training in patients with type 2 diabetes.

What is the central question of this study? Exercise training increases adropin and nitrite/nitrate (NOx) plasma levels in middle-aged and older healthy people. We hypothesized that high-intensity interval training may improve blood pressure and flow-mediated dilatation through the effects of adropin and NOx in patients of this age with type 2 diabetes. What is the main finding and its importance? High-intensity interval training may be more effective than moderate-intensity continuous training in improving endothelial function, blood pressure and flow-mediated dilatation through its effects on adropin and NOx in patients with type 2 diabetes. Adropin is a newly identified bioactive protein that is important in energy hemostasis and vascular endothelial function. Lower levels of adropin in patients with type 2 diabetes are related to coronary atherosclerosis, characterized by impaired flow-mediated dilatation (FMD). The purpose of the present study was to investigate FMD and plasma levels of adropin and nitrite/nitrate (NOx) in patients with type 2 diabetes at baseline and follow-up after 12weeks of high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT). Sixty-six persons with type 2 diabetes were divided into HIIT, MICT, and control groups. The HIIT group intervention was 12 intervals (1.5min) at 85-90% maximal heart rate (HRmax ) separated by 2min at 55-60% HRmax in three sessions per week for 12weeks. MICT training consisted of 42min of cycling at 70% HRmax . Before and after the intervention, FMD was recorded with high-resolution Doppler ultrasound. Plasma levels of adropin and NOx were measured by enzyme-linked immunosorbent assay. After training FMD was significantly higher in the MICT and HIIT groups compared to the control group (P<0.05). Plasma levels of adropin and NOx were higher in both exercise groups, but the increase was greater in the HIIT group (P<0.01). Peak oxygen consumption was increased after exercise training in both groups compared to the control group (P<0.01). Percentage FMD showed a positive correlation with plasma levels of adropin and NOx (both P<0.01), and a negative correlation with diastolic blood pressure (r=-0.530, P=0.035) and systolic blood pressure (r=-0.606, P=0.013) in the HIIT group. The results indicate that HIIT improved FMD whilst increasing adropin, NOx and peak oxygen consumption. Increased plasma levels of adropin may contribute, in part, to blood pressure reduction by increasing nitric oxide production.

Age-related Changes in Renal Arterio-Arteriolosclerosis in Kidney Disease: Renal Biopsy-based Study

Age-related Changes in Renal Arterio-Arteriolosclerosis in Kidney Disease: Renal Biopsy-based Study

Assessment of vascular and endothelial function in Kawasaki disease

BackgroundKawasaki disease (KD) is an acute febrile vasculitis. Patients with previous KD have increased risk of coronary arterial aneurysms (CAA) and early-onset arteriosclerosis. Endothelial dysfunction is the earliest manifestation of arteriosclerosis. We aimed to explore the endothelial function and clinical characteristics of patients with previous KD. MethodsIn this case–control study, we investigated childhood KD patients, with and without CAA, and a group of healthy controls. We obtained the anthropometric measurements, metabolic markers, vascular ultrasonography evaluating arterial stiffness and flow-mediated dilatation (FMD), and clinical information obtained by reviewing the patients' charts. Continuous variables were compared using non-parametric analyses and categorical variables, using the chi-square or Fisher's exact tests. ResultsSeventy KD patients (median current age, 12.95 years; median follow-up duration, 10.88 years) and 14 healthy controls were recruited. FMD was significantly lower in the CAA group (n = 15) than the control group (FMDs: 5.59% [interquartile range, 3.99–6.86%] vs. 7.49% [5.96–9.42%], p = 0.049; diastolic FMD: 6.48% [4.14–7.32%] vs. 7.87% [6.19–9.98%], p = 0.042). The CAA group had a higher percentage of impaired FMD and the significantly largest coronary segments of the three groups. Other parameters including metabolic markers, carotid intima-media thickness, and arterial stiffness were not statistically different. ConclusionKD patients, especially those with CAAs, may have impaired endothelial function. FMD may be a good indicator of endothelial dysfunction for use in long-term follow-up of KD patients.

CHA2DS2 VASc score and brachial artery flow-mediated dilation as predictors for no-reflow phenomenon in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

BackgroundFollowing primary percutaneous coronary intervention (PCI), no-reflow is associated with a high rate of long-term unfavorable clinical outcomes. Despite the importance of early no-reflow prediction in cardiovascular medicine, noninvasive assessment is lacking. This study aimed to evaluate the preprocedural CHA2DS2 VASc score and the brachial artery flow-mediated dilation percentage (FMD%) as predictors of the no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI.ResultsThis study included 150 patients who presented with acute STEMI, underwent primary PCI, and were divided into two groups according to the flow result, reflow group and a no-reflow group. The CHA2DS2 VASc score was calculated and evaluation of endothelial function by measuring the brachial artery FDM% was done for each patient before the procedure. There were 39 (26%) patients in the no-reflow group and 111 (74%) in the reflow group. The no-reflow patients were older and had significantly higher body mass index (BMI), higher frequency of diabetes mellitus, hypertension, history of heart failure, dyslipidemia, Killip class IV on admission, thrombus grade V, multiple affected vessels, conventional stenting, and multiple stents placement, longer ischemic times, higher CHA2DS VASc score, and lower brachial artery FMD% (p-values of < 0.05 for all). Moreover, there was a significant negative correlation between CHA2DS VAS score and preprocedural FMD%, with the higher the score indicating lower FMD among cases (p-value = 0.000).ConclusionsPreprocedural CHA2DS2 VASc score and the brachial artery FMD can be used as predictors for the no-reflow phenomenon in patients with STEMI, undergoing primary PCI.

Impact of Adipokines in Brachial Artery Flow-mediated Dilatation in Lupus Nephritis.

Endothelial dysfunction is evident in systemic lupus erythematosus (SLE). Pro-inflammatory adipokines are involved in endothelial derangement and premature atherosclerosis, particularly in lupus nephritis (LN). This study aimed to investigate the impact of LN on endothelial function by estimating the serum levels of adiponectin, leptin, visfatin, and homeostatic model assessment-insulin resistance (HOMA-IR) and calculating the flow-mediated dilatation (FMD) of the brachial artery. This is a case-control study in which 190 systemic lupus patients who were fulfilling the American College of Rheumatology revised classification were enrolled. The patients were divided into 100 LN patients and 90 lupus non-nephritis patients. Demographic data, clinical parameters, and SLE activity were reported. Serum adiponectin, leptin, visfatin, and HOMA-IR were measured. The endothelial dysfunction was assessed by calculating the FMD of the brachial artery. The mean age of participants was 25.62 ± 5.81 years. Elevated levels of adiponectin, leptin, visfatin, and HOMA-IR were observed in LN cases (12.2 ± 0.3, 20.1 ± 0.5, 16.8 ± 0.1, and 12.0 ± 3.8, respectively) compared to non-nephritis cases (12.2 ± 0.3, 8.5 ± 0.5, 16.8 ± 0.5, and 9.0 ± 3.8, respectively) with a more reduced FMD percentage in LN cases with a statistical significance. Brachial artery FMD is negatively correlated with lipid profile, adipokines, and HOMA. Visfatin has better sensitivity (82.1%) and specificity (81%) with the area under a curve of 0.893, compared to other biomarkers. LN patients are characterized by impaired endothelial function. Elevated serum adiponectin, visfatin, and HOMA-IR were significantly correlated with poor FMD of the brachial artery. Visfatin has a better performance in detecting atherosclerosis.

Serum Osteoprotegerin Level as a Risk Factor for Atherosclerosis in Systemic Lupus Erythematosus Patients: A Cross Sectional Study

Background: Prediction ofthe risk of atherosclerosis in Egyptian patients with systemic lupus erythematosus (SLE) by measuring serum osteoprotegerin (OPG) level and correlation between OPG levels and SLE disease activity (assessed by Systemic Lupus Erythematosus Disease Activity Index [SLEDAI] score), is the aim of this study. Methods:A cross sectional study in which all patients were subjected to full medical history, full clinical examination (with special emphasis to SLE symptoms and signs e.g. photosensitivity, arthralgia, arthritis, malar rash, blood pressure and lower limb edema), laboratory investigations (CBC, random blood sugar [RBS], ESR, albumin/creatinine ratio, serum urea and creatinine, serum albumin, C3, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, calcium and phosphorus). Electrocardiography (ECG) was done to calculate QTc interval using Bazett’s formula: QTC = QT / √ RR. Serum osteoprotegerin level was measured using ELISA technique. All participants were subjected to imaging in the form of: Carotid duplex: to assess intima-media thickness just two cm before carotid bifurcation, and to assess any plaques, if present. Also brachial artery flow mediated dilatation method: for detection of subclinical atherosclerosis. Results: There was a statistically significant negative correlation between serum levels of osteoprotegerin and brachial flow mediated dilation percentage (FMD %) values (P value &gt; 0.001) which means a significant correlation between high serum OPG levels and subclinical atherosclerosis in SLE patients. There were statistically significant differences between SLE cases and controls in right and left carotid intima-media thickness (P value: 0.034 &amp; 0.036 respectively), serum osteoprotegerin levels (P value: &gt; 0.001) and QTc values (P value: 0.011) which were all statistically significantly higher in SLE patients, while brachial FMD % was statistically significantly lower in SLE patients than in controls (P value: &gt; 0.001). Also, there was a statistically significant positive correlation between serum OPG levels and QTc interval (P value: 0.006). Conclusion: We have concluded that serum OPG level has a significant correlation with subclinical atherosclerosis and endothelial dysfunction, which was measured by CIMT and brachial mediated flow dilation method.

Effect of melatonin supplementation on endothelial function in heart failure with reduced ejection fraction: A randomized, double‐blinded clinical trial

BackgroundThis study aimed to investigate the effect of melatonin supplementation on endothelial function in patients with heart failure with reduced ejection fraction (HFrEF).MethodsThis is an analysis of the MeHR trial, a randomized double‐blinded placebo‐controlled clinical trial with two parallel arms of 1:1. Oral 10 mg melatonin tablets or placebo was administered for 24 weeks. Deference in the percentage of flow‐mediated dilatation (FMD) after the intervention was the primary outcome.ResultsNinety‐two patients were included in the study (age: 62.7±10.3 years, 87.0% male, ejection fraction (EF): 28.6±8.1). After adjustment for baseline FMD and age, a statistically significant difference in post‐treatment FMD in favor of the melatonin group was seen (estimated marginal means [95%CI], melatonin: 7.84% [6.69–8.98], placebo: 5.98% [4.84–7.12], p = .027). There was no significant difference in the mean of post‐treatment systolic/diastolic blood pressure, serum total antioxidant capacity, and serum malondialdehyde (MDA) between groups. Subgroup analysis showed significant improvement in FMD and MDA in the melatonin group in nondiabetic patients, while no difference was seen between study groups in diabetic patients.ConclusionsMelatonin supplementation in HFrEF might improve endothelial function; however, this beneficial effect might not be seen in diabetic patients.

Aerobic Versus Resistance Training Effects on Ventricular-Arterial Coupling and Vascular Function in the STRRIDE-AT/RT Trial.

Background: The goal was studying the differential effects of aerobic training (AT) vs. resistance training (RT) on cardiac and peripheral arterial capacity on cardiopulmonary (CP) and peripheral vascular (PV) function in sedentary and obese adults.Methods: In a prospective randomized controlled trial, we studied the effects of 6 months of AT vs. RT in 21 subjects. Testing included cardiac and vascular ultrasoundography and serial CP for ventricular-arterial coupling (Ees/Ea), strain-based variables, brachial artery flow-mediated dilation (BAFMD), and peak VO2 (pVO2; mL/kg/min) and peak O2-pulse (O2p; mL/beat).Results: Within the AT group (n = 11), there were significant increases in rVO2 of 4.2 mL/kg/min (SD 0.93) (p = 0.001); O2p of 1.9 mL/beat (SD 1.3) (p = 0.008) and the brachial artery post-hyperemia peak diameter 0.18 mm (SD 0.08) (p = 0.05). Within the RT group (n = 10) there was a significant increase in left ventricular end diastolic volume 7.0 mL (SD 9.8; p = 0.05) and percent flow-mediated dilation (1.8%) (SD 0.47) (p = 0.004). Comparing the AT and RT groups, post exercise, rVO2 2.97, (SD 1.22), (p = 0.03), O2p 0.01 (SD 1.3), (p = 0.01), peak hyperemic blood flow volume (1.77 mL) (SD 140.69) (p = 0.009), were higher in AT, but LVEDP 115 mL (SD 7.0) (p = 0.05) and Ees/Ea 0.68 mmHg/ml (SD 0.60) p = 0.03 were higher in RT.Discussion: The differential effects of AT and RT in this hypothesis generating study have important implications for exercise modality and clinical endpoints.

Comprehensive Characterization of the Vascular Effects of Cisplatin-Based Chemotherapy in Patients With Testicular Cancer

BackgroundCisplatin-based chemotherapy increases the risk of cardiovascular and renal disease. ObjectivesWe aimed to define the time course, pathophysiology, and approaches to prevent cardiovascular disease associated with cisplatin-based chemotherapy. MethodsTwo cohorts of patients with a history of testicular cancer (n = 53) were recruited. Cohort 1 consisted of 27 men undergoing treatment with: 1) surveillance; 2) 1 to 2 cycles of bleomycin, etoposide, and cisplatin (BEP) chemotherapy (low-intensity cisplatin); or 3) 3 to 4 cycles of BEP (high-intensity cisplatin). Endothelial function (percentage flow-mediated dilatation) and cardiovascular biomarkers were assessed at 6 visits over 9 months. Cohort 2 consisted of 26 men previously treated 1 to 7 years ago with surveillance or 3 to 4 cycles BEP. Vasomotor and fibrinolytic responses to bradykinin, acetylcholine, and sodium nitroprusside were evaluated using forearm venous occlusion plethysmography. ResultsIn cohort 1, the percentage flow-mediated dilatation decreased 24 h after the first cisplatin dose in patients managed with 3 to 4 cycles BEP (10.9 ± 0.9 vs. 16.7 ± 1.6; p < 0.01) but was unchanged from baseline thereafter. Six weeks after starting 3 to 4 cycles BEP, there were increased serum cholesterol levels (7.2 ± 0.5 mmol/l vs. 5.5 ± 0.2 mmol/l; p = 0.01), hemoglobin A1c (41.8 ± 2.0 mmol/l vs. 35.5 ± 1.2 mmol/l; p < 0.001), von Willebrand factor antigen (62.4 ± 5.4 mmol/l vs. 45.2 ± 2.8 mmol/l; p = 0.048) and cystatin C (0.91 ± 0.07 mmol/l vs. 0.65 ± 0.09 mmol/l; p < 0.01). In cohort 2, intra-arterial bradykinin, acetylcholine, and sodium nitroprusside caused dose-dependent vasodilation (p < 0.0001). Vasomotor responses, endogenous fibrinolytic factor release, and cardiovascular biomarkers were not different in patients managed with 3 to 4 cycles of BEP versus surveillance. ConclusionsCisplatin-based chemotherapy induces acute and transient endothelial dysfunction, dyslipidemia, hyperglycemia, and nephrotoxicity in the early phases of treatment. Cardiovascular and renal protective strategies should target the early perichemotherapy period. (Clinical Characterisation of the Vascular Effects of Cis-platinum Based Chemotherapy in Patients With Testicular Cancer [VECTOR], NCT03557177; Intermediate and Long Term Vascular Effects of Cisplatin in Patients With Testicular Cancer [INTELLECT], NCT03557164)

Improved Endothelial Function Following Eight Weeks Of Low-intensity Resistance Training In Young Adults

Cardiovascular diseases (CVD) are the leading cause of death worldwide, and compelling evidence indicates that exercise prevents and attenuates CVD. Resistance training (RT) exerts positive health effects; however, there is a lack of evidence regarding the RT intensities that could be prescribed to improve vascular endothelial function. PURPOSE: To compare the effects of two RT intensities during eight weeks on vascular endothelial function in sedentary young males. METHODS: Thirty-four sedentary men were recruited (age = 20.6 ± 1.8 yr., height = 171.3 ± 5.2 cm, weight = 65.2 ± 10.6 kg, DXA fat mass = 22.3 ± 7.4 %), and randomly assigned to a control group (CTRL, no exercise), RT at 50% of a maximum repetition [1-RM] and RT at 80% 1-RM. The RT program was performed twice a week for eight weeks, and except for the CTRL group, participants performed the same RT exercises at similar total workloads (1920 arbitrary units [AU] for the 80%RM and 1950 AU for the 50%RM). Vascular endothelial function was measured before (pre) and after (post) eight weeks by ultrasound and determined by the percentage of flow-mediated dilatation (%FMD). Mixed factorial ANOVA (3 groups x 2 measurements x 2 occlusions), effect size (ES) and 95% confidence interval (CI95%) were computed for %FMD. RESULTS: A significant triple interaction was found on %FMD (p = 0.021). The eight-week post-intervention follow-up analyses showed a significant increase (p = 0.010) in %FMD in the 50%RM (Mean = 9.93 ± 3.73%, ES = 3.70, CI95% = 1.59 to 5.79) compared to the control group (Mean = 5.72 ± 1.71%, ES = 1.67, CI95% = -0.21 to 3.55), and no significant differences between 50%RM and 80%RM (Mean = 7.90 ± 2.51%, ES = 2.18, CI95% = 0.27 to 4.10), and between 80%RM and control groups. CONCLUSION: A 50%RM intensity RT program elicited a positive vascular endothelial function adaptation following eight-weeks of training. It seems unnecessary to perform high-intensity RT to obtain arterial health benefits.

Abstract P562: Firefighters Have Worse Cardiovascular Health And Mental Health Characteristics Than Civilians And Different Blood Pressure Surge Responses To Pager Activation

Introduction: Heart-related incidents cause over 50% of LODD in firefighters (FF). Physical, health-related, and emotional stress are all part of the FF job; and these all increase BP levels and cardiac risk. Using ambulatory BP (ABP) monitoring to measure BP over time and quantify the BP surge with alarm is a novel way to assess risk, so we compared a group of FF to Civilians. We hypothesized that FF would have worse CV health and higher BP surges compared to civilians. Methods: We included 43 FF and 30 Civilians who completed 3 visits: ABP monitoring with pager activation, a fasted clinical appt, and fitness testing. Participants wore the ABP cuff for a 12-hr period, during which they were paged by a pager app (OnPage) or by emergency service dispatch. When the pager sounded, they were instructed to force an ABP reading to assess the BP surge. Average BP levels and surges were determined. Fasted visit included BP, body fat, lipid panel, and vascular health measures. Fitness test included a treadmill VO 2peak and a battery of other fitness tests. Participants also completed a health history form and the DASS-21 questionnaire assessing stress, anxiety, and depression. Results: We found that FF (39.4 ± 2.2 yrs) had worse CV health, better fitness, but higher stress and depression levels compared to Civilians (39.7 ± 2.7 yrs), P&lt;0.05 for differences. FF had higher clinic SBP (128.7 ± 1.7 vs 119.7 ± 1.9), clinic DBP (81.8 ± 1.2 vs 75.7 ± 1.7), central arterial pressures measured by SphygmoCor® XCEL (121.8 ± 2.7 vs 112.3 ± 2.9 and 84 ± 1.5 vs 78.3 ± 2.3), and average SBP measured by ABP (130.9 ± 1.5 vs 119.6 ± 4.3 mmHg). FF had higher Pre-Alarm SBP levels (126.9 ± 3.3 vs 112.5 ± 4.8 mmHg) but similar Post-Alarm SBP levels. Thus, FF had a smaller SBP surge with alarm (12.5 ± 2.3 vs 16.2 ± 5.5 mmHg). Clinically, FF had similar cholesterol (183.5 ± 5.3 vs 188.9 vs 9.9) and LDL levels (117.9 ± 4.8 vs 116 ± 10.2 mg/dl), had similar BF percentages (29.4 ± 1.5 vs 31.7 ± 1.5 %), but were heavier (203.9 ± 5.5 vs 182.7 ± 7.3 lbs). FF also had lower HDL (46.8 ± 2.6 vs 59.9 ± 3.6 mg/dl), percent flow-mediated dilation (8.4 ± 0.8 vs 10.1 ± 1 %), and SEVR (156.1 ± 4.1 vs 172.6 ± 5.4) levels. For fitness, FF had similar VO 2peak (35.2 ± 0.9 vs 37.1 ± 1.8 ml/kg-min) but better plank pose (110.1 ± 9.5 vs 73.8 ± 6.7), wall sit (112.7 ± 15.9 vs 59.4 ± 5.2 sec), and #steps climbed in 2 min (320.8 ± 10.1 vs 280.2 ± 11.8). FF had worse overall psychometric characteristics: higher DASS-21 total score 13.9 ± 2.3 vs 5.5 ± 1.3; depression score 5.1 ± 1.3 vs 0.7 ± 0.3; stress score 5.9 ± 0.9 vs 2.7 ± 0.7; but similar anxiety scores 2.9 ± 0.4 vs 2 ± 0.6. Conclusions: In conclusion, with this subset of baseline data, we confirmed that FF have worse CV health, stress, depression and perceived health ratings. It is known that exercise and diet can improve all of these. Therefore, our participants are currently undergoing a diet and exercise intervention to assess changes in health, psychometric scores, and BP surge levels.