1
|
Xu J, Zhang Y, Huang Y, Nie H, Yan J, Ruan L, Zhang C. The association between pulse wave velocity and pregnancy-associated diseases: A systematic review and meta-analysis. Heliyon 2024; 10:e29281. [PMID: 38707450 PMCID: PMC11066146 DOI: 10.1016/j.heliyon.2024.e29281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Background Maintaining healthy vascular structure and function is important for a healthy pregnancy. Obesity is a well-known predictor for poor postoperative outcomes of vascular surgery. However, the association between pulse wave velocity (PWV), a well-recognized parameter for arterial stiffness assessment, and pregnancy-associated diseases is still unclear. Therefore, we conducted this systematic review, and a meta-analysis was performed to assess the relevant associations. Methods We systematically searched the Web of Science and PubMed databases to obtain articles on PWV and pregnancy-associated diseases published before April 2023. The mean with standard deviation was used to assess the differences in PWV in pregnant women with or without relevant diseases. Subgroup analysis was conducted according to specific types of PWV. The Newcastle‒Ottawa Scale was used to evaluate the quality of the enrolled studies. Results A total of 6488 individuals from 21 studies were included. All enrolled studies were high-quality. Overall, the PWV was elevated in pregnant women who suffered from preeclampsia (mean difference (MD) = 0.67, 95 % confidence interval (CI): 0.51,0.83, P < 0.00001), hypertension (MD = 1.04, 95 % CI: 1.00,1.08, P < 0.00001), gestational diabetes mellitus (MD = 0.34, 95%CI: 0.19,0.48, P < 0.00001), and diabetes (MD = 0.49, 95%CI: 0.27,0.70, P < 0.00001). Subgroup analysis based on specific types of PWV showed similar results. Conclusion In our study, PWV is elevated in pregnancy-associated diseases, including preeclampsia, hypertension, and diabetes. The PWV assessment should be regarded as a clinical routine for pregnant women to prevent and manage cardiovascular diseases during pregnancy.
Collapse
Affiliation(s)
| | | | - Yue Huang
- Department of Geriatrics, Institute of Gerontology, Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hao Nie
- Department of Geriatrics, Institute of Gerontology, Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jinhua Yan
- Department of Geriatrics, Institute of Gerontology, Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lei Ruan
- Department of Geriatrics, Institute of Gerontology, Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Cuntai Zhang
- Department of Geriatrics, Institute of Gerontology, Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| |
Collapse
|
2
|
Tuesta M, Yáñez-Sepúlveda R, Monsalves-Álvarez M, Vásquez-Bonilla A, Olivares-Arancibia J, Rojas-Valverde D, Alvear-Órdenes I. Muscle Oxygen Extraction during Vascular Occlusion Test in Physically Very Active versus Inactive Healthy Men: A Comparative Study. J Funct Morphol Kinesiol 2024; 9:57. [PMID: 38525758 PMCID: PMC10961797 DOI: 10.3390/jfmk9020057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
An increase in the delivery and use of oxygen to the musculature in physically active subjects are determinants of improving health-related aerobic capacity. Additional health benefits, such as an increase in the muscle mass and a decrease in fat mass, principally in the legs, could be achieved with weekly global physical activity levels of more than 300 min. The objective was to compare the muscle vascular and metabolic profiles of physically very active and inactive subjects. Twenty healthy men participated in the study; ten were assigned to the physically very active group (25.5 ± 4.2 years; 72.7 ± 8.1 kg; 173.7 ± 7.6 cm) and ten to the physically inactive group (30.0 ± 7.4 years; 74.9 ± 11.8 kg; 173.0 ± 6.4 cm). The level of physical activity was determined by the Global Physical Activity Questionnaire (GPAQ). A resting vascular occlusion test (5 min of an ischemic phase and 3 min of a reperfusion phase) was used, whereas a near-field infrared spectroscopy (NIRS) device was used to evaluate the muscle oxygenation in the right vastus lateralis of the quadriceps muscle. The area under the curve of the deoxyhemoglobin (HHb) during the ischemic phase and above the curve of the tissue saturation index (TSI) during the reperfusion phase were obtained to determine muscle metabolic and vascular responses, respectively. Physically very active group showed a higher absolute HHb (3331.9 ± 995.7 vs. 6182.7 ± 1632.5 mmol/s) and lower TSI (7615.0 ± 1111.9 vs. 5420.0 ± 781.4 %/s) and relative to body weight (46.3 ± 14.6 vs. 84.4 ± 27.1 mmol/s/kg and 106.0 ± 20.6 vs. 73.6 ± 13.8 %/s/kg, respectively), muscle mass (369.9 ± 122.2 vs. 707.5 ± 225.8 mmol/kg and 829.7 ± 163.4 vs. 611.9 ± 154.2 %/s/kg) and fat mass (1760.8 ± 522.9 vs. 2981.0 ± 1239.9 mmol/s/kg and 4160.0 ± 1257.3 vs. ±2638.4 ± 994.3 %/s/kg, respectively) than physically inactive subjects. A negative correlation was observed between HHb levels and TSI (r = -0.6; p < 0.05). Physically very active men (>300 min/week) present better muscle oxidative metabolism and perfusion and perform significantly more physical activity than physically inactive subjects. Extra benefits for vascular health and muscle oxidative metabolism are achieved when a subject becomes physically very active, as recommended by the World Health Organization. In addition, a higher level of physical activity determined by GPAQ is related to better vascular function and oxidative metabolism of the main locomotor musculature, i.e., the quadriceps.
Collapse
Affiliation(s)
- Marcelo Tuesta
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Viña del Mar 2520000, Chile;
- Laboratory of Sport Sciences, Centro de Medicina Deportiva Sports MD, Viña del Mar 2521156, Chile
| | - Rodrigo Yáñez-Sepúlveda
- Faculty Education and Social Sciences, Universidad Andres Bello, Viña del Mar 2520000, Chile;
| | | | | | - Jorge Olivares-Arancibia
- Grupo AFySE, Investigación en Actividad Física y Salud Escolar, Escuela de Pedagogía en Educación Física, Facultad de Educación, Universidad de las Américas, Santiago 8320000, Chile
| | - Daniel Rojas-Valverde
- Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD-NARS), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 86-3000, Costa Rica;
- Clínica de Lesiones Deportivas (Rehab&Readapt), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 86-3000, Costa Rica
| | - Ildefonso Alvear-Órdenes
- Applied Physiology Laboratory (FISAP), Institute of Biomedicine (IBIOMED), University of León, 24001 León, Spain;
| |
Collapse
|
3
|
Koutlas A, Smilios I, Kokkinou EM, Myrkos A, Kounoupis A, Dipla K, Zafeiridis A. NIRS-Derived Muscle-Deoxygenation and Microvascular Reactivity During Occlusion-Reperfusion at Rest Are Associated With Whole-Body Aerobic Fitness. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024; 95:127-139. [PMID: 36689603 DOI: 10.1080/02701367.2022.2159309] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Purpose: Near-infrared spectroscopy (NIRS) indices during arterial occlusion-reperfusion maneuver have been used to examine the muscle's oxidative metabolism and microvascular function-important determinants of whole-body aerobic-fitness. The association of NIRS-derived parameters with whole-body VO2max was previously examined using a method requiring exercise (or electrical stimulation) followed by multiple arterial occlusions. We examined whether NIRS-derived indices of muscle deoxygenation and microvascular reactivity assessed during a single occlusion-reperfusion at rest are (a) associated with maximal/submaximal indices of whole-body aerobic-fitness and (b) could discriminate individuals with different VO2max. We, also, investigated which NIRS-parameter during occlusion-reperfusion correlates best with whole-body aerobic-fitness. Methods: Twenty-five young individuals performed an arterial occlusion-reperfusion at rest. Changes in oxygenated- and deoxygenated-hemoglobin (O2Hb and HHb, respectively) in vastus-lateralis were monitored; adipose tissue thickness (ATT) at NIRS-application was assessed. Participants also underwent a maximal incremental exercise test for VO2max, maximal aerobic velocity (MAV), and ventilatory-thresholds (VTs) assessments. Results: The HHbslope and HHbmagnitude of increase (occlusion-phase) and O2Hbmagnitude of increase (reperfusion-phase) were strongly correlated with VO2max (r = .695-.763, p < .001) and moderately with MAV (r = .468-.530; p < .05). O2Hbmagnitude was moderately correlated with VTs (r = .399-.414; p < .05). After controlling for ATT, the correlations remained significant for VO2max (r = .672-.704; p < .001) and MAV (r = .407; p < .05). Individuals in the high percentiles after median and tritile splits for HHbslope and O2Hbmagnitude had significantly greater VO2max vs. those in low percentiles (p < .01-.05). The HHbslope during occlusion was the best predictor of VO2max. Conclusion: NIRS-derived muscle deoxygenation/reoxygenation indices during a single arterial occlusion-reperfusion maneuver are strongly associated with whole-body maximal indices of aerobic-fitness (VO2max, MAV) and may discriminate individuals with different VO2max.
Collapse
|
4
|
Stephens S, Jaffri A, Saliba S. Local microvascular tissue oxygenation of the intrinsic foot muscles in patients with diabetes: A cross-sectional case-comparison study. Foot (Edinb) 2023; 56:102035. [PMID: 37167703 DOI: 10.1016/j.foot.2023.102035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/03/2023] [Accepted: 05/06/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Foot-related complications including impaired peripheral circulation and lower limb ulceration are severe consequences for those with diabetes mellitus. This study aimed to assess differences in tissue oxygenation and oxygen utilization of the plantar surface intrinsic foot muscles between diabetic participants and healthy comparisons following short foot exercise and a standard walking protocol. METHODS Eighteen participants, 9 with diabetes and 9 healthy age- and sex-matched comparisons, completed two interventions in a randomized order. For the short foot exercise intervention, participants completed 5 sets of 15 intrinsic foot muscle contractions. For the walking intervention, participants completed a modified six-minute walk test. Tissue oxygenation variables including oxygenated hemoglobin, deoxygenated hemoglobin, and tissue saturation index were measured using near-infrared spectroscopy in quiet stance and during intrinsic foot muscle contraction cycles following each intervention. Means, standard deviations, 95 % confidence intervals, mean differences, and Cohen's d effect sizes were calculated for each tissue oxygenation variable. RESULTS The results of this study indicated no significant group differences in quiet standing tissue oxygenation measures at baseline and following each intervention. Participants in the diabetic group had significantly less change in tissue saturation index during intrinsic foot muscle contractions compared to healthy participants after the short foot exercise intervention (ES= 4.00, P = .0002) and walking intervention (ES= 1.33, P = .015). CONCLUSIONS By utilizing wireless NIRS and novel research methodology, this study was able to explore changes in plantar surface tissue oxygenation of the intrinsic foot muscles following a targeted short foot exercise intervention as well as a standard walking protocol in patients diagnosed with diabetes compared to age- and sex- matched individuals without diabetes. We identified that diabetic participants presented with less oxygen utilization during intrinsic foot muscle contractions performed following both exercise interventions compared to their healthy age- and sex- matched comparisons.
Collapse
Affiliation(s)
- Stephanie Stephens
- University of Virginia, Department of Kinesiology, Charlottesville, VA, United States.
| | - Abbis Jaffri
- Creighton University, School of Pharmacy and Health Professions, Omaha, NE, United States
| | - Susan Saliba
- University of Virginia, Department of Kinesiology, Charlottesville, VA, United States
| |
Collapse
|
5
|
Theodorakopoulou MP, Zafeiridis A, Dipla K, Faitatzidou D, Koutlas A, Alexandrou ME, Doumas M, Papagianni A, Sarafidis P. Muscle Oxygenation and Microvascular Reactivity Across Different Stages of CKD: A Near-Infrared Spectroscopy Study. Am J Kidney Dis 2023; 81:655-664.e1. [PMID: 36608922 DOI: 10.1053/j.ajkd.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/19/2022] [Indexed: 01/05/2023]
Abstract
RATIONALE & OBJECTIVE Previous studies in chronic kidney disease (CKD) showed that vascular dysfunction in different circulatory beds progressively deteriorates with worsening CKD severity. This study evaluated muscle oxygenation and microvascular reactivity at rest, during an occlusion-reperfusion maneuver, and during exercise in patients with different stages of CKD versus controls. STUDY DESIGN Observational controlled study. SETTING & PARTICIPANTS 90 participants (18 per CKD stage 2, 3a, 3b, and 4, as well as 18 controls). PREDICTOR CKD stage. OUTCOME The primary outcome was muscle oxygenation at rest. Secondary outcomes were muscle oxygenation during occlusion-reperfusion and exercise, and muscle microvascular reactivity (hyperemic response). ANALYTICAL APPROACH Continuous measurement of muscle oxygenation [tissue saturation index (TSI)] using near-infrared spectroscopy at rest, during occlusion-reperfusion, and during a 3-minute handgrip exercise (at 35% of maximal voluntary contraction). Aortic pulse wave velocity and carotid intima-media thickness were also recorded. RESULTS Resting muscle oxygenation did not differ across the study groups (controls: 64.3% ± 2.9%; CKD stage 2: 63.8% ± 4.2%; CKD stage 3a: 64.1% ± 4.1%; CKD stage 3b: 62.3% ± 3.3%; CKD stage 4: 62.7% ± 4.3%; P=0.6). During occlusion, no significant differences among groups were detected in the TSI occlusion magnitude and TSI occlusion slope. However, during reperfusion the maximum TSI value was significantly lower in groups of patients with more advanced CKD stages compared with controls, as was the hyperemic response (controls: 11.2%±3.7%; CKD stage 2: 8.3%±4.6%; CKD stage 3: 7.8%±5.5%; CKD stage 3b: 7.3%±4.4%; CKD stage 4: 7.2%±3.3%; P=0.04). During the handgrip exercise, the average decline in TSI was marginally lower in patients with CKD than controls, but no significant differences were detected across CKD stages. LIMITATIONS Moderate sample size, cross-sectional evaluation. CONCLUSIONS Although no differences were observed in muscle oxygenation at rest or during occlusion, the microvascular hyperemic response during reperfusion was significantly impaired in CKD and was most prominent in more advanced CKD stages. This impaired ability of microvasculature to respond to stimuli may be a crucial component of the adverse vascular profile of patients with CKD and may contribute to exercise intolerance.
Collapse
Affiliation(s)
- Marieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantina Dipla
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Danai Faitatzidou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angelos Koutlas
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria-Eleni Alexandrou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| |
Collapse
|
6
|
Somani YB, Soares RN, Gosalia J, Delgado JM, Flanagan M, Basu S, Kim-Shapiro DB, Murias JM, Proctor DN. A single dose of dietary nitrate supplementation protects against endothelial ischemia-reperfusion injury in early postmenopausal women. Appl Physiol Nutr Metab 2022; 47:749-761. [PMID: 35358395 PMCID: PMC10941101 DOI: 10.1139/apnm-2021-0693] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The onset of menopause and accompanying changes to ovarian hormones often precedes endothelial dysfunction in women. In particular, accelerated impairments in macrovascular and microvascular function coincide with the loss of estrogen, as does impaired endothelial responses to ischemia-reperfusion (IR) injury. In healthy, early postmenopausal women (n = 12; 3.9 ± 1.5 years since menopause) we tested the hypothesis that acute dietary nitrate (NO3-) supplementation would improve endothelial function and attenuate the magnitude of endothelial dysfunction following whole-arm IR in comparison with placebo. In this randomized, double-blind, placebo-controlled, crossover study we tested participants before and after NO3--rich (BRnitrate) and NO3--depleted (BRplacebo) beetroot juice (BR) consumption, as well as following IR injury, and 15 min after IR to assess recovery. Analyses with repeated-measures general linear models revealed a condition × time interaction for brachial artery flow-mediated dilation (FMD; P = 0.04), and no interaction effect was found for the near-infrared spectroscopy-derived reperfusion slope (P = 0.86). Follow-up analysis showed a significant decline in FMD following IR injury with BRplacebo in comparison with all other timepoints (all, P < 0.05), while this decline was not present with BRnitrate (all, P > 0.05). Our findings demonstrate that a single dose of dietary NO3- minimizes IR-induced macrovascular endothelial dysfunction in healthy, early postmenopausal women, but does not improve resting macrovascular and microvascular function. Trial registration number: NCT03644472. Novelty: In healthy, early postmenopausal women, a single dose of NO3--rich BR can protect against IR-induced endothelial dysfunction. This protection may be due to nitric oxide bioactivity during IR rather than improved endothelial function prior to the IR protocol per se.
Collapse
Affiliation(s)
- Y B Somani
- Department of Kinesiology, Integrative Vascular Physiology Lab, Penn State University, University Park, PA, USA
| | - R N Soares
- Dalton Cardiovascular Research Center, Department of Medicine, University of Missouri, Columbia, MO, USA
| | - J Gosalia
- Department of Kinesiology, Integrative Vascular Physiology Lab, Penn State University, University Park, PA, USA
| | - J M Delgado
- Department of Kinesiology, Integrative Vascular Physiology Lab, Penn State University, University Park, PA, USA
| | - M Flanagan
- Penn State Hershey Family and Community Medicine, University Park, PA, USA
| | - S Basu
- Translational Science Center and Department of Physics, Wake Forest University, Winston-Salem, NC, USA
| | - D B Kim-Shapiro
- Translational Science Center and Department of Physics, Wake Forest University, Winston-Salem, NC, USA
| | - J M Murias
- Department of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - D N Proctor
- Department of Kinesiology, Integrative Vascular Physiology Lab, Penn State University, University Park, PA, USA
| |
Collapse
|
7
|
Triantafyllou GA, Triantafyllou A, Zafeiridis AS, Koletsos N, Zafeiridis A, Gkaliagkousi E, Douma S, Dipla K. Association of Cerebral Oxygenation During Exercise With Target Organ Damage in Middle-Aged Hypertensive and Normotensive Individuals. Am J Hypertens 2022; 35:664-671. [PMID: 35325928 PMCID: PMC11024639 DOI: 10.1093/ajh/hpac040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The brain is one of the main target organs affected by hypertension. Impaired cerebral oxygenation during exercise is an indicator of cerebral dysfunction. We aimed to investigate whether cerebral oxygenation during exercise correlates with subclinical markers of early target organ damage in a population of middle-aged, newly diagnosed hypertensive and healthy individuals. METHODS Carotid intima-media thickness (cIMT) was measured using ultrasound, arterial stiffness was estimated measuring the augmentation index and pulse wave velocity, and retinal vessel diameter was assessed via the central retinal-arteriolar and vein equivalent and retinal-arteriovenous ratio. Participants (n = 93) performed a 3-minute isometric handgrip exercise. Cerebral prefrontal oxygenation was measured continuously using near infrared spectroscopy. The average exercise responses in oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb), and total hemoglobin (tHb) were assessed. Univariate analyses were performed; partial correlation was used to account for traditional cardiovascular risk factors to identify independent associations between cerebral-oxygenation indices and early markers of target organ damage. RESULTS Mean cIMT was negatively correlated with the average exercise response in cerebral oxygenation (rhoO2Hb = -0.348, PO2Hb = 0.001; rhotHb = -0.253, Pthb = 0.02). Augmentation index was negatively correlated with cerebral oxygenation during exercise (rhoO2Hb = -0.374, P < 0.001; rhotHb = -0.332, P = 0.02), whereas no significant correlation was observed between pulse wave velocity and cerebral-oxygenation indices. In the adjusted analysis, cerebral oxygenation was correlated with central retinal arteriolar diameter (CRAE r = 0.233, P = 0.043). CONCLUSIONS Our novel findings suggest that indices of lower cerebral oxygenation during a submaximal physical task are associated with markers of early, subclinical target organ damage, namely increased cIMT, arterial stiffness, and arteriolar retinal narrowing in newly diagnosed, untreated, hypertensive individuals.
Collapse
Affiliation(s)
- Georgios A Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Savvas Zafeiridis
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Koletsos
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Exercise Physiology and Biochemistry Laboratory, Department of Sports Science at Serres, Agios Ioannis 62110, Aristotle University of Thessaloniki, Serres, Greece
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantina Dipla
- Exercise Physiology and Biochemistry Laboratory, Department of Sports Science at Serres, Agios Ioannis 62110, Aristotle University of Thessaloniki, Serres, Greece
| |
Collapse
|
8
|
Rech DA, da Silveira LS, Martins EM, de Oliveira Roque ABA, Althoff A, Maiorana AJ, Vieira AM, Karsten M. Frailty influences the vascular responsiveness of elderly individuals with chronic heart failure. Microvasc Res 2022; 141:104316. [PMID: 35038445 DOI: 10.1016/j.mvr.2022.104316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Frailty is highly prevalent in heart failure (HF) patients. HF is associated with oxidative stress and chronic inflammation, which impair oxygen use by skeletal muscles. Little is known about the influence of frailty on vascular responsiveness and tissue oxygenation. OBJECTIVE Analyze the influence of frailty on vascular responsiveness and muscle oxygenation in elderly individuals with and without HF. METHODS Individuals aged ≥60 years, with or without HF, were evaluated for frailty (phenotype). Near-infrared spectroscopy (NIRS) was used to assess muscle oxygenation at rest (oxygen saturation - StO2 and deoxyhemoglobin) and during handgrip exercise (minimum StO2 and maximum deoxyhemoglobin), and oxygenation variables. STATISTICAL ANALYSIS Results were grouped according to the frailty phenotype: non-frail, pre-frail, and frail. Shapiro-Wilk test was used to assess normality. Data were compared using a two-way analysis of variance (ANOVA). Bonferroni post hoc test was applied to determine the influence of frailty or HF on NIRS variables. SPSS software was used in the analyses; p < 0.05 was considered significant. RESULTS 55 elderly participants (61.8% female; 70.4 ± 7.2 years old; 28 HF patients) participated in the study. 32.7% (n = 18) were classified as non-frail, 43.3% (n = 24) as pre-frail, and 23.6% (n = 13) as frail. The analysis of vascular responsiveness (n = 52) identified an influence (p < 0.05) of frailty on the reperfusion rate (slope 2 and ∆StO2 of nadir-peak) and desaturation during occlusion (area under the curve of StO2) in HF patients. There was no influence of frailty or HF on muscle oxygenation at rest and during exercise (n = 54; p > 0.05). CONCLUSION The coexistence of frailty and HF seems to impair vascular responsiveness, as frail elderly participants with HF presented lower reperfusion rates and higher desaturation levels during the arterial occlusion test. However, the presence of frailty or HF alone had no influence on muscle oxygenation at rest or during exercise.
Collapse
Affiliation(s)
- Daiana Aparecida Rech
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil
| | - Lucas Santos da Silveira
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil
| | - Edgar Manoel Martins
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil
| | | | - Amanda Althoff
- Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil
| | - Andrew John Maiorana
- Department of Allied Health, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia; School of Allied Health, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia.
| | - Ariany Marques Vieira
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Montreal Behavioural Medicine Centre, 5400 Boul Gouin O, Montréal, Québec, QC H4J 1C5, Canada
| | - Marlus Karsten
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre, RS 90050-170, Brazil.
| |
Collapse
|
9
|
The influence of cardiovascular risk factors on near-infrared spectroscopy-derived muscle oxygen saturation during exercise recovery in older adults. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-021-00892-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
A non-interventional study of microcirculation dynamics in allogeneic hematopoietic cell transplantation survivors compared to controls: evidence of impaired microvascular response regardless of conventional cardiovascular risk factors. Bone Marrow Transplant 2022; 57:72-77. [PMID: 34645924 DOI: 10.1038/s41409-021-01500-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 02/08/2023]
Abstract
Allogeneic hematopoietic cell transplantation (alloHCT) survivors have been recently recognized as patients at increased cardiovascular risk. We hypothesized that vascular function remains impaired in alloHCT survivors free of graft-versus-host-disease or relapse. We enrolled consecutive adult alloHCT survivors and non-HCT control individuals (January 2019-March 2020), matched for traditional cardiovascular risk factors. Microvascular dysfunction was dynamically assessed in real time by Laser Speckle Contrast Analysis (LASCA). Carotid-femoral pulse-wave velocity (PWV) and carotid intima media thickness (IMT) were assessed as surrogate markers of cardiovascular disease. We studied 75 patients after a median of 3.2 (range 2.1-4.9) years from alloHCT, who had suffered from grade 2 to 3 acute (20%) and/or moderate/severe chronic GVHD (42%), and 75 controls. Although traditional cardiovascular risk factors and surrogate markers of cardiovascular disease did not differ between groups, alloHCT survivors showed significantly impaired microvascular function (baseline and peak flux, time to peak, base to peak and base to occlusion change). LASCA indices were also independently associated with alloHCT. Our study shows for the first-time impaired microcirculation dynamics in alloHCT survivors, independently of cardiovascular risk factors. Additional studies are needed to address the role of novel markers in cardiovascular risk prediction, along with effects of disease type, phase, and pre-transplant treatments.
Collapse
|
11
|
Theodorakopoulou MP, Triantafyllou A, Zafeiridis A, Boutou AΚ, Grigoriadou I, Kintiraki E, Douma S, Goulis DG, Dipla K. Impaired vagal adaptation to an exercise task in women with gestational diabetes mellitus versus women with uncomplicated pregnancies. Hormones (Athens) 2021; 20:753-760. [PMID: 34308519 DOI: 10.1007/s42000-021-00311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Gestational diabetes mellitus (GDM) is associated with an increased risk for maternal and fetal complications. Patients with GDM have an increased cardiovascular risk in later life. The aim of this study was to investigate cardiac autonomic nervous system (ANS) function at rest and during exercise in women with GDM vs. women with uncomplicated pregnancies. METHODS Thirty-six normotensive pregnant women (21 with GDM and 15 age- and parity-matched women with an uncomplicated pregnancy) were enrolled in this case-control study. Continuous beat-by-beat blood pressure (BP) measurements were recorded during rest, intermittent handgrip exercise, and recovery (via photoplethysmography, Finapres®). Heart rate variability (HRV) (Kubios®) was used for the assessment of autonomic nervous system function. RESULTS The groups were similar in age, gestational week, and handgrip strength. At rest, no differences in HRV indices [root mean square of successive differences (RMSSD), standard deviation Poincaré plot 1, and 2 (SD1, SD2), SD2/SD1 ratio] were detected between women with GDM and women with an uncomplicated pregnancy. However, during exercise, a different pattern in the HRV responses was detected: in the control group, RMSSD and SD1 (indices of parasympathetic function) significantly decreased (p < 0.001) during handgrip exercise and returned to baseline during recovery. In contrast, in GDM, the above HRV indices remained unaltered throughout the protocol. CONCLUSION Normotensive women with GDM present impaired parasympathetic system ability to adapt to an exercise stimulus, as suggested by the blunted sensitivity in RMSSD and SD1. This finding suggests early alterations in ANS may exist in women with GDM, even when no differences are detected in resting conditions.
Collapse
Affiliation(s)
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Department of Sports Science At Serres, Exercise Physiology and Biochemistry Laboratory, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Κ Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Iris Grigoriadou
- Department of Sports Science At Serres, Exercise Physiology and Biochemistry Laboratory, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Kintiraki
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Konstantina Dipla
- Department of Sports Science At Serres, Exercise Physiology and Biochemistry Laboratory, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| |
Collapse
|
12
|
Brislane Á, Steinback CD, Davenport MH. The Nine Month Stress Test: Pregnancy and Exercise - Similarities and Interactions. Can J Cardiol 2021; 37:2014-2025. [PMID: 34534622 DOI: 10.1016/j.cjca.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/18/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022] Open
Abstract
Of all physiological systems, the cardiovascular system takes on the most profound adaptation in pregnancy to support fetal growth and development. The adaptations that arise are systemic and involve structural and functional changes that can be observed at the cerebral, central, peripheral, and microvascular beds. This includes, although is not limited to increased heart rate, stroke volume and cardiac output with negligible change to blood pressure, reductions in vascular resistance and cerebral blood flow velocity, systemic artery enlargement, enhanced endothelial function. All of this takes place to accommodate blood volume expansion and ensure adequate fetal and maternal oxygen delivery. In some instances, the demand placed on the vasculature can manifest as cardiovascular maladaptation and thus, cardiovascular complications can arise. Exercise is recommended in pregnancy because of its powerful ability to reduce the incidence and severity of cardiovascular complications in pregnancy. However, the mechanism by which it acts is poorly understood. The first aim of this review is to describe the systemic adaptations that take place in pregnancy. Secondly, this review aims to describe the influence of exercise on these systemic adaptations. It is anticipated that this review can comprehensively capture the extent of knowledge in this area while identifying areas that warrant further investigation.
Collapse
Affiliation(s)
- Áine Brislane
- Program for Pregnancy & Postpartum Health, Neurovascular Health Lab, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Alberta, Canada
| | - Craig D Steinback
- Program for Pregnancy & Postpartum Health, Neurovascular Health Lab, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Alberta, Canada
| | - Margie H Davenport
- Program for Pregnancy & Postpartum Health, Neurovascular Health Lab, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Alberta, Canada.
| |
Collapse
|
13
|
Eftychidis I, Sakellari I, Anagnostopoulos A, Gavriilaki E. Endothelial dysfunction and vascular complications after allogeneic hematopoietic cell transplantation: an expert analysis. Expert Rev Hematol 2021; 14:831-840. [PMID: 34388057 DOI: 10.1080/17474086.2021.1968823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Allogeneic hematopoietic cell transplantation (alloHCT) is the standard of care for many diseases. However, survivors often present with serious complications resulting from acute and chronic toxicities and it is crucial to increase consciousness from treating physicians. We performed a comprehensive review of the literature and critically examined recent available data, mostly using the PubMed and Medline search engines for original articles published over the last decade. Better understanding of many alloHCT-related disorders has shown that endothelial injury and vascular damage plays a critical role. The most widely studied endothelial injury syndromes (EIS) are veno-occlusive disease/sinusoidal obstruction syndrome (SOS/VOD), graft-versus-host-disease (GVHD), and transplant-associated thrombotic microangiopathy (TA-TMA). TA-TMA, frequently underdiagnosed, needs to be clarified using certain criteria and, as a life-threatening condition, requires immediate and intensive treatment. The first-in-class complement inhibitor eculizumab has significantly improved outcomes in both the pediatric and adult population. Cardiovascular (CV) events are the second major cause of morbidity and mortality of alloHCT survivors, after GVHD. Long-term monitoring and management of CV risk is expected to also incorporate patient stratification with CV risk prediction models, early markers of vascular dysfunction or procoagulant activity, subclinical target organ damage, arterial stiffness, and subclinical atherosclerosis.
Collapse
Affiliation(s)
- Ioannis Eftychidis
- Hematology Department-BMT Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Ioanna Sakellari
- Hematology Department-BMT Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Eleni Gavriilaki
- Hematology Department-BMT Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| |
Collapse
|
14
|
Theodorakopoulou MP, Dipla K, Zafeiridis A, Sarafidis P. Εndothelial and microvascular function in CKD: Evaluation methods and associations with outcomes. Eur J Clin Invest 2021; 51:e13557. [PMID: 33774823 DOI: 10.1111/eci.13557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/19/2021] [Accepted: 03/14/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cardiovascular disease is the major cause of morbidity and mortality in patients with chronic kidney disease (CKD). Endothelial dysfunction, the hallmark of atherosclerosis, is suggested to be involved pathogenetically in cardiovascular and renal disease progression in these patients. METHODS This is a narrative review presenting the techniques and markers used for assessment of microvascular and endothelial function in patients with CKD and discussing findings of the relevant studies on the associations of endothelial dysfunction with co-morbid conditions and outcomes in this population. RESULTS Venous Occlusion Plethysmography was the first method to evaluate microvascular function; subsequently, several relevant techniques have been developed and used in patients with CKD, including brachial Flow-Mediated Dilatation, and more recently, Near-Infrared Spectroscopy and Laser Speckle Contrast Analysis. Furthermore, several circulating biomarkers are commonly used in clinical research. Studies assessing endothelial function using the above techniques and biomarkers suggest that endothelial dysfunction occurs early in CKD and contributes to the target organ damage, cardiovascular events, death and progression towards end-stage kidney disease. CONCLUSIONS Older and newer functional methods and several biomarkers have assessed endothelial dysfunction in CKD; accumulated evidence supports an association of endothelial dysfunction with outcomes. Future research with new, non-invasive and easily applicable methods could further delineate the role of endothelial dysfunction on cardiovascular and renal disease progression in patients with CKD.
Collapse
Affiliation(s)
- Marieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantina Dipla
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Andreas Zafeiridis
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
15
|
Theodorakopoulou MP, Alexandrou ME, Bakaloudi DR, Pitsiou G, Stanopoulos I, Kontakiotis T, Boutou AK. Endothelial dysfunction in COPD: a systematic review and meta-analysis of studies using different functional assessment methods. ERJ Open Res 2021; 7:00983-2020. [PMID: 34195258 PMCID: PMC8236757 DOI: 10.1183/23120541.00983-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/09/2021] [Indexed: 01/18/2023] Open
Abstract
Background Cardiovascular disease is a major cause of morbidity and mortality in COPD. Endothelial dysfunction is suggested to be one of the pathogenetic mechanisms involved. This is a systematic review and meta-analysis of studies using any available functional method to examine differences in endothelial function between patients with COPD and individuals without COPD (controls). Methods Literature search involved PubMed and Scopus databases. Eligible studies included adult patients and evaluated endothelial damage via functional methods. The Newcastle–Ottawa scale was applied to evaluate the quality of retrieved studies. Subgroup analyses were performed to explore heterogeneity across the studies. Funnel plots were constructed to evaluate publication bias. Results Of the 21 reports initially identified, 19 studies with a total of 968 participants were included in the final meta-analysis. A significantly impaired response in endothelium-dependent (weighted mean between-group difference (WMD) −2.59, 95% CI −3.75 to −1.42) and -independent vasodilation (WMD −3.13, 95% CI −5.18 to −1.09) was observed in patients with COPD compared to controls. When pooling all studies together, regardless of the technique used for assessment of vascular reactivity, pronounced endothelial dysfunction was observed in COPD compared to controls (standardised mean difference (SMD) −1.19, 95% CI −1.69 to −0.68). Subgroup analysis showed that the difference was larger when patients with COPD were compared with nonsmoking controls (SMD −1.75, 95% CI −2.58 to −0.92). Sensitivity analyses confirmed the results. Conclusions Patients with COPD have significantly impaired endothelial function compared to controls without COPD. Future studies should delineate the importance of endothelial dysfunction towards development of cardiovascular disease in COPD. COPD is significantly associated with endothelial dysfunction of both conduit vessels and microvasculature. This association is further strengthened when patients with COPD are compared to nonsmoking controls.https://bit.ly/2NlWLFN
Collapse
Affiliation(s)
| | - Maria Eleni Alexandrou
- Dept of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Georgia Pitsiou
- Dept of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Stanopoulos
- Dept of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Kontakiotis
- Dept of Respiratory Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi K Boutou
- Dept of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| |
Collapse
|
16
|
de Oliveira GV, Volino-Souza M, Leitão R, Pinheiro V, Conte-Júnior CA, Alvares TS. Suitability of the muscle O 2 resaturation parameters most used for assessing reactive hyperemia: a near-infrared spectroscopy study. J Vasc Bras 2021; 20:e20200143. [PMID: 34104131 PMCID: PMC8153062 DOI: 10.1590/1677-5449.200143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background There is a spectrum of possibilities for analyzing muscle O2 resaturation parameters for measurement of reactive hyperemia in microvasculature. However, there is no consensus with respect to the responsiveness of these O2 resaturation parameters for assessing reactive hyperemia. Objectives This study investigates the responsiveness of the most utilized muscle O2 resaturation parameters to assess reactive hyperemia in the microvasculature of a clinical group known to exhibit impairments of tissue O2 saturation (StO2). Methods Twenty-three healthy young adults, twenty-nine healthy older adults, and thirty-five older adults at risk of cardiovascular disease (CVD) were recruited. Near-infrared spectroscopy (NIRS) was used to assess StO2 after a 5-min arterial occlusion challenge and the following parameters were analyzed: StO2slope_10s, StO2slope_30s, and StO2slope_until_baseline (upslope of StO2 over 10s and 30s and until StO2 reaches the baseline value); time to StO2baseline and time to StO2max (time taken for StO2 to reach baseline and peak values, respectively); ∆StO2reperfusion (the difference between minimum and maximum StO2 values); total area under the curve (StO2AUCt); and AUC above the baseline value (StO2AUC_above_base). Results Only StO2slope_10s was significantly slower in older adults at risk for CVD compared to healthy young individuals (p < 0.001) and to healthy older adults (p < 0.001). Conversely, time to StO2max was significantly longer in healthy young individuals than in older adult at CVD risk. Conclusions Our findings suggest that StO2slope_10s may be a measure of reactive hyperemia, which provides clinical insight into microvascular function assessment.
Collapse
Affiliation(s)
| | | | - Renata Leitão
- Universidade Federal do Rio de Janeiro - UFRJ, Macaé, RJ, Brasil
| | - Vivian Pinheiro
- Universidade Federal do Rio de Janeiro - UFRJ, Macaé, RJ, Brasil
| | | | | |
Collapse
|
17
|
Theodorakopoulou MP, Bakaloudi DR, Dipla K, Zafeiridis A, Boutou AK. Vascular endothelial damage in COPD: current functional assessment methods and future perspectives. Expert Rev Respir Med 2021; 15:1121-1133. [PMID: 33874819 DOI: 10.1080/17476348.2021.1919089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Cardiovascular disease is a major cause of death in chronic obstructive pulmonary disease (COPD), but the relationship between these two entities is not fully understood; smoking, inflammation, arterial stiffness and endothelial dysfunction are significant determinants. Endothelial dysfunction is not only associated with cardiovascular disease, but also with COPD severity.Areas covered: Several functional methods have been developed to evaluate endothelial function in healthy and diseased individuals; from the invasive angiography of epicardial coronary arteries and Venous-Occlusion-Plethysmography, to more modern, noninvasive approaches such as Flow-Mediated-Dilatation, Peripheral-Arterial-Tonometry and Near-Infrared-Spectroscopy, all these methods have boosted clinical research in this field. In this context, this narrative review, which included articles published in PubMed and Scopus up to 25-November-2020, summarizes available functional methods for endothelial damage assessment in COPD and discusses existing evidence on their associations with comorbidities and outcomes in this population.Expert opinion: Accumulated evidence suggests that endothelial dysfunction occurs in early stages of CΟPD and worsens with pulmonary obstruction severity and during acute exacerbations. Novel methods evaluating endothelial function offer a detailed, real-time assessment of different parameters related to vascular function and should be increasingly used to shed more light on the role of endothelial damage on cardiovascular and COPD progression.
Collapse
Affiliation(s)
- Marieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Rafailia Bakaloudi
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantina Dipla
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi K Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| |
Collapse
|
18
|
Abstract
Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Regular exercise is important for a healthy pregnancy and can lower the risk of developing GDM. For women with GDM, exercise is safe and can affect the pregnancy outcomes beneficially. A single exercise bout increases skeletal muscle glucose uptake, minimizing hyperglycemia. Regular exercise training promotes mitochondrial biogenesis, improves oxidative capacity, enhances insulin sensitivity and vascular function, and reduces systemic inflammation. Exercise may also aid in lowering the insulin dose in insulin-treated pregnant women. Despite these benefits, women with GDM are usually inactive or have poor participation in exercise training. Attractive individualized exercise programs that will increase adherence and result in optimal maternal and offspring benefits are needed. However, as women with GDM have a unique physiology, more attention is required during exercise prescription. This review (i) summarizes the cardiovascular and metabolic adaptations due to pregnancy and outlines the mechanisms through which exercise can improve glycemic control and overall health in insulin resistance states, (ii) presents the pathophysiological alterations induced by GDM that affect exercise responses, and (iii) highlights cardinal points of an exercise program for women with GDM.
Collapse
|
19
|
Theodorakopoulou MP, Schoina M, Sarafidis P. Assessment of Endothelial and Microvascular Function in CKD: Older and Newer Techniques, Associated Risk Factors, and Relations with Outcomes. Am J Nephrol 2020; 51:931-949. [PMID: 33311014 DOI: 10.1159/000512263] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Endothelium is the inner cellular lining of the vessels that modulates multiple biological processes including vasomotor tone, permeability, inflammatory responses, hemostasis, and angiogenesis. Endothelial dysfunction, the basis of atherosclerosis, is characterized by an imbalance between endothelium-derived relaxing factors and endothelium-derived contracting factors. SUMMARY Starting from the semi-invasive venous occlusion plethysmography, several functional techniques have been developed to evaluate microvascular function and subsequently used in patients with CKD. Flow-mediated dilatation of the forearm is considered to be the "gold standard," while in the last years, novel, noninvasive methods such as laser speckle contrast imaging and near-infrared spectroscopy are scarcely used. Moreover, several circulating biomarkers of endothelial function have been used in studies in CKD patients. This review summarizes available functional methods and biochemical markers for the assessment of endothelial and microvascular function in CKD and discusses existing evidence on their associations with comorbid conditions and outcomes in this population. Key Messages: Accumulated evidence suggests that endothelial dysfunction occurs early in CKD and is associated with target organ damage, progression of renal injury, cardiovascular events, and mortality. Novel methods evaluating microvascular function can offer a detailed, real-time assessment of underlying phenomena and should be increasingly used to shed more light on the role of endothelial dysfunction on cardiovascular and renal disease progression in CKD.
Collapse
Affiliation(s)
- Marieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Schoina
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece,
| |
Collapse
|
20
|
Sartorão Filho CI, Pinheiro FA, Prudencio CB, Nunes SK, Takano L, Enriquez EMA, Orlandi MIG, Junginger B, Hallur RLS, Rudge MVC, Barbosa AMP. Impact of gestational diabetes on pelvic floor: A prospective cohort study with three-dimensional ultrasound during two-time points in pregnancy. Neurourol Urodyn 2020; 39:2329-2337. [PMID: 32857893 DOI: 10.1002/nau.24491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/10/2020] [Indexed: 01/24/2023]
Abstract
AIM To evaluate the pelvic floor (PF) biometry using three-dimensional ultrasound (US) at two-time points of gestational in pregnant women with gestational diabetes mellitus (GDM). METHODS A prospective cohort study conducted at the Perinatal Diabetes Research Center including 44 pregnant women with GDM and 66 pregnant women without GDM at 24 to 28 weeks of gestation. Three-dimensional transperineal US was performed at 24 to 28 and 34 to 38 weeks of gestation in the lithotomy position at rest. The axial plane of the minimal Levator hiatal dimensions was used to determine Levator ani muscle and Hiatal area (HA) biometry at 24 to 28 and 34 to 38 weeks of gestation. RESULTS Of the 110 pregnant women, 100 (90.9%) completed the follow-up at 34 to 38 weeks of gestation. The evaluation by US showed a negative biometric change between the two-time points, during pregnancy in women with GDM; in the HA (β coefficient: estimative of effect in biometric progression according to GDM diagnosis, using the non-GDM group as reference = -6.76; P = .020), anteroposterior diameter (β = -5.07; P = .019), and Levator ani thickness (β = -12.34; P = .005). CONCLUSIONS Pregnant women with GDM had a significantly lower than expected percentage of changes in biometry of Levator ani thickness and HA from 24 to 28 to 34 to 38 weeks of gestation when compared with the group of pregnant women without GDM. GDM alters the morphology of PF structures assessed by three-dimension US. This reported complication may be implicated in adverse birth outcomes and may play a role in the development of PF dysfunction.
Collapse
Affiliation(s)
- Carlos I Sartorão Filho
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.,Department of Medicine, Assis Municipality Educational Foundation (FEMA), Medical School, Fundação Educacional do Município de Assis (FEMA), Assis, São Paulo, Brazil
| | - Fabiane A Pinheiro
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Caroline B Prudencio
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Sthefanie K Nunes
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Luiz Takano
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Eusebio M A Enriquez
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Maiara I G Orlandi
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Baerbel Junginger
- Department of Gynecology, Pelvic Floor Center Charité, Charité University Hospital, Berlin, Germany
| | - Raghavendra L S Hallur
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Marilza V C Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Angélica M P Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.,Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University (UNESP), Marilia, São Paulo, Brazil
| |
Collapse
|
21
|
Wang M, Pu D, Zhao Y, Chen J, Zhu S, Lu A, Liao Z, Sun Y, Xiao Q. Sulforaphane protects against skeletal muscle dysfunction in spontaneous type 2 diabetic db/db mice. Life Sci 2020; 255:117823. [PMID: 32445760 DOI: 10.1016/j.lfs.2020.117823] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 12/12/2022]
Abstract
AIMS Skeletal muscle diseases have become to be the most common complication in patients with type 2 diabetic mellitus (T2DM). However, the effective therapies against skeletal muscle diseases are not yet available. Sulforaphane (SFN) is an organic isothiocyanate found in cruciferous plants. Our aim was to explore whether SFN could attenuate the skeletal muscle diseases in spontaneous type 2 diabetic db/db mice. MATERIALS AND METHODS The db/m and littermate db/db mice were treated with SFN or dimethyl sulfoxide. The grip strength of mice was measured by a grasping forcing machine. The electron transmission microscopy was used to perform the skeletal muscle. The western blot was used to detect the nuclear factor E2-related factor 2/heme oxygenase 1 (Nrf2/HO-1) signal pathway related proteins, and inflammatory and apoptotic associated proteins. The mRNA levels of anti-inflammatory and anti-oxidative relative genes were detected by RT-QPCR. KEY FINDINGS We found that SFN could significantly increase the grip strength of the db/db mice. The lean mass and gastrocnemius mass were increased in the db/db mice after administration with SFN. Additionally, the db/db mice restored the skeletal muscle fiber organization after SFN treatment. Mechanistically, SFN could activate the Nrf2/HO-1 signal pathway, and downregulate the expression of inflammatory and apoptotic associated proteins. Furthermore, SFN could also regulate the mRNA levels of anti-inflammatory and anti-oxidative related genes. SIGNIFICANCE Our results demonstrated that SFN can protect against skeletal muscle diseases in db/db type 2 diabetic mice and provide a potential drug to prevent skeletal muscle dysfunction in T2DM patients.
Collapse
Affiliation(s)
- Meili Wang
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Die Pu
- Department of Geriatrics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yuxing Zhao
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jinliang Chen
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Shiyu Zhu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ankang Lu
- Department of Geriatrics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zhilin Liao
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yue Sun
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qian Xiao
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| |
Collapse
|
22
|
Han D, Jiang L, Gu X, Huang S, Pang J, Wu Y, Yin J, Wang J. SIRT3 deficiency is resistant to autophagy-dependent ferroptosis by inhibiting the AMPK/mTOR pathway and promoting GPX4 levels. J Cell Physiol 2020; 235:8839-8851. [PMID: 32329068 DOI: 10.1002/jcp.29727] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/23/2020] [Accepted: 04/10/2020] [Indexed: 12/11/2022]
Abstract
Ferroptosis, an autophagy-dependent cell death, is characterized by lipid peroxidation and iron accumulation, closely associated with pathogenesis of gestational diabetes mellitus (GDM). Sirtuin 3 (SIRT3) has positive regulation on phosphorylation of activated protein kinase (AMPK), related to maintenance of cellular redox homeostasis. However, whether SIRT3 can confer autophagy by activating the AMPK-mTOR pathway and consequently promote induction of ferroptosis is unknown. We used human trophoblastic cell line HTR8/SVneo and porcine trophoblastic cell line pTr2 to deterimine the mechanism of SIRT3 on autophagy and ferroptosis. The expression of SIRT3 protein was significantly elevated in trophoblastic cells exposed to high concentrations of glucose and ferroptosis-inducing compounds. Increased SIRT3 expression contributed to classical ferroptotic events and autophagy activation, whereas SIRT3 silencing led to resistance against both ferroptosis and autophagy. In addition, autophagy inhibition impaired SIRT3-enhanced ferroptosis. On the contrary, autophagy induction had a synergistic effect with SIRT3. Based on mechanistic investigations, SIRT3 depletion inhibited activation of the AMPK-mTOR pathway and enhanced glutathione peroxidase 4 (GPX4) level, thereby suppressing autophagy and ferroptosis. Furthermore, depletion of AMPK blocked induction of ferroptosis in trophoblasts. We concluded that upregulated SIRT3-enhanced autophagy activation by promoting AMPK-mTOR pathway and decreasing GPX4 level to induce ferroptosis in trophoblastic cells. SIRT3 deficiency was resistant to high glucose- and erastin-induced autophagy-dependent ferroptosis and is, therefore, a potential therapeutic approach for treating GDM.
Collapse
Affiliation(s)
- Dandan Han
- State Key Laboratory of Animal Nutrition, Animal Nutrition and Feed Science, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Lili Jiang
- State Key Laboratory of Animal Nutrition, Animal Nutrition and Feed Science, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Xiaolong Gu
- Clinical Veterinary Medicine, College of Veterinary Medicine, Yunnan Agricultural University, Kunming, China
| | - Shimeng Huang
- State Key Laboratory of Animal Nutrition, Animal Nutrition and Feed Science, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Jiaman Pang
- State Key Laboratory of Animal Nutrition, Animal Nutrition and Feed Science, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Yujun Wu
- State Key Laboratory of Animal Nutrition, Animal Nutrition and Feed Science, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Jingdong Yin
- State Key Laboratory of Animal Nutrition, Animal Nutrition and Feed Science, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Junjun Wang
- State Key Laboratory of Animal Nutrition, Animal Nutrition and Feed Science, College of Animal Science and Technology, China Agricultural University, Beijing, China
| |
Collapse
|
23
|
|
24
|
de Oliveira GV, Volino-Souza M, Leitão R, Pinheiro V, Alvares TS. Is flow-mediated dilatation associated with near-infrared spectroscopy-derived magnitude of muscle O 2 desaturation in healthy young and individuals at risk for cardiovascular disease? Microvasc Res 2019; 129:103967. [PMID: 31837305 DOI: 10.1016/j.mvr.2019.103967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/11/2019] [Accepted: 12/10/2019] [Indexed: 01/10/2023]
Abstract
Vascular occlusion test (VOT)-induced reactive hyperemia in brachial artery is crucial to flow-mediated dilation (FMD). Emerging studies have suggested that reactive hyperemia depends on the magnitude of the O2 desaturation (ischemia) in downstream microvessels. Although near-infrared spectroscopy-derived tissue O2 saturation index (TSI) has been used to assess the magnitude of ischemia, the association between FMD and the magnitude of O2 desaturation has not been addressed. Therefore, the aim of the present study was to evaluate whether FMD correlates with the magnitude of muscle O2 desaturation in healthy young individuals and older adults at risk for cardiovascular disease (CVD). Twenty healthy young individuals and 20 others at risk for CVD participated in the study. The magnitude of ischemic stimulus was determined by calculating the area under curve of TSI signal over 5 min of cuff occlusion period. Oxygen resaturation rate was calculated as the upslope of the TSI signal over 10 s following cuff deflation. There was no significant correlation between FMD and the magnitude of ischemic stimulus in both groups assessed (young: R = 0.327; P = 0.159 and older: R = -0.184; P = 0.436). However, a significant correlation between the magnitude of O2 desaturation and O2 resaturation rate in young (R = 0.555; P = 0.011) and older individuals at risk for CVD (R = 0.539; P = 0.014). In conclusion, FMD response did not correlate with the magnitude of muscle O2 desaturation, although it seems to be partially associated with O2 resaturation rate.
Collapse
Affiliation(s)
- Gustavo Vieira de Oliveira
- Nutrition and Exercise Metabolism Research Group, Federal University of Rio de Janeiro, Macaé Campus, Rio de Janeiro, Brazil; Postgraduate Program in Bioactive Products and Biosciences, Federal University of Rio de Janeiro, Macaé, RJ, Brazil
| | - Mônica Volino-Souza
- Nutrition and Exercise Metabolism Research Group, Federal University of Rio de Janeiro, Macaé Campus, Rio de Janeiro, Brazil; Postgraduate Program in Food Science, Chemistry Institute, Federal University of Rio de Janeiro, RJ, Brazil
| | - Renata Leitão
- Nutrition and Exercise Metabolism Research Group, Federal University of Rio de Janeiro, Macaé Campus, Rio de Janeiro, Brazil
| | - Vivian Pinheiro
- Nutrition and Exercise Metabolism Research Group, Federal University of Rio de Janeiro, Macaé Campus, Rio de Janeiro, Brazil
| | - Thiago Silveira Alvares
- Nutrition and Exercise Metabolism Research Group, Federal University of Rio de Janeiro, Macaé Campus, Rio de Janeiro, Brazil; Postgraduate Program in Bioactive Products and Biosciences, Federal University of Rio de Janeiro, Macaé, RJ, Brazil; Postgraduate Program in Food Science, Chemistry Institute, Federal University of Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
25
|
Prudencio CB, Rudge MVC, Pinheiro FA, Sartorão Filho CI, Nunes SK, Pedroni CR, Junginger B, Barbosa AMP. Negative impact of gestational diabetes mellitus on progress of pelvic floor muscle electromyography activity: Cohort study. PLoS One 2019; 14:e0223261. [PMID: 31697712 PMCID: PMC6857854 DOI: 10.1371/journal.pone.0223261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/17/2019] [Indexed: 12/31/2022] Open
Abstract
Background and objective Pelvic floor muscles are involved in postural stability, in maintenance
intra-abdominal pressure, and on mechanical support for pelvic organ.
Gestational Diabetes Mellitus’ (GDM) pregnancies complicated by fetal
macrosomia, large placenta and polyhydramnios contribute for abrupt and
intense increase in maternal intra-abdominal pressure. Our objective was
analyze the impact of GDM on pelvic floor muscle (PFM) electromyography
(EMG) activity progress from 24–30 to 36–38 weeks of gestation. We conducted
a prospective cohort study. PFM EMG was performed in nulliparous or
primiparous women with one previous elective cesarean delivery and with or
not GDM diagnosed by the American Diabetes Association criteria. A careful
explanation of the muscle anatomy and functionality of the PFM was given
before EMG assessment. The outcome measures were PFM recruitment and
progress from 24–30 to 36–38 weeks of gestation analyzed by the normalized
root mean square (RMS) during rest-activity, fast and hold pelvic floor
muscle contraction. Results Fifty-two pregnant women were assigned to 2 groups: the GDM (n = 26) and
normoglycemic (NG) (n = 26). The demographic and obstetric data showed
homogeneity between the groups. PFM activity progress was decreased in
rest-activity (P = 0.042) and hold contraction (P = 0.044)
at 36–38 weeks of gestation in the GDM group relative to that in the NG
group. Conclusion GDM group showed a progressive decrease in EMG-PFM activity during
rest-activity and hold contractions from 24–30 to 36–38 weeks of
gestation.
Collapse
Affiliation(s)
- Caroline B. Prudencio
- Department of Gynecology and Obstetrics, Botucatu Medical School, São
Paulo State University (Unesp), Universidade Estadual Paulista (UNESP),
Botucatu, São Paulo, Brazil
- * E-mail:
| | - Marilza V. C. Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School, São
Paulo State University (Unesp), Universidade Estadual Paulista (UNESP),
Botucatu, São Paulo, Brazil
| | - Fabiane A. Pinheiro
- Department of Gynecology and Obstetrics, Botucatu Medical School, São
Paulo State University (Unesp), Universidade Estadual Paulista (UNESP),
Botucatu, São Paulo, Brazil
| | - Carlos I. Sartorão Filho
- Department of Gynecology and Obstetrics, Botucatu Medical School, São
Paulo State University (Unesp), Universidade Estadual Paulista (UNESP),
Botucatu, São Paulo, Brazil
| | - Sthefanie K. Nunes
- Department of Gynecology and Obstetrics, Botucatu Medical School, São
Paulo State University (Unesp), Universidade Estadual Paulista (UNESP),
Botucatu, São Paulo, Brazil
| | - Cristiane R. Pedroni
- Department of Physiotherapy and Occupational Therapy, School of
Philosophy and Sciences, São Paulo State University (Unesp), Universidade
Estadual Paulista (UNESP), Marilia, São Paulo, Brazil
| | | | - Angélica M. P. Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São
Paulo State University (Unesp), Universidade Estadual Paulista (UNESP),
Botucatu, São Paulo, Brazil
- Department of Physiotherapy and Occupational Therapy, School of
Philosophy and Sciences, São Paulo State University (Unesp), Universidade
Estadual Paulista (UNESP), Marilia, São Paulo, Brazil
| |
Collapse
|
26
|
Soares RN, de Oliveira GV, Alvares TS, Murias JM. The effects of the analysis strategy on the correlation between the NIRS reperfusion measures and the FMD response. Microvasc Res 2019; 127:103922. [PMID: 31479661 DOI: 10.1016/j.mvr.2019.103922] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/30/2019] [Accepted: 08/30/2019] [Indexed: 11/19/2022]
Abstract
This study aimed to investigate the correlation between near-infrared spectroscopy (NIRS)-derived measures of microvascular responses using a range of different analysis and flow-mediated dilation (FMD). Additionally, we aimed to investigate whether assessing NIRS and FMD simultaneously or non-simultaneously would affect this association. Thirty-five healthy young individuals (26 ± 13 years old) participated in the study. Twenty were submitted to a simultaneous NIRS/FMD test (NIRS probe placed below the cuff during FMD test) and fifteen to a non-simultaneous FMD and NIRS intervention (NIRS test performed 20 min after FMD). NIRS-derived oxygen saturation signal (StO2) during reperfusion was analyzed as follow: upslope of a 10 s (slope 10 s) and 30 s (slope 30 s) reperfusion window immediately following cuff deflation, time for the StO2 to reach the pre-occlusion (baseline) values after cuff release (time to baseline) and to reach the peak after cuff release (time to max), difference between the minimum and maximum StO2 value reached after cuff deflation (Magnitude) and; the total area under the reperfusion curve above the baseline value until the end of the 2 min post cuff release (AUC 2 min). There was a significant positive correlation between slope 10 s and FMD in the simultaneous (r = 0.60; p < 0.05) and non-simultaneous (r = 0.62; p < 0.05) assessments. There was no significant correlation between NIRS-derived slope 30 s, time to baseline, time to max, magnitude, and AUC 2 min and the FMD in both methods. The association between NIRS and FMD is analysis strategy dependent, regardless if assessed simultaneously or non-simultaneously.
Collapse
Affiliation(s)
| | - Gustavo Vieira de Oliveira
- Nutrition and Exercise Metabolism Research Group, Nutrition Institute, Federal University of Rio de Janeiro, Macaé, Rio de Janeiro, Brazil; Postgraduate Program in Bioactive Products and Biosciences, Federal University of Rio de Janeiro, Macaé, RJ, Brazil
| | - Thiago Silveira Alvares
- Nutrition and Exercise Metabolism Research Group, Nutrition Institute, Federal University of Rio de Janeiro, Macaé, Rio de Janeiro, Brazil; Postgraduate Program in Bioactive Products and Biosciences, Federal University of Rio de Janeiro, Macaé, RJ, Brazil
| | - Juan Manuel Murias
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, Canada.
| |
Collapse
|
27
|
de Oliveira GV, Soares RN, Volino-Souza M, Leitão R, Murias JM, Alvares TS. The effects of aging and cardiovascular risk factors on microvascular function assessed by near-infrared spectroscopy. Microvasc Res 2019; 126:103911. [PMID: 31425692 DOI: 10.1016/j.mvr.2019.103911] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/12/2019] [Accepted: 08/15/2019] [Indexed: 01/07/2023]
Abstract
This study aimed to evaluate whether NIRS-derived reperfusion rate would detect potential differences in the forearm microvascular responsiveness between young healthy adults, and older adults free from or with cardiovascular disease (CVD) risk factors. Fifteen healthy young (age: 24.8 ± 4.0 years), seventeen older adults free of CVD risk factors (age: 67.0 ± 6.8 years), and twenty-three older adults with CVD risk factors (age: 67.9 ± 8.0 years) participated this study. Individuals underwent a blood draw and vascular occlusion test (30 s of baseline, 5 min of occlusion, and 2 min of reperfusion) and microvascular responsiveness was evaluated by using NIRS-derived tissue oxygen saturation indexes during reperfusion. A significant slower reperfusion rate and lower reperfusion magnitude was observed in older adults with CVD risk factors compared to healthy young and older adults. Although no statistical differences were found between healthy young and older individuals, there was a small (d = 0.4) effect size for reperfusion rate and moderate (d = 0.7) effects size for reperfusion magnitude when comparing these groups. In conclusion, this study demonstrated that even though the effects of aging per se on microvascular function should not be completely neglected, the CVD risk factors seem to be determinant on microvascular responsiveness impairment associated with aging.
Collapse
Affiliation(s)
- Gustavo Vieira de Oliveira
- Nutrition and Exercise Metabolism Research Group, Federal University of Rio de Janeiro, Macaé Campus, Rio de Janeiro, Brazil; Postgraduate Program in Bioactive Products and Biosciences, Federal University of Rio de Janeiro, Macaé, RJ, Brazil
| | | | - Mônica Volino-Souza
- Nutrition and Exercise Metabolism Research Group, Federal University of Rio de Janeiro, Macaé Campus, Rio de Janeiro, Brazil; Postgraduate Program in Food Science, Chemistry Institute, Federal University of Rio de Janeiro, RJ, Brazil
| | - Renata Leitão
- Nutrition and Exercise Metabolism Research Group, Federal University of Rio de Janeiro, Macaé Campus, Rio de Janeiro, Brazil
| | - Juan Manuel Murias
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, Canada
| | - Thiago Silveira Alvares
- Nutrition and Exercise Metabolism Research Group, Federal University of Rio de Janeiro, Macaé Campus, Rio de Janeiro, Brazil; Postgraduate Program in Bioactive Products and Biosciences, Federal University of Rio de Janeiro, Macaé, RJ, Brazil; Postgraduate Program in Food Science, Chemistry Institute, Federal University of Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
28
|
Tsirou E, Grammatikopoulou MG, Theodoridis X, Gkiouras K, Petalidou A, Taousani E, Savvaki D, Tsapas A, Goulis DG. Guidelines for Medical Nutrition Therapy in Gestational Diabetes Mellitus: Systematic Review and Critical Appraisal. J Acad Nutr Diet 2019; 119:1320-1339. [PMID: 31201104 DOI: 10.1016/j.jand.2019.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/02/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Medical nutrition therapy is the cornerstone of gestational diabetes mellitus treatment. However, guidelines often present contradictory guidance to health care practitioners. OBJECTIVE To systematically review and critically appraise medical nutrition therapy guidelines for treating patients with gestational diabetes mellitus. DESIGN We searched Medline, the Cochrane Library, Guidelines International Network, and Google Scholar to retrieve clinical practice guidelines (CPGs) for medical nutrition therapy in gestational diabetes mellitus from professional or governmental organizations, published in English, between January 1, 2007, and November 24, 2018. CPGs were reviewed and appraised using the Appraisal of Guidelines, Research, and Evaluation II instrument. RESULTS Of 1,286 retrieved articles, 21 CPGs fulfilled the inclusion criteria. CPGs of the Academy of Nutrition and Dietetics, Diabetes Canada, and Malaysia Health Technology Assessment Section received the greatest overall scores and the highest scores concerning rigor of recommendations development. Many CPGs failed to involve multidisciplinary teams in their development, including patients, and often, dietitians. Applicability of the recommendations was low, lacking facilitators and tools to enhance implementation. Many CPGs demonstrated low editorial independence by failing to disclose funding and competing interests. More medical nutrition therapy recommendations were incorporated in the Academy of Nutrition and Dietetics and Malaysia Health Technology Assessment Section CPGs. The Malaysia Health Technology Assessment Section, Diabetes Canada, Academy of Nutrition and Dietetics, and Endocrine Society guidelines were recommended by the review panel herein without modifications. Overall, the CPGs suggested the consumption of adequate protein and the selection of foods with low glycemic index, divided into three main meals and two to four snacks. Weight gain recommendations were mostly based on the Institute of Medicine body mass index thresholds. CONCLUSIONS With few exceptions, the main developmental limitations of the appraised CPGs involved low rigor of recommendations development, lack of multidisciplinary stakeholder involvement, low applicability, and inadequate editorial independence. This indicates a need for developing more clear, unbiased, practical, and evidence-based CPGs.
Collapse
|
29
|
Vieira de Oliveira G, Soares RN, Volino-Souza M, Murias JM, Alvares TS. The association between near-infrared spectroscopy assessment of microvascular reactivity and flow-mediated dilation is disrupted in individuals at high risk for cardiovascular disease. Microcirculation 2019; 26:e12556. [PMID: 31077636 DOI: 10.1111/micc.12556] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study aimed to evaluate the correlation between the NIRS-derived reperfusion slope and %FMD in the arm of healthy and at high risk for CVD individuals. METHODS Twelve healthy (24 ± 4 years) and twelve at high risk for cardiovascular disease (65 ± 11 years) individuals participated in the study. The individuals were submitted to a conduit artery FMD followed by a NIRS-VOT microvascular function test in the arm. Microvascular responsiveness was calculated as the forearm reperfusion slope, and macrovascular function was assessed as the percent of change in FMD (%FMD) of the brachial artery. RESULTS There was a significant correlation between reperfusion slope and %FMD (R = 0.61, P < 0.05) in the healthy group; however, no significant correlation between FMD and reperfusion slope (R = -0.21, P > 0.05) was found in individuals at high risk for CVD. CONCLUSION The correlation between NIRS-derived reperfusion slope and %FMD was disrupted in the arm of individuals at high risk for cardiovascular disease compared to healthy individuals. The findings of the present study reinforce the importance of examining vascular function at microvasculature and conduit artery level, especially in populations with risk factors for CVD.
Collapse
Affiliation(s)
- Gustavo Vieira de Oliveira
- Nutrition and Exercise Metabolism Research Group, Nutrition Institute, Federal University of Rio de Janeiro, Macaé, Rio de Janeiro, Brazil.,Postgraduate Program in Bioactive Products and Biosciences, Federal University of Rio de Janeiro, Macaé, Rio de Janeiro, Brazil
| | | | - Mônica Volino-Souza
- Nutrition and Exercise Metabolism Research Group, Nutrition Institute, Federal University of Rio de Janeiro, Macaé, Rio de Janeiro, Brazil.,Postgraduate Program in Food Science, Chemistry Institute, Federal University of Rio de Janeiro, Macaé, Rio de Janeiro, Brazil
| | | | - Thiago Silveira Alvares
- Nutrition and Exercise Metabolism Research Group, Nutrition Institute, Federal University of Rio de Janeiro, Macaé, Rio de Janeiro, Brazil.,Postgraduate Program in Bioactive Products and Biosciences, Federal University of Rio de Janeiro, Macaé, Rio de Janeiro, Brazil.,Postgraduate Program in Food Science, Chemistry Institute, Federal University of Rio de Janeiro, Macaé, Rio de Janeiro, Brazil
| |
Collapse
|
30
|
Pastorino S, Bishop T, Crozier SR, Granström C, Kordas K, Küpers LK, O'Brien EC, Polanska K, Sauder KA, Zafarmand MH, Wilson RC, Agyemang C, Burton PR, Cooper C, Corpeleijn E, Dabelea D, Hanke W, Inskip HM, McAuliffe FM, Olsen SF, Vrijkotte TG, Brage S, Kennedy A, O'Gorman D, Scherer P, Wijndaele K, Wareham NJ, Desoye G, Ong KK. Associations between maternal physical activity in early and late pregnancy and offspring birth size: remote federated individual level meta-analysis from eight cohort studies. BJOG 2019; 126:459-470. [PMID: 30230190 PMCID: PMC6330060 DOI: 10.1111/1471-0528.15476] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Evidence on the impact of leisure time physical activity (LTPA) in pregnancy on birth size is inconsistent. We aimed to examine the association between LTPA during early and late pregnancy and newborn anthropometric outcomes. DESIGN Individual level meta-analysis, which reduces heterogeneity across studies. SETTING A consortium of eight population-based studies (seven European and one US) comprising 72 694 participants. METHODS Generalised linear models with consistent inclusion of confounders (gestational age, sex, parity, maternal age, education, ethnicity, BMI, smoking, and alcohol intake) were used to test associations between self-reported LTPA at either early (8-18 weeks gestation) or late pregnancy (30+ weeks) and the outcomes. Results were pooled using random effects meta-analyses. MAIN OUTCOME MEASURES Birth weight, large-for-gestational age (LGA), macrosomia, small-for-gestational age (SGA), % body fat, and ponderal index at birth. RESULTS Late, but not early, gestation maternal moderate to vigorous physical activity (MVPA), vigorous activity, and LTPA energy expenditure were modestly inversely associated with BW, LGA, macrosomia, and ponderal index, without heterogeneity (all: I2 = 0%). For each extra hour/week of MVPA, RR for LGA and macrosomia were 0.97 (95% CI: 0.96, 0.98) and 0.96 (95% CI: 0.94, 0.98), respectively. Associations were only modestly reduced after additional adjustments for maternal BMI and gestational diabetes. No measure of LTPA was associated with risk for SGA. CONCLUSIONS Physical activity in late, but not early, pregnancy is consistently associated with modestly lower risk of LGA and macrosomia, but not SGA. TWEETABLE ABSTRACT In an individual participant meta-analysis, late pregnancy moderate to vigorous physical activity modestly reduced birth size outcomes.
Collapse
Affiliation(s)
- S Pastorino
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - T Bishop
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - SR Crozier
- MRC Lifecourse Epidemiology Unit (University of Southampton)Southampton General HospitalSouthamptonUK
| | - C Granström
- Department of Epidemiology ResearchCentre for Fetal ProgrammingState Serum InstituteCopenhagenDenmark
| | - K Kordas
- Epidemiology and Environmental HealthSchool of Public Health and Health ProfessionsUniversity at BuffaloBuffaloNYUSA
| | - LK Küpers
- Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
- MRC Integrative Epidemiology UnitSchool of Social and Community MedicineUniversity of BristolBristolUK
| | - EC O'Brien
- Obstetrics & GynaecologyUCD Perinatal Research CentreSchool of MedicineUniversity College DublinNational Maternity HospitalDublinIreland
| | - K Polanska
- Department of Environmental EpidemiologyNofer Institute of Occupational MedicineLodzPoland
| | - KA Sauder
- Department of PediatricsUniversity of Colorado School of MedicineAuroraCOUSA
| | - MH Zafarmand
- Department of Public HealthAmsterdam Public Health Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
- Department of Obstetrics & GynaecologyAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
- Department of Clinical EpidemiologyBiostatistics and BioinformaticsAmsterdam Public Health Research InstituteAmsterdam UMCUniversity of Amsterdamthe Netherlands
| | - RC Wilson
- Institute of Health and SocietyNewcastle UniversityNewcastleUK
| | - C Agyemang
- Department of Public HealthAmsterdam Public Health Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - PR Burton
- Institute of Health and SocietyNewcastle UniversityNewcastleUK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit (University of Southampton)Southampton General HospitalSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity Hospital Southampton NHS Foundation Trust and University of SouthamptonSouthamptonUK
| | - E Corpeleijn
- Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - D Dabelea
- Department of EpidemiologyColorado School of Public HealthUniversity of Colorado Anschutz Medical CampusDenverCOUSA
| | - W Hanke
- Department of Environmental EpidemiologyNofer Institute of Occupational MedicineLodzPoland
| | - HM Inskip
- MRC Lifecourse Epidemiology Unit (University of Southampton)Southampton General HospitalSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity Hospital Southampton NHS Foundation Trust and University of SouthamptonSouthamptonUK
| | - FM McAuliffe
- Obstetrics & GynaecologyUCD Perinatal Research CentreSchool of MedicineUniversity College DublinNational Maternity HospitalDublinIreland
| | - SF Olsen
- Department of Epidemiology ResearchCentre for Fetal ProgrammingState Serum InstituteCopenhagenDenmark
| | - TG Vrijkotte
- Department of Public HealthAmsterdam Public Health Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - S Brage
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - A Kennedy
- 3U Diabetes Consortium and School of Health and Human PerformanceDublin City UniversityDublinIreland
- School of Biological SciencesDublin Institute of TechnologyDublinIreland
| | - D O'Gorman
- NIHR Southampton Biomedical Research CentreUniversity Hospital Southampton NHS Foundation Trust and University of SouthamptonSouthamptonUK
| | - P Scherer
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - K Wijndaele
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - NJ Wareham
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - G Desoye
- Department of Obstetrics & GynaecologyMedical University of GrazGrazAustria
| | - KK Ong
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| |
Collapse
|
31
|
Zafeiridis A, Triantafyllou A, Papadopoulos S, Koletsos N, Touplikioti P, Zafeiridis AS, Gkaliagkousi E, Dipla K, Douma S. Dietary nitrate improves muscle microvascular reactivity and lowers blood pressure at rest and during isometric exercise in untreated hypertensives. Microcirculation 2019; 26:e12525. [DOI: 10.1111/micc.12525] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 01/30/2023]
Affiliation(s)
- Andreas Zafeiridis
- Laboratory of Exercise Physiology and BiochemistryDepartment of Physical Education and Sports Science at SerresAristotle University of Thessaloniki Serres Greece
| | - Areti Triantafyllou
- Third Department of Internal MedicinePapageorgiou HospitalAristotle University of Thessaloniki Thessaloniki Greece
| | - Stavros Papadopoulos
- Laboratory of Exercise Physiology and BiochemistryDepartment of Physical Education and Sports Science at SerresAristotle University of Thessaloniki Serres Greece
| | - Nikolaos Koletsos
- Third Department of Internal MedicinePapageorgiou HospitalAristotle University of Thessaloniki Thessaloniki Greece
| | | | - Alexandros S. Zafeiridis
- Third Department of Internal MedicinePapageorgiou HospitalAristotle University of Thessaloniki Thessaloniki Greece
| | - Eugenia Gkaliagkousi
- Third Department of Internal MedicinePapageorgiou HospitalAristotle University of Thessaloniki Thessaloniki Greece
| | - Konstantina Dipla
- Laboratory of Exercise Physiology and BiochemistryDepartment of Physical Education and Sports Science at SerresAristotle University of Thessaloniki Serres Greece
| | - Stella Douma
- Third Department of Internal MedicinePapageorgiou HospitalAristotle University of Thessaloniki Thessaloniki Greece
| |
Collapse
|
32
|
Rahman A, Munisamy S, Ghaffar NA, Mahmood NZ, Rasool AHG. Impaired microvascular reactivity in gestational diabetes is associated with altered glycemic parameters. Microcirculation 2018; 26:e12513. [PMID: 30422359 DOI: 10.1111/micc.12513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 11/08/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess microvascular reactivity and glycemic parameters in GDM compared to age and GA matched controls. METHODS This study involved 21 GDM patients and 31 controls. Microvascular reactivity was assessed using LDF and PORH. Microvascular parameters; PORHmax , PORHpeak , and time to peak perfusion (Tp) were recorded after the release of 3 minutes' upper arm occlusion. HOMA-IR was performed to evaluate insulin resistance. RESULTS Average age and GA for subjects were 32.9 years and 29.2 weeks. Mean FBG and a 2-hour postprandial for GDM and controls were 4.87 ± 0.71 vs 3.99 ± 0.59 mmol/L; P < 0.001 and 9.50 ± 1.8 vs 5.67 ± 1.0 mmol/L; P < 0.001. Fasting insulin (13.88 ± 18.9 vs 8.37 ± 11.0 μLU/mL; P = 0.031) and HOMA-IR (3.14 ± 4.6 vs 1.52 ± 2.2; P = 0.004) were higher in GDM. Tp was prolonged in GDM (16.27 ± 4.3 vs 13.86 ± 2.1 seconds; P = 0.011). Positive correlations were seen between Tp and FBG and 2-hour postprandial levels. CONCLUSION Tp was prolonged in GDM compared to age-matched controls, indicating impaired microvascular reactivity.
Collapse
Affiliation(s)
- Aisyah Rahman
- Pharmacology Vascular Laboratory, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Seetha Munisamy
- Pharmacology Vascular Laboratory, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | | | - Nik Zaki Mahmood
- Obstetric & Gynecology Department, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.,Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Aida H G Rasool
- Pharmacology Vascular Laboratory, Universiti Sains Malaysia, Kota Bharu, Malaysia.,Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kota Bharu, Malaysia
| |
Collapse
|
33
|
Vounzoulaki E, Dipla K, Kintiraki E, Triantafyllou A, Grigoriadou I, Koletsos N, Zafeiridis A, Goulis DG, Douma S. Pregnancy and post-partum muscle and cerebral oxygenation during intermittent exercise in gestational diabetes: A pilot study. Eur J Obstet Gynecol Reprod Biol 2018; 232:54-59. [PMID: 30468984 DOI: 10.1016/j.ejogrb.2018.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/10/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This pilot, prospective, observational, cohort study aimed to examine, for the first time, the in vivo alterations in the oxygenation of the forearm skeletal muscles and the prefrontal lobes during intermittent exercise in women diagnosed with gestational diabetes mellitus (GDM), during and after pregnancy. STUDY DESIGN Nine pregnant women, diagnosed with GDM, performed a 3-min intermittent handgrip exercise protocol (at 35% of Maximal Voluntary Contraction) during pregnancy (mean 27th gestational week) and following labor (mean 71 weeks). During the protocol, muscle and cerebral oxygenation were assessed with near-infrared spectroscopy. Resting vascular parameters [carotid intima-media thickness (cIMT) and hemodynamic parameters (using rheocardiography)], and hematological/biochemical parameters during pregnancy and after delivery have been compared. RESULTS Although changes were observed in certain hematological parameters (p< 0.05), cIMT and hemodynamic parameters were not altered post-partum. In addition, both muscle and cerebral oxygenation parameters during handgrip were not significantly altered post-partum. CONCLUSIONS Despite significant changes in specific hematological parameters in women with GDM, impairments in muscle and cerebral oxygenation during exercise remained at one year after labor. These results indicate that alterations in vascular parameters and muscle/cerebral oxygenation associated with GDM do not entirely reverse post-partum. Future studies are needed to examine which interventions will lead to improvements in microvascular parameters and prevent type 2 diabetes.
Collapse
Affiliation(s)
- Elpida Vounzoulaki
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece.
| | - Konstantina Dipla
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Greece
| | - Evangelia Kintiraki
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Areti Triantafyllou
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Iris Grigoriadou
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Greece
| | - Nikolaos Koletsos
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Stella Douma
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| |
Collapse
|
34
|
A single dose of beetroot juice improves endothelial function but not tissue oxygenation in pregnant women: a randomised clinical trial. Br J Nutr 2018; 120:1006-1013. [PMID: 30229712 DOI: 10.1017/s0007114518002441] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Beetroot juice (BJ) consumption has been associated with improved cardiovascular health owing to an increase in NO bioconversion. This study evaluates the effect of BJ consumption on macrovascular endothelial function (flow-mediated dilation (FMD)) and muscle oxygen saturation (StO2) parameters in pregnant women within a randomised, crossover, double-blind design in which twelve pregnant women consumed a single dose (140 ml) of BJ or placebo (PLA). Urinary nitrate was assessed before (T0) and 150 min after BJ/PLA consumption. FMD was used to evaluate macrovascular endothelial function, and near-IR spectroscopy was used to evaluate muscle StO2 parameters during the occlusion and reperfusion phases, which were taken at baseline (PRE) and 120 and 140 min after BJ/PLA consumption, respectively. A significant increase in urinary nitrate was observed at 150 min after BJ consumption when compared with T0 (BJ: 0·20 (sd 0·13) v. T0: 0·02 (sd 0·00), P=0·000) and PLA intervention (PLA: 0·02 (sd 0·00), P=0·001). FMD improved after BJ consumption when compared with PRE (BJ: 11·00 (sd 1·67) v. PRE: 5·53 (sd 1·17), P=0·000) and PLA (5·34 (sd 1·31), P=0·000). No significant difference between PLA and PRE in FMD (P=1·000) was observed. In StO2 parameters, a difference was not observed after BJ consumption compared with PRE and PLA intervention. The data demonstrate that a single dose of 140 ml of BJ consumption improves macrovascular endothelial function, but not StO2 parameters.
Collapse
|
35
|
Kintiraki E, Goulis DG. Gestational diabetes mellitus: Multi-disciplinary treatment approaches. Metabolism 2018; 86:91-101. [PMID: 29627447 DOI: 10.1016/j.metabol.2018.03.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 02/08/2023]
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disease of pregnancy, associated with several perinatal complications. Adequate glycemic control has been proved to decrease risk of GDM-related complications. Several studies have shown the beneficial effect of exercise and medical nutrition treatment on glycemic and weight control in GDM-affected women. Moreover, pharmacological agents, such as insulin and specific oral anti-diabetic agents can be prescribed safely during pregnancy, decreasing maternal blood glucose and, thus, perinatal adverse outcomes. Multi-disciplinary treatment approaches that include both lifestyle modifications (medical nutritional therapy and daily physical exercise) and pharmacological treatment, in cases of failure of the former, constitute the most effective approach. Insulin is the gold standard pharmacological agent for GDM treatment. Metformin and glyburide are two oral anti-diabetic agents that could serve as alternative, although not equal in terms of effectiveness and safety, treatment for GDM. As studies on short-term safety of metformin are reassuring, in some countries it is considered as first-line treatment for GDM management. More studies are needed to investigate the long-term effects on offspring. As safety issues have been raised on the use of glyburide during pregnancy, it must be used only when benefits surpass possible risks.
Collapse
Affiliation(s)
- Evangelia Kintiraki
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
36
|
Kintiraki E, Dipla K, Triantafyllou A, Koletsos N, Grigoriadou I, Poulakos P, Sachpekidis V, Vrabas IS, Zafeiridis A, Bili E, Douma S, Goulis DG. Blunted cerebral oxygenation during exercise in women with gestational diabetes mellitus: associations with macrovascular function and cardiovascular risk factors. Metabolism 2018; 83:25-30. [PMID: 29410188 DOI: 10.1016/j.metabol.2018.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 01/03/2018] [Accepted: 01/17/2018] [Indexed: 01/23/2023]
Abstract
AIM/HYPOTHESIS This cross-sectional, observational, controlled study examined cerebral oxygenation during exercise, an index of cerebrovascular function and cortical activation, in pregnancies complicated by gestational diabetes mellitus (GDM) and unaffected pregnancies. The association of cerebral oxygenation with macrovascular and cardiovascular function indices was also evaluated. MATERIAL AND METHODS Vascular function and structure [aortic pulse-wave-velocity (PWV), augmentation index (AI), carotid intima-media thickness], as well as 24-hour ambulatory blood pressure (BP) were assessed in women with GDM (n = 21) and uncomplicated pregnancies (n = 16), at 26-32 gestational weeks. Changes in cerebral oxygenation [oxy- (O2Hb), deoxy- (HHb) and total- (tHb) hemoglobin] were continuously recorded by near-infrared spectroscopy (NIRS) during intermittent handgrip exercise. Beat-by-beat BP and systemic vascular resistance (SVR) were assessed (Finapres). RESULTS Women with GDM had higher AI than controls. During exercise, women with GDM maintained a smaller force (p < 0.05), despite similar ratings of perceived exertion. Despite similar increases in BP during exercise, the GDM group exhibited a lower average and total (AUC) increase in cerebral-O2Hb than controls (p < 0.05). In addition, GDM exhibited a slower rate of cerebral-O2Hb decay during recovery (p < 0.05). SVR was lower in GDM compared to controls throughout the protocol (p < 0.01). Cerebral oxygenation indices were correlated with PWV and AI (p < 0.05). CONCLUSIONS This study provided novel evidence for blunted cerebral oxygenation during exercise in women with GDM compared to uncomplicated pregnancies, suggesting a link between reduced cerebrovascular function with exercise intolerance in GDM. Cerebral oxygenation during physical stress was correlated with macrovascular function and cardiovascular risk factors. More studies are needed to examine whether this impaired cerebral oxygenation reflects early cerebrovascular disease.
Collapse
Affiliation(s)
- Evangelia Kintiraki
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Ring Road, Nea Efkarpia, Thessaloniki, Greece.
| | - Konstantina Dipla
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Areti Triantafyllou
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Ring Road, Nea Efkarpia, Thessaloniki, Greece
| | - Nikolaos Koletsos
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Ring Road, Nea Efkarpia, Thessaloniki, Greece
| | - Iris Grigoriadou
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Pavlos Poulakos
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Ring Road, Nea Efkarpia, Thessaloniki, Greece
| | - Vasileios Sachpekidis
- Second Department of Cardiology, "Papageorgiou" General Hospital, Ring Road, Nea Efkarpia, Thessaloniki, Greece
| | - Ioannis S Vrabas
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Andreas Zafeiridis
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Eleni Bili
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Ring Road, Nea Efkarpia, Thessaloniki, Greece
| | - Stella Douma
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Ring Road, Nea Efkarpia, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Ring Road, Nea Efkarpia, Thessaloniki, Greece
| |
Collapse
|
37
|
Papadopoulos S, Dipla K, Triantafyllou A, Nikolaidis MG, Kyparos A, Touplikioti P, Vrabas IS, Zafeiridis A. Beetroot Increases Muscle Performance and Oxygenation During Sustained Isometric Exercise, but Does Not Alter Muscle Oxidative Efficiency and Microvascular Reactivity at Rest. J Am Coll Nutr 2018; 37:361-372. [DOI: 10.1080/07315724.2017.1401497] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Stavros Papadopoulos
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Konstantina Dipla
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Areti Triantafyllou
- Third Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michalis G Nikolaidis
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Antonios Kyparos
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | | | - Ioannis S Vrabas
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Andreas Zafeiridis
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| |
Collapse
|
38
|
Kotani H, Kato M, Matsuno M, Kuramoto K, Nakagawa H. Functional hemispheric asymmetry in female prefrontal hemodynamics corresponding to changes in auditory sense during pregnancy and child raising. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2574-2577. [PMID: 29060425 DOI: 10.1109/embc.2017.8037383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We carried out further research into the prefrontal hemodynamics corresponding to changes in a women's auditory sense during pregnancy and child raising. A total of forty-six volunteers took part in our experiment, and we divided them into several groups in accordance with the progress of their child raising. For the auditory tasks performed by the volunteers, we used two auditory stimulations: the sound of baby crying, and a classical music as a control. Hemodynamic changes at the prefrontal regions were measured using a 2 ch functional near-infrared spectroscopy (fNIRS) along with a 47 ch fNIRS instrument equipped with 3×5 probes (22 ch). Judging the results of the female groups about their prefrontal hemodynamics, there were almost no significant differences across the groups in the dynamics with the music task. However, in the section of the baby crying task, their hemodynamics were regarded as significant compared to the control. Concerning the time scale of the changes in the hemodynamic response to the two tasks, especially in the postnatal group, we took notice of the possibility that higher activations were clearly observed at the right sides of their brains than their left sides. Our experimental results not only demonstrated that postnatal women within one and a half years of their childbearing might have acute ears, but also revealed the hemispheric asymmetry in their prefrontal hemodynamics, as compared to pregnant and nonpregnant volunteers. We inferred that the pregnancy-inducing expression of such women's special capabilities is definitely due to a boost-up of a built-in female disposition, which is destined for expressions of maternal love.
Collapse
|
39
|
Long-Term Effects of Pregnancy Complications on Maternal Health: A Review. J Clin Med 2017; 6:jcm6080076. [PMID: 28749442 PMCID: PMC5575578 DOI: 10.3390/jcm6080076] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/26/2017] [Accepted: 07/20/2017] [Indexed: 12/17/2022] Open
Abstract
Background: Most pregnancy-related medical complications appear to resolve at delivery or shortly thereafter. Common examples are preterm labor, placental abruption, preeclampsia, and gestational diabetes. Women who developed such complications are known to be at increased risk of developing similar complications in future pregnancies. It has recently become evident that these women are at an increased risk of long term medical complications. Methods: A search through scientific publications in English regarding the association of obstetric complications and long-term maternal illness. Results: There is a clear association between various obstetric complications and long-term effects on maternal health. Conclusions: Women with a history of adverse pregnancy outcomes are at increased risk of cardiovascular and metabolic diseases later in life. Data increasingly links maternal vascular, metabolic, and inflammatory complications of pregnancy with an increased risk of vascular disease in later life.
Collapse
|
40
|
Dipla K, Triantafyllou A, Koletsos N, Papadopoulos S, Sachpekidis V, Vrabas IS, Gkaliagkousi E, Zafeiridis A, Douma S. Impaired Muscle Oxygenation and Elevated Exercise Blood Pressure in Hypertensive Patients: Links With Vascular Stiffness. Hypertension 2017; 70:444-451. [PMID: 28607132 DOI: 10.1161/hypertensionaha.117.09558] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 04/21/2017] [Accepted: 05/14/2017] [Indexed: 12/31/2022]
Abstract
This study examined in vivo (1) skeletal muscle oxygenation and microvascular function, at rest and during handgrip exercise, and (2) their association with macrovascular function and exercise blood pressure (BP), in newly diagnosed, never-treated patients with hypertension and normotensive individuals. Ninety-one individuals (51 hypertensives and 40 normotensives) underwent office and 24-hour ambulatory BP, arterial stiffness, and central aortic BP assessment, followed by a 5-minute arterial occlusion and a 3-minute submaximal handgrip exercise. Changes in muscle oxygenated and deoxygenated hemoglobin and tissue oxygen saturation were continuously monitored by near-infrared spectroscopy and beat-by-beat BP by Finapres. Hypertensives had higher (P<0.001) central aortic BP and pulse wave velocity versus normotensives and exhibited (1) a blunted tissue oxygen saturation response during occlusion, with slower (P=0.006) deoxygenation rate, suggesting reduced muscle oxidative capacity, and (2) a slower reoxygenation rate and blunted hyperemic response (P<0.05), showing reduced microvascular reactivity. Muscle oxygenation responses were correlated with aortic systolic and pulse pressure and augmentation index (P<0.05; age and body mass index (BMI) adjusted). When exercising at the same submaximal intensity, hypertensives required a significantly greater (P<0.001) increase in BP for achieving similar muscle oxygenation levels as normotensives. This response was correlated with the magnitude of microvascular hyperemia and aortic BP. In conclusion, nontreated patients with hypertension exhibit prominent reductions in in vivo indices of skeletal muscle oxidative capacity, suggestive of mitochondrial dysfunction, and blunted muscle microvascular reactivity. These dysfunctions were associated with higher aortic systolic BP and arterial stiffness. Dysregulations in muscle oxygen delivery/utilization and microvascular stiffness, in hypertensive patients, partially contribute to their exaggerated BP during exercise.
Collapse
Affiliation(s)
- Konstantina Dipla
- From the Exercise Physiology and Biochemistry Laboratory, Department of Sports Science at Serres (K.D., S.P., I.S.V., A.Z.) and 3rd Department of Internal Medicine, Papageorgiou Hospital (A.T., N.K., E.G., S.D.), Aristotle University of Thessaloniki, Greece; and 2nd Cardiology Department, Papageorgiou Hospital, Thessaloniki, Greece (V.S.).
| | - Areti Triantafyllou
- From the Exercise Physiology and Biochemistry Laboratory, Department of Sports Science at Serres (K.D., S.P., I.S.V., A.Z.) and 3rd Department of Internal Medicine, Papageorgiou Hospital (A.T., N.K., E.G., S.D.), Aristotle University of Thessaloniki, Greece; and 2nd Cardiology Department, Papageorgiou Hospital, Thessaloniki, Greece (V.S.)
| | - Nikolaos Koletsos
- From the Exercise Physiology and Biochemistry Laboratory, Department of Sports Science at Serres (K.D., S.P., I.S.V., A.Z.) and 3rd Department of Internal Medicine, Papageorgiou Hospital (A.T., N.K., E.G., S.D.), Aristotle University of Thessaloniki, Greece; and 2nd Cardiology Department, Papageorgiou Hospital, Thessaloniki, Greece (V.S.)
| | - Stavros Papadopoulos
- From the Exercise Physiology and Biochemistry Laboratory, Department of Sports Science at Serres (K.D., S.P., I.S.V., A.Z.) and 3rd Department of Internal Medicine, Papageorgiou Hospital (A.T., N.K., E.G., S.D.), Aristotle University of Thessaloniki, Greece; and 2nd Cardiology Department, Papageorgiou Hospital, Thessaloniki, Greece (V.S.)
| | - Vasileios Sachpekidis
- From the Exercise Physiology and Biochemistry Laboratory, Department of Sports Science at Serres (K.D., S.P., I.S.V., A.Z.) and 3rd Department of Internal Medicine, Papageorgiou Hospital (A.T., N.K., E.G., S.D.), Aristotle University of Thessaloniki, Greece; and 2nd Cardiology Department, Papageorgiou Hospital, Thessaloniki, Greece (V.S.)
| | - Ioannis S Vrabas
- From the Exercise Physiology and Biochemistry Laboratory, Department of Sports Science at Serres (K.D., S.P., I.S.V., A.Z.) and 3rd Department of Internal Medicine, Papageorgiou Hospital (A.T., N.K., E.G., S.D.), Aristotle University of Thessaloniki, Greece; and 2nd Cardiology Department, Papageorgiou Hospital, Thessaloniki, Greece (V.S.)
| | - Eugenia Gkaliagkousi
- From the Exercise Physiology and Biochemistry Laboratory, Department of Sports Science at Serres (K.D., S.P., I.S.V., A.Z.) and 3rd Department of Internal Medicine, Papageorgiou Hospital (A.T., N.K., E.G., S.D.), Aristotle University of Thessaloniki, Greece; and 2nd Cardiology Department, Papageorgiou Hospital, Thessaloniki, Greece (V.S.)
| | - Andreas Zafeiridis
- From the Exercise Physiology and Biochemistry Laboratory, Department of Sports Science at Serres (K.D., S.P., I.S.V., A.Z.) and 3rd Department of Internal Medicine, Papageorgiou Hospital (A.T., N.K., E.G., S.D.), Aristotle University of Thessaloniki, Greece; and 2nd Cardiology Department, Papageorgiou Hospital, Thessaloniki, Greece (V.S.)
| | - Stella Douma
- From the Exercise Physiology and Biochemistry Laboratory, Department of Sports Science at Serres (K.D., S.P., I.S.V., A.Z.) and 3rd Department of Internal Medicine, Papageorgiou Hospital (A.T., N.K., E.G., S.D.), Aristotle University of Thessaloniki, Greece; and 2nd Cardiology Department, Papageorgiou Hospital, Thessaloniki, Greece (V.S.)
| |
Collapse
|