The association between near-infrared spectroscopy-derived and flow-mediated dilation assessment of vascular responsiveness in the arm

Comparison of analysis strategies to assess sex differences in microvascular reperfusion using near-infrared spectroscopy

The near-infrared spectroscopy (NIRS) vascular occlusion test (VOT) assesses microvascular reperfusion. Two strategies have been used to quantify reperfusion following reactive hyperemia, but it is unclear whether both yield similar results when comparing biological sex. This study aimed to determine whether sex differences in NIRS-based microvascular reperfusion are similarly apparent using the 10-s reactive hyperemia slope of the tissue saturation index (StO2) signal (slope 2) and the halftime to maximal reperfusion (T ½). Healthy, recreationally active males (n = 31) and females (n = 31) between 18 and 82 years took part in this study. A NIRS VOT was performed on the tibialis anterior muscle, and reperfusion was quantified using slope 2 (% s-1) and T ½ (s). Adipose tissue thickness (ATT) was higher in females (P = 0.009), which was associated with a lower StO2 (P = 0.001) and oxygenated hemoglobin (O2Hb) (P = 0.05) signal range. The StO2 slope 2 was significantly steeper in males versus females (P = 0.001) but not after correcting for ATT (P = 0.295). There were no sex differences in StO2 T ½ (P = 0.067) or O2Hb T ½ (P = 0.197). In a subset of males (n = 26) and females (n = 21) with similar ATT, there were no sex differences in StO2 slope 2 (P = 0.068), StO2 T ½ (P = 0.491), or O2Hb T ½ (P = 0.899). An ATT-corrected StO2 slope 2 or the T ½ approach is recommended for analysis of NIRS-based microvascular reperfusion when differences in ATT are present between sexes.NEW & NOTEWORTHY Sex differences in near-infrared spectroscopy (NIRS)-based microvascular reperfusion have been previously reported. We found that greater adipose tissue thickness in females reduces kinetic measures of NIRS-based microvascular reperfusion. Sex differences are eliminated when performing an adipose tissue thickness correction, when the NIRS signal range is accounted for, or when adipose tissue thickness is similar between sexes. This highlights the importance of considering factors that affect NIRS signals, such as adipose tissue thickness, when drawing comparisons between groups.

Tissue desaturation is not a major determinant of aging-related impairment in skeletal muscle reactive hyperemia: a retrospective analysis

Near-infrared spectroscopy combined with vascular occlusion test (NIRS-VOT) is a reactive hyperemia technique for in vivo evaluation of skeletal muscle microvascular reactivity. Previous studies using NIRS-VOT have been shown to be able to detect impairments in microvascular function in high-risk cardiovascular disease populations, such as older individuals. It has been demonstrated that older individuals have slower reactive hyperemia compared with young individuals. Importantly, older individuals also show less desaturation during ischemia compared with young individuals. Based on these findings, it has been suggested that the slower reactive hyperemia observed in older individuals is explained by the lower desaturation during blood flow occlusion (reduced ischemic stimulus). This retrospective analysis compared reactive hyperemia in 36 young and 47 older tissue desaturation-matched individuals that underwent 5-min blood flow occlusion. Overall, we showed that older individuals have impaired reactive hyperemia compared with young when matching for the degree of desaturation and blood flow occlusion time. These findings provide evidence that lower tissue desaturation during ischemia is not a major determinant of impaired reactive hyperemia in older individuals.NEW & NOTEWORTHY Previous findings have suggested that aging-related impairment in skeletal muscle reactive hyperemia is majorly influenced by a lower degree of tissue desaturation during ischemia in older individuals compared with young individuals. In a retrospective analysis including 83 tissue desaturation-matched individuals, we show that the degree of tissue desaturation is not a major determinant of aging-related impairments in reactive hyperemia.

Interaction of macro- and microvascular function underlies brachial artery flow-mediated dilation in humans

Brachial artery flow-mediated dilation (BAFMD) is induced by hyperemic wall shear rate (WSR) following forearm ischemia. In older adults, there appears to be a reduced brachial hyperemic WSR and altered stimulus-response relationship compared with young adults. However, it is unclear if an altered forearm microvascular response to ischemia influences brachial hyperemic WSR in older adults. We determined associations between brachial hyperemic WSR and forearm skeletal muscle oxygen saturation in young and older adults. Healthy young (n = 17, 29 ± 7 yr) and older (n = 32, 65 ± 4 yr) adults participated in the study. BAFMD by a multigate spectral Doppler system and forearm skeletal muscle oxygen saturation by near-infrared spectroscopy were concurrently measured. When compared with the young, older adults showed reduced oxygen extraction kinetics (OE, 0.15 [0.12-0.17] vs. 0.09 [0.05-0.12]%s-1) and magnitude (So2deficit, 3,810 ± 1,420 vs. 2,723 ± 1,240%s) during ischemia, as well as oxygen resaturation kinetics (So2slope, 2.5 ± 0.7 vs. 1.7 ± 0.7%s-1) upon reperfusion (all P < 0.05). When OE in the young and So2slope in older adults were stratified by their median values, young adults with OE above the median had greater hyperemic WSR parameters compared with those below the median (P < 0.05), but So2slope in older adults did not show clear differences in hyperemic WSR parameters between those above/below the median. This study demonstrates that, in addition to a reduced microvascular response to ischemia, there may be a dissociation between microvascular response to ischemia and brachial hyperemic WSR in older adults, which may result in a further impairment of BAFMD in this cohort.NEW & NOTEWORTHY Microvascular response to ischemia and subsequent reperfusion is diminished in older adults compared with the young. Furthermore, there appears to be a dissociation between the microvascular response to ischemia and brachial hyperemic WSR in older adults, which may further disturb the BAFMD process in this cohort. A reduced BAFMD in older adults may be a result of multiple alterations occurring both at macro- and microcirculation.

Noninvasive estimation of skeletal muscle oxygen consumption rate and microvascular reactivity in chronic stroke survivors using near-infrared spectroscopy

Understanding post-stroke changes in skeletal muscle oxidative metabolism and microvascular reactivity could help create therapeutic targets that optimize rehabilitative interventions. Due to disuse atrophy, we hypothesized that basal muscle oxygen consumption rate and microvascular endothelial function would be impaired in the tibialis anterior (TA) muscle of the affected leg of chronic stroke survivors compared with the nonaffected leg and versus matched controls. Fifteen chronic stroke survivors (10 females) and 15 matched controls (9 females) completed this study. A near-infrared spectroscopy oximeter measured tissue oxygen saturation (StO2) of the TA in both legs of stroke survivors and the dominant leg of controls. A cuff was placed around the thigh and inflated to 225 mmHg for 5 min while StO2 was continuously measured. The rate of change in StO2 was calculated during cuff occlusion and immediately post-cuff release. The rate of oxygen desaturation was similar between the legs of the stroke survivors (paretic -0.12 ± 0.04%·s-1 vs. nonparetic -0.16 ± 011%·s-1; P = 0.49), but the paretic leg had a reduced desaturation rate versus controls (-0.25 ± 0.18%·s-1; P = 0.007 vs. paretic leg). After cuff release, there was a greater oxygen resaturation rate in the nonparetic leg compared with the paretic leg (3.13 ± 2.08%·s-1 vs. 1.60 ± 1.11%·s-1, respectively; P = 0.01). The control leg had a similar resaturation rate versus the nonparetic leg (control = 3.41 ± 1.79%·s-1; P = 0.69) but was greater than the paretic leg (P = 0.003). The TA in the paretic leg had an impaired muscle oxygen consumption rate and reduced microvascular endothelial function compared with controls.NEW & NOTEWORTHY Secondary consequences of stroke are not well described. In this study, we show that basal muscle oxidative consumption and microvascular endothelial function are reduced in the paretic tibialis anterior muscle of chronic stroke survivors compared with matched controls using near-infrared spectroscopy and the vascular occlusion technique. There was a moderately strong correlation between microvascular endothelial function and paretic leg strength.

Jaboticaba berry (Myrciaria jaboticaba) supplementation protects against micro- and macrovascular dysfunction induced by eccentric exercise: a randomized clinical trial

Physical activities that are unaccustomed and involve eccentric muscle contractions have been demonstrated to temporarily impair macrovascular and microvascular functions, which may be caused by exercise-induced oxidative stress. Jaboticaba (Myrciaria jaboticaba) is a famous Brazilian berry that has been described to exhibit high antioxidant activity. However, no human study has investigated the protective effects of jaboticaba consumption against the vascular damage induced by eccentric exercise. Therefore, the present study aimed to assess whether supplementation with jaboticaba berry juice could positively affect macro- and microvascular functions within 48 hours after eccentric exercise. This randomized, double-blind, placebo-controlled, parallel trial enrolled 24 healthy participants consuming 250 mL per day of jaboticaba berry juice (containing ∼1,300 mg of total polyphenols) or placebo for 6 days. At the baseline, pre-exercise, and 24 h and 48 h postexercise stages, blood samples were taken for analysis of reduced glutathione (GSH) levels. Also, brachial artery flow-mediated dilation (FMD), blood flow, and tissue oxygen saturation (StO2) responses to 5-minute cuff occlusion were assessed using Doppler ultrasound and near-infrared spectroscopy, respectively. Our findings revealed significant decreases in blood GSH (P < 0.001, ES = 0.76), FMD (P = 0.005, ES = 0.48), reperfusion slope of StO2 (P = 0.018, ES = 0.42) at 24 h and blood flow (P = 0.012, ES = 0.42) at 48 h following eccentric exercise in the control group as compared to the jaboticaba berry juice group. Our results demonstrated that jaboticaba berry juice prevented the exercise-induced increase in reactive oxygen species production and protected macro- and microvascular functions against the damage caused by eccentric exercise, suggesting that jaboticaba berry consumption could protect the vascular function under conditions of imbalance in redox homeostasis.

Post-occlusive reactive hyperemia variables can be used to diagnose vascular dysfunction in hemorrhagic shock

INTRODUCTION

Laser doppler flowmetry (LDF) allows non-invasive assessment of microvascular functions. The combination of LDF with an occlusion functional test enables study of post-occlusive reactive hyperemia (PORH), providing additional information about vasomotor function, capillary blood flow reserve, and the overall reactivity of the microvascular system.

AIM

To identify early alterations of PORH variables in the skin of a rat in hemorrhagic shock (HS).

MATERIAL AND METHODS

Male Wistar rats (n = 14) weighing 400-450 g were anesthetized with a combination of tiletamine/zolazepam (20 mg/kg) and xylazine (5 mg/kg). The animals breathed on their own, and were placed on a heated platform in the supine position. A PE-50 catheter was inserted into the carotid artery to measure the mean arterial pressure (MAP). The optical probe of the Laser Doppler device was installed on the plantar surface of the hind limb of a rat; a pneumatic cuff was applied proximal to the same limb. The occlusion time was 3 min. The following physiological variables were measured at baseline and 30 min after blood loss: MAP, mmHg; mean cutaneous blood flow (M, PU); cutaneous vascular conductance (CVC = M/MAP); peak hyperemia (Mmax, PU) and maximum cutaneous vascular conductance (CVCmax) during PORH. In the HS group (n = 7), 30 % of the estimated blood volume was taken within 5 min. There was no blood loss in the group of sham-operated animals (Sham, n = 7). The results are presented as Me [25 %;75 %]. The U-Mann-Whitney criterion was used to evaluate intergroup differences. Differences were considered statistically significant at p < 0.05.

RESULTS

The groups did not differ at baseline. Blood loss led to a significant decrease in MAP (43 [31;46] vs. 94 [84;104] mmHg), M (11.5 [16.9;7.8] vs 16.7 [20.2;13.9]) and Mmax (18.1 [16.4;21.8] vs. 25.0 [23.0;26.2]) in the HS group compared to the Sham group, respectively. At the same time, both CVC (0.25 [0.23;0.30] vs. 0.16 [0.14;0.21]) and CVCmax (0.55 [0.38;0.49] vs 0.24 [0.23; 0.29]) increased after blood loss in the HS group compared to the Sham group. Arterial blood gas analysis revealed metabolic lactic acidosis in the HS group.

CONCLUSION

In this rat model of HS, alterations in cutaneous blood flow are manifested by a decrease in perfusion (M) and the intensity of PORH (Mmax) with a simultaneous increase in vascular conductance (CVC and CVCmax).

The utility of the reperfusion rate of tissue oxygen saturation as a measure of vascular endothelial function in adolescents: reliability, validity and sensitivity

Introduction: The near-infrared spectroscopy (NIRS)-derived reperfusion rate of tissue oxygen saturation (slope 2 StO2) may provide a surrogate measure of vascular function, however, this has yet to be examined in a paediatric population. This study investigated in adolescents: 1) the between-day reliability of NIRS-derived measurements; 2) the relationship between slope 2 StO2 and macro- (flow-mediated dilation, FMD) and microvascular (peak reactive hyperaemia, PRH) function; and 3) the effect of high-intensity interval exercise (HIIE) on slope 2 StO2, FMD, and PRH. Methods: Nineteen boys (13.3 ± 0.5 y) visited the laboratory on two occasions, separated by ∼ 1 week. On visit 1, participants underwent simultaneous assessment of brachial artery FMD and slope 2 StO2 and PRH on the internal face of the forearm. On visit 2, participants completed a bout of HIIE with slope 2 StO2, FMD and PRH measured pre-, immediately post- and 1.5 h post-exercise. Results: Slope 2 StO2 showed no mean bias (p = 0.18) and an intraclass correlation coefficient of 0.67 (p = 0.003) between visits. No significant correlation between slope 2 StO2 and FMD or PRH was observed on visit 1 (r = -0.04, p = 0.89 and r = -0.30, p = 0.23, respectively) or visit 2 pre-exercise (r = -0.28, p = 0.25 and r = -0.31, p = 0.20, respectively). Compared to pre-exercise, FMD decreased immediately post-exercise (p < 0.001) and then increased 1.5 h post-exercise (p < 0.001). No significant change was detected for slope 2 StO2 (p = 0.30) or PRH (p = 0.55) following HIIE. Conclusion: In adolescents, slope 2 StO2 can be measured reliably, however, it is not correlated with FMD or PRH and does not follow the acute time course of changes in FMD post-exercise. Hence, the use of slope 2 StO2 as a surrogate measure of vascular function in youth must be refuted.

Partial-body cryostimulation does not impact peripheral microvascular responsiveness but reduces muscular metabolic O2 consumption (mV˙O2) at rest

This study aimed to investigate the effect of partial-body cryostimulation (PBC) on microvascular responsiveness and muscular metabolic O2 consumption rate (mV˙O2). Twenty healthy young adults (ten males and ten females) underwent a post-occlusive reactive hyperemia (PORH) test at the flexor digitorum superficialis area before and after a 3-min PBC session and a 3-min control session. Using near-infrared spectroscopy, occlusion and reperfusion slopes were calculated: oxyhemoglobin ([HbO2]) decrease rate ([HbO2] slope 1), deoxyhaemoglobin ([HHb]) increase rate ([HHb] slope 1), [HbO2] increase rate ([HbO2] slope 2), and [HHb] increase rate ([HHb] slope 2. Using HbO2 kinetics during the occlusion, mV˙O2 was also calculated to characterize myocytes' metabolic O2 consumption. HbO2 slope 1 value was lower after PBC than before PBC (-0.15 ± 0.08 vs -0.24 ± 0.11 s-1; respectively; P < 0.05) in male participants only. A lower [HHb] slope 1 was also observed after PBC compared to before PBC (0.18 ± 0.10 vs 0.24 ± 0.16 s-1; P < 0.05) with no interaction for sex categories. mV˙O2 was significantly lower after PBC than before (pre values 14.75 ± 3.94 vs 18.47 ± 5.73 μMO2Hb.s-1; respectively; P < 0.01) with no interaction between sex categories. No changes in the calculated slope 2 were observed. These findings suggest that a single session of PBC reduces the muscular metabolic O2 needs at rest; however, it does not alter the vascular ability to provide O2 to the myocytes.

Evaluation of inter-rater and test-retest reliability for near-infrared spectroscopy reactive hyperemia measures

BACKGROUND

Near-infrared spectroscopy (NIRS) is a non-invasive tool used to measure blood flow in peripheral tissues. More information on inter-rater agreement and test-retest reliability of NIRS-based reperfusion assessments is needed.

PURPOSE

To assess inter-rater agreement for NIRS based data analysis, and evaluate the measurement's reliability across days.

METHODS

On three separate days (average days between visits 1 and 3: 19.4 ± 6.9 days), participants' (N = 15 males, 22 ± 2 yr.) post-occlusion reactive hyperemia (PORH) was measured in the left gastrocnemius muscle using Continuous-Wave NIRS (CW-NIRS). A blood pressure cuff was placed proximal to the knee and inflated to occlude lower leg blood flow for 5 min. The following CW-NIRS parameters were selected: (1) percent saturation in HbO₂ (StO₂%) at baseline; (2) the O₂Hb range used to normalize the NIRS signal; (3) the time for the O₂Hb signal to reach 50 % peak post-occlusion hyperemia (T_1/2), and (4) the post peak hyperemic O₂Hb recovery slope (O₂REC-SLP). Absolute agreement between the two analysts was calculated using two-way random effects Intraclass Correlation Coefficients (ICC_2,1). Consistency between analysts and across days was calculated using two-way mixed models (ICC_3,1). Mean and 95 % confidence intervals (CI) of ICCs are reported. Coefficient of variation (CV) and standard error of the measurement (SEM) are reported.

RESULTS

The ICC_2,1 data indicated "adequate" to "excellent" absolute agreement between the two NIRS analysts. ICC_2,3 data indicated "adequate" to "good" reliability across visits. The CV and SEM for rater 1 and rater 2 across visit were StO₂ (CV: 3.79 % ± 2.71 % and 4.50 % ± 2.37 %; SEM: 3.42 and 3.82), O₂Hb range (CV: 10.50 ± 5.93 and 12.79 ± 12.41; SEM: 3.26 and 4.71), T_1/2 (CV: 11.15 % ± 5.52 % and 10.96 % ± 4.50; SEM: 1.22 and 1.11), and O₂REC-SLP (CV: 19.49 % ± 9.99 % and 18.45 % ± 9.48 %; SEM: 0.04 and 0.04).

CONCLUSION

It is concluded that NIRS parameters assessed show adequate reliability between analysts and across three visits. It is recommended, when feasible and because of the absence of 100 % reliability, that investigators employ more than one rater for scoring at least a portion of the data across each trial in a study's control condition in order to have the ability to estimate the magnitude of error attributable to imperfect reliability.

Association between Femoral Artery Flow-Mediated Dilation and Muscle Oxygen Saturation Parameters in Healthy, Young Individuals

Flow-mediated dilation (FMD) and muscle oxygen saturation (StO₂) are measurements utilized to assess macro- and microvascular function, respectively. Macro- and microvascular dysfunction may occur differently depending on the clinical condition. Since microvascular responsiveness can influence upstream conduit artery hemodynamics, the present study aimed to investigate whether a correlation between FMD and muscle StO₂ parameters exists. Sixteen healthy, young individuals were enrolled in this study. Femoral artery FMD and tibial anterior muscle StO₂ were evaluated by ultrasound and near-infrared spectroscopy, respectively. The FMD and muscle StO₂ parameters were assessed by employing a vascular occlusion test (VOT). The oxygen resaturation rate was determined by calculating the upslope of StO₂ immediately after occlusion and the magnitude of reperfusion as the difference between the highest and lowest StO₂ value achieved during the reperfusion phase. The oxygen desaturation rate and the magnitude of desaturation during the VOT were also evaluated. A significant correlation between the FMD and oxygen resaturation rate (r = 0.628; p = 0.009), magnitude of reperfusion (r = 0.568; p = 0.022), oxygen desaturation rate (r = -0.509; p = 0.044), and magnitude of desaturation (r = 0.644; p = 0.007) was observed. This study demonstrated a moderate association between the femoral artery FMD and tibial anterior StO₂ parameters in young individuals.

Elevated Fibroblast Growth Factor 23 Impairs Endothelial Function through the NF-κB Signaling Pathway

AIM

Roles of fibroblast growth factor 23 (FGF23) in endothelial dysfunction remain controversial, and evidence from population-based studies is lacking. The present study aimed to explore the effects of FGF23 on endothelial dysfunction on the basis of both clinical data of patients with coronary artery disease (CAD) and the in vitro research in human umbilical vein endothelial cells (HUVECs).

METHODS

A total of 321 CAD patients were enrolled after coronary angiography, brachial artery flow-mediated dilation (FMD) was assessed using ultrasound equipment. Serum FGF23, nitric oxide (NO), and endothelin-1 (ET-1) were detected via enzyme-linked immunosorbent assay. Apoptosis was determined using the annexin V-fluorescein isothiocyanate/propidium lodide apoptosis detection kit. Cell migration was evaluated by wound healing and transwell migration assays. Reactive oxide species levels were determined using fluorescent probes, and NF-κB p65 nuclear translocation was assessed via immunofluorescence.

RESULTS

Serum FGF23 was significantly increased in CAD patients combined with severe endothelial dysfunction (FMD ＜2%) compared to those with FMD ≥ 2% (P＜0.001). Furthermore, the levels of FGF23 were negatively correlated with NO, whereas positively correlated with ET-1 both in unadjusted analysis and multivariate-adjusted analysis. In HUVECs, FGF23 interfered with the bioavailability of NO via increased oxidative stress. Moreover, FGF23 directly impaired the endothelium by promoting HUVECs apoptosis and attenuating the migration of HUVECs. Additional experiments showed that FGF23 induced endothelial injury through activation of the NF-κB signaling pathway.

CONCLUSIONS

Elevated FGF23 is clinically associated with endothelial dysfunction in CAD patients, and FGF23 impairs endothelial function through activation of the NF-κB signaling pathway.

Does sex influence near-infrared spectroscopy-derived indicators of microvascular reactivity and the response to acute dietary capsaicin

Endothelial dysfunction is associated with cardiovascular disease development, nitric oxide (NO) deficiencies, and may be limb or sex-specific. Prior in vitro work indicated that the transient receptor potential vanilloid channel-1 (TRPV₁) is expressed in human arteries and the TRPV₁ agonist capsaicin alters vasodilation in an endothelium-dependent manner; however, it is unknown if this translates in vivo or is limb or sex-dependent. Therefore, we sought to determine if there was limb or sex-specificity in the effect of capsaicin on microvascular function using near-infrared spectroscopy (NIRS)-derived tissue oxygen saturation (StO₂) reperfusion slope. In a blinded placebo-controlled crossover design, 45 young males (M: n = 25) and females (F: n = 20), the reperfusion slopes of the forearm and quadriceps were assessed, and a urine sample obtained to assay for nitrate/nitrite (NOx) concentrations and antioxidant capacity after acutely ingesting placebo or capsaicin. Under placebo, females had greater reperfusion rates in both the forearm (M: 0.44 ± 0.24 vs. F: 0.98 ± 0.46 %/sec; p = 0.002, d = -1.50) and quadricep (M: 0.86 ± 0.31 vs. F: 1.17 ± 0.43 %/sec; p = 0.010, d = -0.85). Capsaicin decreased microvascular responsiveness in the forearm of females (placebo: 0.98 ± 0.45 vs. capsaicin: 0.84 ± 0.45 %/sec) as compared to males (placebo: 0.45 ± 0.24 vs. capsaicin: 0.38 ± 0.16 %/sec, interaction p < 0.001, η² = 0.475). There was a sex*treatment interaction for NOx concentrations, where males increased (placebo: 21.13 ± 12.83 vs. capsaicin: 23.82 ± 13.34 μM), while females decreased (placebo: 22.78 ± 14.40 vs. capsaicin: 14.43 ± 10.01 μM; p = 0.037, η² = 0.042). Using NIRS to assess microvascular function, there is apparent limb and sex-specificity, and, for the first-time, document that acute oral capsaicin alters reperfusion slope in a sexually divergent manner.

Intra- and Inter-Day Reliability of the NIRS Portamon Device after Three Induced Muscle Ischemias

(1) Background: Near-infrared spectroscopy (NIRS) is an innovative and non-invasive technology used to investigate muscular oxygenation. The aim of this study is to assess the within- and between-session reliability of the NIRS Portamon (Artinis, Elst, Netherlands) device following three sets of induced muscle ischemia. (2) Methods: Depending on the experimental group (G1, G2 or G3), a cuff was inflated three times on the left upper arm to 50 mmHg (G1), systolic blood pressure (SBP) + 50 mmHg (G2) or 250 mmHg (G3). Maximum, minimum and reoxygenation rate values were assessed after each occlusion phase, using a Portamon device placed on the left brachioradialis. Reliability was assessed with intraclass correlation coefficient (ICC) value and ICC 95% confidence interval (CI-95%), coefficient of variation (CV) and standard error of measurement (SEM) (3) Results: Our results showed a good to excellent reliability for maximums and minimums within-session. However, the reoxygenation rate within sessions as well as measurements between sessions cannot predominantly show good reliability. (4) Conclusions: Multiple measurements of maximums and minimums within a single session appeared to be reliable which shows that only one measurement is necessary to assess these parameters. However, it is necessary to be cautious with a comparison of maximum, minimum and reoxygenation rate values between sessions.

A single dose of dietary nitrate supplementation protects against endothelial ischemia-reperfusion injury in early postmenopausal women

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.

Fitness Level- and Sex-related Differences in Macro- and Microvascular Responses during Reactive Hyperemia

PURPOSE

Reactive hyperemia (RH) is widely used for the investigation of macrovascular (Flow-Mediated Dilation, FMD) and microvascular (Near Infrared Spectroscopy-Vascular Occlusion Test, NIRS-VOT) function. Mixed results have been reported on fitness level- and sex-related differences in FMD outcomes, and little is known about microvascular differences in untrained and chronically trained males and females.

METHODS

Fifteen chronically trained (CT: 8 MALES, 7 FEMALES) and sixteen untrained (UT: 8 MALES, 8 FEMALES) individuals participated in this study. Aerobic fitness (V[Combining Dot Above]O2max) was assessed during a cycling incremental exercise test to volitional exhaustion. FMD and NIRS-VOT were performed simultaneously on the lower limb investigating superficial femoral artery and vastus lateralis muscle, respectively.

RESULTS

%FMD was not different between groups (CT MALES, 4.62 ± 1.42; CT FEMALES, 4.15 ± 2.23; UT MALES, 5.10 ± 2.53; CT FEMALES, 3.20 ± 1.67). Peak blood flow showed greater values in CT vs UT (p ≤ 0.0001) and MALES vs FEMALES (p = 0.032). RH blood flow AUC was greater in CT vs UT (p = 0.001). At the microvascular level, desaturation and reperfusion rates were faster in CT vs UT (p = 0.018 and p = 0.013) and MALES vs FEMALES (p = 0.011 and p = 0.005). V[Combining Dot Above]O2max was significantly correlated with reperfusion rate (p = 0.0005) but not with %FMD.

CONCLUSION

Whereas NIRS-VOT outcomes identified fitness- and sex-related differences in vascular responses, %FMD did not. However, when reactive hyperemia-related outcomes from the FMD analysis were considered, fitness- and/or sex-related differences were detected. These data highlight the importance of integrating FMD and NIRS-VOT outcomes for a more comprehensive evaluation of vascular function.

The Association Between Contrast-Enhanced Ultrasound and Near-Infrared Spectroscopy-Derived Measures of Calf Muscle Microvascular Responsiveness in Older Adults

BACKGROUND AND AIM

Contrast-enhanced ultrasound (CEUS) measures of post-occlusion skeletal muscle microvascular responsiveness demonstrate the microvascular dysfunction associated with ageing and age-related disease. However, the accessibility of CEUS is limited by the need for intravenous administration of ultrasound contrast agents and sophisticated imaging analysis. Alternative methods are required for the broader assessment of microvascular dysfunction in research and clinical settings. Therefore, we aimed to evaluate the level of association and agreement between CEUS and near-infrared spectroscopy (NIRS)-derived measures of post-occlusion skeletal muscle microvascular responsiveness in older adults.

METHODS

During supine rest, participants (n=15, 67±11 years) underwent 5 minutes of thigh cuff-occlusion (200 mmHg). Post-occlusion CEUS measures of calf muscle microvascular responsiveness were made, including time to 95% peak acoustic intensity (TTP⁹⁵ AI) and the rate of rise (slope AI). Simultaneous measures, including time to 95% peak oxygenated haemoglobin (TTP⁹⁵ O₂Hb) and slope O₂Hb, were made using continuous-wave NIRS in the same muscle region.

RESULTS

There were strong correlations between TTP⁹⁵ measures derived from CEUS and NIRS (r=0.834, p=<0.001) and the corresponding measures of slope (r=0.735, p=0.004). The limits of agreement demonstrated by Bland Altman plot analyses for CEUS and NIRS-derived measures of TTP⁹⁵ (-9.67-1.98 s) and slope (-1.29-5.23%. s^-1) were smaller than the minimum differences expected in people with microvascular dysfunction.

CONCLUSIONS

The strong correlations and level of agreement in the present study support the use of NIRS as a non-invasive, portable and cost-effective method for assessing post-occlusion skeletal muscle microvascular responsiveness in older adults.

Suitability of the muscle O2 resaturation parameters most used for assessing reactive hyperemia: a near-infrared spectroscopy study

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: StO_{2slope_10s}, StO_{2slope_30s}, and StO_{2slope_until_baseline} (upslope of StO₂ over 10s and 30s and until StO₂ reaches the baseline value); time to StO_2baseline and time to StO_2max (time taken for StO₂ to reach baseline and peak values, respectively); ∆StO_2reperfusion (the difference between minimum and maximum StO₂ values); total area under the curve (StO_2AUCt); and AUC above the baseline value (StO_{2AUC_above_base}).

Results

Only StO_{2slope_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 StO_2max was significantly longer in healthy young individuals than in older adult at CVD risk.

Conclusions

Our findings suggest that StO_{2slope_10s} may be a measure of reactive hyperemia, which provides clinical insight into microvascular function assessment.

Changes in the microvascular reactivity during spinal anesthesia

PURPOSE

Anesthesia alters microcirculation and tissue oxygen saturation (StO₂). We sought to examine changes in StO₂ using near-infrared spectroscopy and a vascular occlusion test (VOT) during spinal anesthesia.

METHODS

This prospective observational study was included 51 patients without comorbidities who underwent elective surgery under spinal anesthesia. We measured the StO₂ in the lower extremity during VOT before and after intrathecal injection.

RESULTS

The baseline, minimum, and maximum StO₂ values during VOT significantly increased after intrathecal injection (baseline StO₂ from 68.6 ± 7.3% to 77.1 ± 10.1%, minimum StO₂ from 39.7 ± 14.9% to 48.8 ± 17.6%, and maximum StO₂ from 74.2 ± 7.5% to 80.2 ± 10.0%, all P < 0.0001). The occlusion slope and ischemic stimulus did not significantly change after intrathecal injection. The reperfusion slope was 1.38 ± 0.69%/sec before intrathecal injection and significantly decreased to 1.15 ± 0.61%/sec after intrathecal injection (P = 0.0001).

CONCLUSIONS

Our results showed that despite an increased perfusion, reperfusion rate was significantly decreased by spinal anesthesia. Further studies are required to confirm how these contradictory results (improving oxygenation while reducing microvascular reactivity) actually affect the clinical impact of spinal anesthesia on microvascular function.

Young healthy adults with a family history of hypertension have increased microvascular reactivity but decreased macrovascular function

OBJECTIVE

To determine whether, like hypertensives, normotensive adults with a family history of hypertension (+FHH) display lower microvascular reactivity and conduit artery function than normotensive adults without a family history of hypertension (-FHH).

METHODS

A forearm vascular occlusion test was performed on healthy normotensive adults while resting in the supine position. A near-infrared spectroscopy sensor placed on the forearm measured skeletal muscle oxygen saturation kinetics to determine microvascular reactivity. Simultaneously, an ultrasound probe placed on the brachial artery above the occlusion cuff was used to assess flow-mediated dilation; a test of macrovascular function.

RESULTS

Twenty-two participants were included in this investigation (-FHH n = 13, +FHH n = 9). Following cuff release, the resaturation slope (1st 10 s median ± SD, -FHH 2.76 ± 2.10, +FHH 5.59 ± 2.47%/s; p = .036) was greater in +FHH when accounting for the magnitude and rate of the decrease in skeletal muscle oxygen saturation during occlusion. Conversely, flow-mediated dilation (median ± SD, -FHH 5.96 ± 5.22, +FHH 4.10 ± 3.17%∆; p = .031) was lower in +FHH when accounting for baseline artery diameter and shear rate.

CONCLUSIONS

Young +FHH adults have altered microvascular and macrovascular reactivity compared with young -FHH adults.

Effects of menstrual cycle and menopause on internal carotid artery shear-mediated dilation in women

This study aimed to elucidate the effects of change in estrogen during the menstrual cycle and menopause on shear-mediated dilation of the internal carotid artery (ICA), a potential index of cerebrovascular endothelial function. Shear-mediated dilation of the ICA and serum estradiol were measured in 11 premenopausal (Pre-M, 21 ± 1 yr), 13 perimenopausal (Peri-M, 49 ± 2 yr), and 10 postmenopausal (Post-M, 65 ± 7 yr) women. Measurements were made twice within the Pre-M group at their early follicular (EF, lower estradiol) and late follicular (LF, higher estradiol) phases. Shear-mediated dilation was induced by 3 min of hypercapnia (target P_ETCO₂ + 10 mmHg from individual baseline) and was calculated as the percent rise in peak diameter relative to baseline diameter. ICA diameter and blood velocity were simultaneously measured by Doppler ultrasound. In Pre-M, shear-mediated dilation was higher during the LF phase than during the EF phase (P < 0.01). Comparing all groups, shear-mediated dilation was reduced across the menopausal transition (P < 0.01), and Pre-M during the LF phase showed the highest value (8.9 ± 1.4%) compared with other groups (Pre-M in EF, 6.4 ± 1.1%; Peri-M, 5.5 ± 1.3%; Post-M, 5.2 ± 1.9%, P < 0.05 for all). Shear-mediated dilation was positively correlated with serum estradiol even after adjustment of age (P < 0.01, r = 0.55, age-adjusted; P = 0.02, r = 0.35). Collectively, these data indicate that controlling the menstrual cycle phase is necessary for the cross-sectional assessments of shear-mediated dilation of the ICA in premenopausal women. Moreover, current findings suggest that a decline in cerebrovascular endothelial function may be partly related to the reduced circulating estrogen levels in peri- and postmenopausal women.NEW & NOTEWORTHY The present study evaluated the effects of the menstrual cycle and menopause stages on the shear-mediated dilation of the ICA, a potential index of cerebrovascular endothelial function, in pre-, peri-, and postmenopausal women. Shear-mediated dilation of the ICA was increased from the low- to high-estradiol phases in naturally cycling premenopausal women and was reduced with advancing menopause stages. Furthermore, lower estradiol was associated with reduced shear-mediated dilation of the ICA, independent of age.

Mild obesity does not affect the forearm muscle microvascular responses to hyperglycemia

INTRODUCTION

Mild obesity has been associated with postprandial brachial artery vascular dysfunction. However, direct assessment of these effects within the forearm skeletal muscle microcirculation remains unclear. Thus, this study aimed to investigate the effects of mild obesity on the arm micro- and macrovascular responses to glucose ingestion.

METHODS

This cross-sectional study combined NIRS assessments of forearm skeletal muscle (FDS) reactivity (reperfusion slope) with %FMD of conduit artery function (brachial artery) before (Pre), as well as 60 and 120 min after glucose ingestion in 10 lean (BMI 23.9 ± 1.8) and 10 obese (BMI 32.9 ± 1.9) individuals.

RESULTS

Both groups showed a significant increase in the reperfusion slope at 60 and 120 min after glucose ingestion compared with the pre-glucose ingestion measurements. Obese individuals showed a significant (p < .05) reduction in %FMD at 60 min after glucose ingestion, while no significant changes in postprandial %FMD were observed in lean participants.

CONCLUSION

Even though obese individuals showed impaired postprandial brachial artery function, the current findings suggest that mild obesity does not affect the forearm skeletal muscle responses to glucose ingestion.

Evaluation of Different Near-Infrared Spectroscopy Devices for Assessing Tissue Oxygenation with a Vascular Occlusion Test in Healthy Volunteers

Near-infrared spectroscopy devices can measure peripheral tissue oxygen saturation (StO2). This study aims to compare StO2 using INVOS® and different O3™ settings (O325:75 and O330:70). Twenty adults were recruited. INVOS® and O3™ probes were placed simultaneously on 1 side of forearm. After baseline measurement, the vascular occlusion test was initiated. The baseline value, rate of deoxygenation and reoxygenation, minimum and peak StO2, and time from cuff release to peak value were measured. The parameters were compared using ANOVA and Kruskal-Wallis tests. Bonferroni's correction and Mann-Whitney pairwise comparison were used for post hoc analysis. The agreement between StO2 of devices was evaluated using Bland-Altman plots. INVOS® baseline value was higher (79.7 ± 6.4%) than that of O325:75 and O330:70 (62.4 ± 6.0% and 63.7 ± 5.5%, respectively, p < 0.001). The deoxygenation rate was higher with INVOS® (10.6 ± 2.1%/min) than with O325:75 and O330:70 (8.4 ± 2.2%/min, p = 0.006 and 7.5 ± 2.1%/min, p < 0.001). The minimum and peak StO2 were higher with INVOS®. No significant difference in the reoxygenation rate was found between the devices and settings. The time to reach peak after cuff deflation was faster with INVOS® (both p < 0.001). Other parameters were similar. There were no differences between the different O3™ settings. There were differences in StO2 measurements between the devices, and these devices should not be interchanged. Differences were not observed between O3™ device settings.

Rolling massage acutely improves skeletal muscle oxygenation and parameters associated with microvascular reactivity: The first evidence-based study

Although it has been claimed that rolling massage (RM), may lead to improvements in skeletal muscle oxygenation, metabolism, blood flow, and vascular function, scientific evidence has not yet been provided. Thus, the current study investigated the effects of 30 s and 2 min of RM on forearm muscle oxygenation, parameters associated with oxidative metabolism, and microvascular reactivity as well as brachial artery endothelial function. Forearm skeletal muscle parameters were assessed in 12 healthy young men (26 ± 6 yrs) using near-infrared spectroscopy (NIRS) combined with a 5-min vascular occlusion test. Additionally, brachial artery endothelial function was simultaneously assessed by measuring the relative change in brachial artery diameter normalized to the hyperemic blood flow (Normalized %FMD). These measurements were performed before and after the RM interventions performed on the anterior forearm muscles. Forearm muscle oxygenation increased after 30 s of RM (62 ± 7 to 71 ± 11%; p = 0.02) while there was no change from baseline to post-intervention after 2 min of RM. No change was observed for oxidative metabolism, however, the significant main effect (p = 0.02) for NIRS-derived reperfusion slope (%·s^-1) indicated that microvascular function improved after both 30 s (2.30 ± 0.5 to 2.61 ± 0.70%·s^-1) and 2 min of RM (2.33 ± 0.4 to 2.60 ± 0.85%·s^-1). The lack of significant effects of RM on Normalized %FMD suggest that the RM did not acutely improve brachial artery endothelial function. These findings provide, for the first time, evidence that RM improves skeletal muscle oxygenation and parameters associated with microvascular reactivity. Additionally, RM increased brachial artery blood flow, but not upstream brachial artery endothelial function.

Near-infrared spectroscopy-derived total haemoglobin as an indicator of changes in muscle blood flow during exercise-induced hyperaemia

Blood flow changes in response to exercise have been attributed, among other factors, to the effect of vasodilators factors on the microvasculature, suggesting a close relationship between small blood vessels and conducting arteries. The main purpose of this study was to determine the relationship between the changes in near infrared spectroscopy (NIRS)-derived total haemoglobin ([tHb]) and muscle oxygen saturation (SmO₂) signals and femoral artery blood flow in response to resistance exercise at fast- and slow-velocity muscle contraction. The study randomised crossover design included twelve participants. NIRS and blood flow measurements were continuously monitored before, during, and 5 min after the exercise protocol. There was a significant correlation between [tHb] reperfusion slope ([tHb]_slope) and peak blood flow (BF_peak) after slow- and fast-velocity muscle contraction (r = 0.83, p = 0.0008 and r = 0.72, p = 0.0080, respectively). No significant correlation existed between the SmO₂ reperfusion slope (SmO_{2_slope}) and BF_peak after both slow- and fast-velocity muscle contraction exercise (r = -0.46, p = 0.1253 and r = 0.33, p = 0.2841, respectively). This study demonstrated a strong relationship between the NIRS-derived [tHb] and Doppler ultrasound BF during the recovery period of dynamic resistance exercise at both slow- and fast-velocity contraction.

Microvascular responses during reactive hyperemia assessed by near-infrared spectroscopy and arterial stiffness in young, middle-aged, and older women

We investigated the effects of age on microvascular responses during reactive hyperemia and arterial stiffness in 13 young (22 ± 1 years), 12 middle-aged (42 ± 5 years), and 15 older (63 ± 2 years) women. During the vascular occlusion test (VOT), forearm tissue oxygen saturation (StO₂) was measured using near-infrared spectroscopy (NIRS). During reperfusion, the area under the curve (AUC) during hyperemia in young women (1123 ± 208% s) was significantly greater than that in middle-aged (771 ± 445% s, P = 0.024) and older women (619 ± 356% s, P = 0.001) with no differences between middle-aged and older women (P = 0.265). Cardio-ankle vascular index (CAVI) as an indicator of arterial stiffness was assessed using four-limb oscillometry. CAVI significantly increased with age (8.1 ± 0.7 in the older group, 6.0 ± 0.8 in the middle-aged group, and 5.8 ± 0.4 in the young group), with significant differences between older women and women in the other groups (P < 0.001); however, no differences in CAVI between young and middle-aged women (P = 0.484) were found. When the data of all groups were pooled, the AUC or upslope was associated with CAVI or body mass index or mean arterial pressure (all P < 0.05). To conclude, the AUC derived by NIRS measures of StO₂ during the reperfusion phase can be used as one of the evaluations of microvascular function, followed by the development of atherosclerosis in middle-aged and older women.

Is flow-mediated dilatation associated with near-infrared spectroscopy-derived magnitude of muscle O2 desaturation in healthy young and individuals at risk for cardiovascular disease?

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.

The effects of the analysis strategy on the correlation between the NIRS reperfusion measures and the FMD response

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.

The association between near-infrared spectroscopy assessment of microvascular reactivity and flow-mediated dilation is disrupted in individuals at high risk for cardiovascular disease

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.

Reduced insulin sensitivity in young, normoglycaemic subjects alters microvascular tissue oxygenation during postocclusive reactive hyperaemia

NEW FINDINGS

What is the central question of the study? Are measures of reduced insulin sensitivity in young, normoglycaemic subjects correlated with near-infrared spectroscopy-derived microvascular responsiveness [tissue oxygen saturation reperfusion rate (STO₂ upslope)] during postocclusive reactive hyperaemia? What is the main finding and its importance? A sevenfold range of hepatic insulin sensitivity is significantly correlated (r = 0.44, P = 0.02) with STO₂ upslope after transient tissue ischaemia. Near-infrared spectroscopy may be an important tool for determining altered microvascular function before onset of hyperglycaemia. Identification of pre-type 2 diabetes much earlier than with the present clinical criteria is important for pre-emptive measures against microvascular deterioration.

ABSTRACT

Near-infrared spectroscopy (NIRS) measurement of postocclusive reactive hyperaemia (PORH) tissue oxygen saturation reperfusion rate [STO₂ upslope (as a percentage per minute)] has recently been correlated with the percentage of flow-mediated dilatation (%FMD). Cardiovascular disease is associated with impairments in %FMD. Reduced insulin sensitivity may negatively affect the vascular system for many years before prediabetes/type 2 diabetes states. The aim of this study was to determine whether static and dynamic STO₂ parameters during PORH are correlated with reduced insulin sensitivity in young, normoglycaemic subjects. Glucose and insulin were measured during an oral glucose tolerance test in 18- to 26-year-old, healthy subjects (11 men and 11 women), and STO₂ was measured during PORH of antebrachial muscle. Hepatic (ISI_HOMA ) and whole-body (ISI_COMP ) insulin sensitivities were calculated. The STO₂ upslope was negatively correlated with minimal STO₂ (r = -0.5, P = 0.01). The change of STO₂ from minimum to baseline (ΔSTO₂ ) was significantly negatively correlated with fasting insulin (r = -0.5, P = 0.01) and a positively correlated with ISI_HOMA (r = 0.65, P = 0.001). The minimum STO₂ was significantly negatively correlated with ISI_HOMA , and STO₂ upslope was significantly positively correlated with ISI_HOMA (r = 0.44, P = 0.02). The minimum STO₂ (a measure of O₂ extraction while the cuff was inflated), ΔSTO₂ (a measure of the amount of reperfusion) and STO₂ upslope (a measure of responsiveness of the microcirculation to ischaemia) were all positively correlated with ISI_HOMA , one of the longest-used measures of insulin sensitivity. The NIRS-derived STO₂ might be a useful tool for assessing how levels of reduced insulin sensitivity in young, normoglycaemic adults affect the microvasculature.