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Gouzi F, Philippe A, Pastre J, Renaud B, Gendron N, Subileau M, Hua-Huy T, Planquette B, Sanchez O, Smadja DM, Günther S. Recovery of Endothelium-dependent vascular relaxation impairment in convalescent COVID-19 patients: Insight from a pilot study. Respir Med Res 2023; 84:101044. [PMID: 37625374 DOI: 10.1016/j.resmer.2023.101044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/16/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Endothelial dysfunction is a key-feature in acute COVID-19. However, follow-up data regarding endothelial dysfunction and injury after COVID-19 infection are lacking. We aimed to investigate the changes in endothelium-dependent vasorelaxation at baseline and four months after hospital discharge in COVID-19 patients. METHODS Twenty COVID-19 patients were compared to 24 healthy controls. Clinical and morphological data were collected after hospital admission for SARS-CoV-2 infection and reactive hyperaemia index (RHI) measurement was performed with a delay between 24 and 48 h after hospital admission and four months after hospital discharge in the outpatient clinics. Blood tests including inflammatory markers and measurement of post-occlusive vasorelaxation by digital peripheral arterial tonometry were performed at both visits. RESULTS At baseline, COVID-19 patients exhibited reduced RHI compared to controls (p < 0.001), in line with an endothelial dysfunction. At four months follow-up, there was a 51% increase in the RHI (1.69 ± 0.32 to 2.51 ± 0.91; p < 0.01) in favor of endothelium-dependent vascular relaxation recovery. RHI changes were positively correlated with baseline C-reactive protein (r = 0.68; p = 0.02). Compared to COVID-19 patients with a decrease in RHI, COVID-19 patients with an increase in RHI beyond the day-to-day variability (i.e. >11%) had less severe systemic inflammation at baseline. CONCLUSION Convalescent COVID-19 patients showed a recovery of systemic artery endothelial dysfunction, in particular patients with lower inflammation at baseline. Further studies are needed to decipher the interplay between inflammation and endothelial dysfunction in COVID-19 patients.
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Affiliation(s)
- Fares Gouzi
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France; Université Paris Cité, Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris Cité, F-75006 Paris, France
| | - Aurélien Philippe
- Université Paris Cité, Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris Cité, F-75006 Paris, France; Hematology Department, AP-HP, Georges Pompidou European Hospital, F-75015 Paris, France
| | - Jean Pastre
- Department of Respiratory Medicine, AP-HP, Georges Pompidou European Hospital, F-75015 Paris, France
| | - Bertrand Renaud
- Unité d'Explorations Fonctionnelles Respiratoires et du Sommeil, AP-HP, Georges Pompidou European Hospital, F-75015 Paris, France; Université Paris Cité, UFR de médecine, F-75006 Paris, France
| | - Nicolas Gendron
- Université Paris Cité, Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris Cité, F-75006 Paris, France; Hematology Department, AP-HP, Georges Pompidou European Hospital, F-75015 Paris, France
| | - Marielle Subileau
- Unité d'Explorations Fonctionnelles Respiratoires et du Sommeil, AP-HP, Georges Pompidou European Hospital, F-75015 Paris, France
| | - Thông Hua-Huy
- Unité d'Explorations Fonctionnelles Respiratoires et du Sommeil, AP-HP, Georges Pompidou European Hospital, F-75015 Paris, France
| | - Benjamin Planquette
- Université Paris Cité, Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris Cité, F-75006 Paris, France; Unité d'Explorations Fonctionnelles Respiratoires et du Sommeil, AP-HP, Georges Pompidou European Hospital, F-75015 Paris, France
| | - Olivier Sanchez
- Université Paris Cité, Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris Cité, F-75006 Paris, France; Unité d'Explorations Fonctionnelles Respiratoires et du Sommeil, AP-HP, Georges Pompidou European Hospital, F-75015 Paris, France
| | - David M Smadja
- Université Paris Cité, Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris Cité, F-75006 Paris, France; Hematology Department, AP-HP, Georges Pompidou European Hospital, F-75015 Paris, France
| | - Sven Günther
- Université Paris Cité, Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris Cité, F-75006 Paris, France; Unité d'Explorations Fonctionnelles Respiratoires et du Sommeil, AP-HP, Georges Pompidou European Hospital, F-75015 Paris, France.
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Araújo CRDS, Fernandes J, Caetano DS, Barros AEVDR, de Souza JAF, Machado MDGR, de Aguiar MIR, Brandão SCS, Campos SL, de Andrade ADFD, Brandão DC. Endothelial function, arterial stiffness and heart rate variability of patients with cardiovascular diseases hospitalized due to COVID-19. Heart Lung 2023; 58:210-216. [PMID: 36621104 PMCID: PMC9805900 DOI: 10.1016/j.hrtlng.2022.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND The novel coronavirus disease (COVID-19) may cause vascular (e.g., endothelial dysfunction, and arterial stiffness), cardiac, autonomic (e.g., heart rate variability [HRV]), and systemic inflammatory response via direct viral attack, hypoxia-induced injury, or immunological dysregulation, especially in those patients with pre-existing cardiovascular diseases (CVD). However, to date, no study has shown prevalence of endothelial dysfunction, arterial stiffness and heart rate variability assessed by bedside peripheral arterial tonometry in patients with previous CVD hospitalized in the acute phase of COVID-19. OBJECTIVE This study aimed to assess the prevalence of endothelial dysfunction, arterial stiffness, and altered HRV in patients with CVD hospitalized due to COVID-19. METHODS This cross-sectional study was conducted from July 2020 to February 2021. Included male and female adult patients aged 40 to 60 years with previous CVD and diagnosed with COVID-19. Anthropometric data, comorbidities, and blood tests were analyzed. Endothelial function, arterial stiffness, and HRV were assessed using peripheral arterial tonometry (PAT), and the statistical significance was set at 5%. RESULTS Fourteen (51.8%) patients presented endothelial dysfunction (reactive hyperemia index = 1.2 ± 0.3) and enhancement in the high-frequency component of HRV (p < 0.05). There was a high prevalence of endothelial dysfunction, especially in patients with chronic heart failure (10 (71.4%)). Patients with preserved endothelial function showed a high augmentation index normalized to a heart rate of 75 bpm (p < 0.01), suggesting arterial stiffness. CONCLUSION Patients with CVD hospitalized due to COVID-19 presented endothelial dysfunction assessed using PAT, which could be used as a biomarker for arterial stiffness and altered HRV. The possibility of detecting vascular and autonomic changes during phase II of COVID-19 may help to prevent possible long-term complications.
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Affiliation(s)
| | - Juliana Fernandes
- Department of Physiotherapy. Federal University of Pernambuco, Recife, Brazil
| | | | | | | | | | | | | | - Shirley Lima Campos
- Department of Physiotherapy. Federal University of Pernambuco, Recife, Brazil
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3
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Ahn J, Jeong H, Seo BG, Park KS, Hwangbo C, Kim HG, Koh JS, Kim J. Genome-wide association study for vascular aging highlights pathways shared with cardiovascular traits in Koreans. Front Cardiovasc Med 2022; 9:1058308. [PMID: 36620623 PMCID: PMC9813851 DOI: 10.3389/fcvm.2022.1058308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Vascular aging plays a pivotal role in the morbidity and mortality of older people. Reactive hyperemia index (RHI) detected by pulse amplitude tonometry (PAT) is a non-invasive measure of vascular endothelial function and aging-induced pathogenesis of both microvascular and macrovascular diseases. We conducted a genome-wide association study (GWAS) to comprehensively identify germline genetic variants associated with vascular aging in a Korean population, which revealed 60 suggestive genes underlying angiogenesis, inflammatory response in blood vessels, and cardiovascular diseases. Subsequently, we show that putative protective alleles were significantly enriched in an independent population with decelerated vascular aging phenotypes. Finally, we show the differential mRNA expression levels of putative causal genes in aging human primary endothelial cells via quantitative real-time polymerase chain reaction (PCR). These results highlight the potential contribution of genetic variants in the etiology of vascular aging and may suggest the link between vascular aging and cardiovascular traits.
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Affiliation(s)
- JaeKyoung Ahn
- Division of Applied Life Science (BK21 Four), Gyeongsang National University, Jinju, Republic of Korea,Institute of Agriculture and Life Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Hankyeol Jeong
- Division of Applied Life Science (BK21 Four), Gyeongsang National University, Jinju, Republic of Korea,Institute of Agriculture and Life Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Bo-Gyeong Seo
- Division of Applied Life Science (BK21 Four), Gyeongsang National University, Jinju, Republic of Korea,Division of Life Science, College of National Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Ki-Soo Park
- Department of Preventive Medicine, College of Medicine and Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea,Center for Farmer’s Safety and Health, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Cheol Hwangbo
- Division of Applied Life Science (BK21 Four), Gyeongsang National University, Jinju, Republic of Korea,Division of Life Science, College of National Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Han-Gyul Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jin-Sin Koh
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea,*Correspondence: Jin-Sin Koh,
| | - Jaemin Kim
- Division of Applied Life Science (BK21 Four), Gyeongsang National University, Jinju, Republic of Korea,Institute of Agriculture and Life Sciences, Gyeongsang National University, Jinju, Republic of Korea,Jaemin Kim,
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Janssen LE, Simons N, Simons PI, Schaper NC, Feskens EJ, van der Ploeg LM, Van den Eynde MD, Schalkwijk CG, Houben AJ, Stehouwer CD, Brouwers MC. Effects of fructose restriction on blood pressure: Secondary analysis of a double-blind randomized controlled trial. Clin Nutr ESPEN 2022; 51:97-103. [DOI: 10.1016/j.clnesp.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
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Is the TOAST Classification Suitable for Use in Personalized Medicine in Ischemic Stroke? J Pers Med 2022; 12:jpm12030496. [PMID: 35330495 PMCID: PMC8949213 DOI: 10.3390/jpm12030496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
Pathophysiologic classification of ischemic stroke is essential to a personalized approach to stroke treatment. The Trial of Org 101072 in Acute Stroke Treatment (TOAST) classification is the most frequently used tool to classify index ischemic strokes. We aimed to assess presence of small and large vessel disease markers across the TOAST groups. In an observational study, 99 ischemic stroke patients were consecutively included and classified according to TOAST. The assessment was supplemented with cerebral small vessel disease (SVD) score, based on Magnetic Resonance Imaging (MRI), and tests for carotid atherosclerosis, ankle−brachial index (ABI), estimated glomerular filtration rate (eGFR), and peripheral reactive hyperemia index (RHI). Markers of small and large vessel disease were present in all TOAST groups. Carotid stenosis and atrial fibrillation were associated with their respective TOAST groups (p = 0.023 and p < 0.001, respectively). We found no association between the SVD score and the small vessel occlusion TOAST group (p = 0.59), and carotid atherosclerosis (p = 0.35), RHI (p = 0.39), ABI (p = 0.20), and eGFR (p = 0.79) were not associated with TOAST groups. The TOAST classification does not provide differential information on the pathophysiologies of the ischemic stroke. An operational classification that contains quantification of each vascular pathophysiology in the individual patient is pivotal for future research and development of personalized medicine.
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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
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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
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7
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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.
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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
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Dasari TW, Csipo T, Amil F, Lipecz A, Fulop GA, Jiang Y, Samannan R, Johnston S, Zhao YD, Silva-Palacios F, Stavrakis S, Yabluchanskiy A, Po SS. Effects of Low-Level Tragus Stimulation on Endothelial Function in Heart Failure With Reduced Ejection Fraction. J Card Fail 2021; 27:568-576. [PMID: 33387632 PMCID: PMC9473302 DOI: 10.1016/j.cardfail.2020.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Autonomic dysregulation in heart failure with reduced ejection fraction plays a major role in endothelial dysfunction. Low-level tragus stimulation (LLTS) is a novel, noninvasive method of autonomic modulation. METHODS AND RESULTS We enrolled 50 patients with heart failure with reduced ejection fraction (left ventricular ejection fraction of ≤40%) in a randomized, double-blinded, crossover study. On day 1, patients underwent 60 minutes of LLTS with a transcutaneous stimulator (20 Hz, 200 μs pulse width) or sham (ear lobule) stimulation. Macrovascular function was assessed using flow-mediated dilatation in the brachial artery and cutaneous microcirculation with laser speckle contrast imaging in the hand and nail bed. On day 2, patients were crossed over to the other study arm and underwent sham or LLTS; vascular tests were repeated before and after stimulation. Compared with the sham, LLTS improved flow-mediated dilatation by increasing the percent change in the brachial artery diameter (from 5.0 to 7.5, LLTS on day 1, P = .02; and from 4.9 to 7.1, LLTS on day 2, P = .003), compared with no significant change in the sham group (from 4.6 to 4.7, P = .84 on day 1; and from 5.6 to 5.9 on day 2, P = .65). Cutaneous microcirculation in the hand showed no improvement and perfusion of the nail bed showed a trend toward improvement. CONCLUSIONS Our study demonstrated the beneficial effects of acute neuromodulation on macrovascular function. Larger studies to validate these findings and understand mechanistic links are warranted.
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Affiliation(s)
- Tarun W Dasari
- Cardiovascular Section, Department of Internal Medicine; Heart Rhythm Institute.
| | - Tamas Csipo
- Department of Biochemistry and Molecular Biology; Section of Geriatrics, Department of Internal Medicine
| | - Faris Amil
- Cardiovascular Section, Department of Internal Medicine
| | - Agnes Lipecz
- Department of Biochemistry and Molecular Biology; Section of Geriatrics, Department of Internal Medicine
| | - Gabor A Fulop
- Department of Biochemistry and Molecular Biology; Section of Geriatrics, Department of Internal Medicine
| | | | | | - Sarah Johnston
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Yan D Zhao
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Stavros Stavrakis
- Cardiovascular Section, Department of Internal Medicine; Heart Rhythm Institute
| | - Andriy Yabluchanskiy
- Department of Biochemistry and Molecular Biology; Section of Geriatrics, Department of Internal Medicine
| | - Sunny S Po
- Cardiovascular Section, Department of Internal Medicine; Heart Rhythm Institute
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Malheiro LF, Gaio R, Vaz da Silva M, Martins S, Sarmento A, Santos L. Peripheral arterial tonometry as a method of measuring reactive hyperaemia correlates with organ dysfunction and prognosis in the critically ill patient: a prospective observational study. J Clin Monit Comput 2020; 35:1169-1181. [PMID: 32889643 PMCID: PMC7474512 DOI: 10.1007/s10877-020-00586-9] [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: 06/02/2020] [Accepted: 08/24/2020] [Indexed: 11/05/2022]
Abstract
Predictions of mortality may help in the selection of patients who benefit from intensive care. Endothelial dysfunction is partially responsible for many of the organic dysfunctions in critical illness. Reactive hyperaemia is a vascular response of the endothelium that can be measured by peripheral arterial tonometry (RH-PAT). We aimed to assess if reactive hyperaemia is affected by critical illness and if it correlates with outcomes. Prospective study with a cohort of consecutive patients admitted to an Intensive Care Unit. RH-PAT was accessed on admission and on the 7th day after admission. Early and late survivors were compared to non-survivors. The effect of RH-PAT variation on late mortality was studied by a logistic regression model. The association between RH-PAT and severity scores and biomarkers of organic dysfunction was investigated by multivariate analysis. 86 patients were enrolled. Mean ln(RHI) on admission was 0.580 and was significantly lower in patients with higher severity scores (p < 0.01) and early non-survivors (0.388; p = 0.027). The model for prediction of early-mortality estimated that each 0.1 decrease in ln(RHI) increased the odds for mortality by 13%. In 39 patients, a 2nd RH-PAT measurement was performed on the 7th day. The variation of ln(RHI) was significantly different between non-survivors and survivors (− 24.2% vs. 63.9%, p = 0.026). Ln(RHI) was significantly lower in patients with renal and cardiovascular dysfunction (p < 0.01). RH-PAT is correlated with disease severity and seems to be an independent marker of early mortality, cardiovascular and renal dysfunctions. RH-PAT variation predicts late mortality. There appears to be an RH-PAT impairment in the acute phase of severe diseases that may be reversible and associated with better outcomes.
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Affiliation(s)
- Luis Filipe Malheiro
- Intensive Care Unit, Infectious Diseases Department, Centro Hospitalar de São João, Porto, Portugal. .,Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, Porto, Portugal. .,Department of Medicine Faculty of Medicine, University of Porto, Porto, Portugal. .,Serviço de Doenças Infeciosas, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Rita Gaio
- Department of Mathematics, Faculty of Science Sciences and CMUP, Centre of Mathematics of the University of Porto; University of Porto, Porto, Portugal
| | - Manuel Vaz da Silva
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra Martins
- Clinical Pathology Department, Centro Hospitalar de São João and EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - António Sarmento
- Intensive Care Unit, Infectious Diseases Department, Centro Hospitalar de São João, Porto, Portugal.,Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, Porto, Portugal.,Department of Medicine Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lurdes Santos
- Intensive Care Unit, Infectious Diseases Department, Centro Hospitalar de São João, Porto, Portugal.,Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, Porto, Portugal.,Department of Medicine Faculty of Medicine, University of Porto, Porto, Portugal
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Hedetoft M, Olsen NV, Smidt-Nielsen IG, Wahl AM, Bergström A, Juul A, Hyldegaard O. Measurement of peripheral arterial tonometry in patients with diabetic foot ulcers during courses of hyperbaric oxygen treatment. Diving Hyperb Med 2020; 50:17-23. [PMID: 32187613 DOI: 10.28920/dhm50.1.17-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/22/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Treatment of diabetic foot ulcers is complex and often protracted. Hyperbaric oxygen treatment (HBOT) improves wound healing in diabetic ulcers and serves as an important adjunct to regular diabetic wound care. Endothelial dysfunction plays a central role in diabetes-related vascular complications and may be evaluated by a non-invasive technique called peripheral arterial tonometry which measures a reactive hyperaemia index (RHI). We hypothesized that endothelial function measured by peripheral arterial tonometry is impaired in diabetic foot ulcer patients and that HBOT might improve endothelial function. METHODS Endothelial function was prospectively assessed by peripheral arterial tonometry in 22 subjects with diabetic foot ulcers and 17 subjects without diabetes during courses of HBOT. Endothelial function was evaluated before first (baseline) and 30th treatments, and at 90-day follow-up. Serum insulin growth factor-I (IGF-I) concentrations were determined by immunoassay. Results were compared to 23 healthy subjects. RESULTS No baseline differences were found in endothelial function between subjects with diabetes, HBOT patients without-diabetes and healthy control subjects (RHI; 1.26, 1.61 and 1.81, respectively). No significant changes in RHI were found in patients with (P = 0.17) or without (P = 0.30) diabetes during courses of HBOT. At 90-day follow-up IGF-I was significantly reduced in the subjects with diabetes (P = 0.001) and unchanged in the group without diabetes (P = 0.99). CONCLUSIONS We found no significant differences in RHI between subjects with diabetic foot ulcers and patients without diabetes, nor improvement in endothelial function assessed by peripheral arterial tonometry during courses of HBOT.
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Affiliation(s)
- Morten Hedetoft
- The Hyperbaric Oxygen Treatment Unit, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Corresponding author: Dr Morten Hedetoft, The Hyperbaric Oxygen Treatment Unit, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark,
| | - Niels V Olsen
- The Hyperbaric Oxygen Treatment Unit, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Isabel G Smidt-Nielsen
- The Hyperbaric Oxygen Treatment Unit, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anna M Wahl
- The Hyperbaric Oxygen Treatment Unit, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anita Bergström
- Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Anders Juul
- Department of Clinical Medicine, University of Copenhagen, Denmark.,Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Denmark
| | - Ole Hyldegaard
- The Hyperbaric Oxygen Treatment Unit, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
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Aoyama A, Yamaoka-Tojo M, Obara S, Shimizu E, Fujiyoshi K, Noda C, Matsunaga A, Ako J. Acute Effects of Whole-Body Vibration Training on Endothelial Function and Cardiovascular Response in Elderly Patients with Cardiovascular Disease. Int Heart J 2019; 60:854-861. [PMID: 31257335 DOI: 10.1536/ihj.18-592] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this single-arm pilot study was to determine the effects of whole-body vibration training (WBVT) on endothelial function in elderly patients with cardiovascular diseases, as well as its safety. A total of 20 elderly patients with stable cardiovascular diseases underwent WBVT, which consisted of five static resistance training exercises (squats, wide stance squats, toe-stands, squats + band, and front lunges). The parameters of WBVT included vertical vibrations, 30 Hz frequency, and a 3-mm peak-to-peak amplitude. Each vibration session lasted 30 seconds, with 120 seconds of rest between sessions. Before and after WBVT, the reactive hyperemia peripheral arterial tonometry index (RH-PAT index) and transcutaneous oxygen pressure (tcPO2) were recorded as a measure of endothelial function and peripheral blood circulation. Systolic blood pressure, diastolic blood pressure, heart rate, and arterial oxygen saturation of pulse oximetry (SpO2) were measured at each rest interval as well as before and after WBVT. All patients completed our WBVT protocol without adverse events. The RH-PAT index significantly increased following WBVT (1.42 to 2.06, P < 0.001). There were no significant changes in heart rate (P = 0.777), systolic blood pressure (P = 0.183), diastolic blood pressure (P = 0.925), or SpO2 (P = 0.248) during WBVT. In conclusion, we demonstrated the acute effects of WBVT on endothelial function, with no reports of adverse events. These findings support the need for further randomized controlled studies to investigate the long-term effects of WBVT.
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Affiliation(s)
- Akihiro Aoyama
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences
| | - Shinichi Obara
- Department of Cardiac Rehabilitation, Kitasato University East Hospital
| | - Erika Shimizu
- Department of Cardiac Rehabilitation, Kitasato University East Hospital
| | - Kazuhiro Fujiyoshi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Chiharu Noda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Atsuhiko Matsunaga
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
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12
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Mannaerts D, Faes E, Cornette J, Gyselaers W, Spaanderman M, Goovaerts I, Stoop T, Roelant E, Jacquemyn Y, Van Craenenbroeck EM. Low-flow mediated constriction as a marker of endothelial function in healthy pregnancy and preeclampsia: A pilot study. Pregnancy Hypertens 2019; 17:75-81. [PMID: 31487661 DOI: 10.1016/j.preghy.2019.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 01/27/2019] [Accepted: 02/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Overwhelming clinical evidence exists on disturbed vascular and endothelial function in the pathophysiology of preeclampsia (PE). In a non-pregnant (NP) population, L-FMC (low-flow mediated constriction) provides insight in the 'resting' endothelial capacity in contrast to the gold standard of flow mediated dilatation (FMD), reflecting endothelial nitric oxide bioavailability. STUDY DESIGN Longitudinal follow-up of 100 healthy pregnant (HP) women, 33 PE women and 16 NP controls with non-invasive vascular assessments. HP women were evaluated at 12 and 35 weeks of gestation and at 6 months postpartum. PE patients were assessed at diagnosis (mean 30 weeks) and 6 months postpartum. MAIN OUTCOME MEASURES Endothelial function (L-FMC, FMD, peripheral arterial tonometry (PAT)) and arterial stiffness (pulse wave velocity (PWV) and analysis (PWA)) were measured at the different visits and compared between groups. RESULTS Overall endothelial dysfunction is present in PE (FMD HP 9.09 ± 4.20 vs PE 5.21 ± 4.47, p = 0.0004; L-FMC HP -1.90 ± 2.66 vs PE -0.40 ± 2.09, p = 0.03). L-FMC gradually elevates during the course of a HP (1st trim -0.31 ± 1.75 vs 3rd trim -1.97 ± 3.02, p < 0.0001) and is present in 85% of women in the third trimester. In NP, only 27% of women has L-FMC. In PE, L-FMC is present in 50% of cases. Arterial stiffness is increased in PE (all p < 0.0001). There is no correlation between L-FMC and other markers of vascular function (p > 0.05). CONCLUSION PE is characterized by dysfunction of both resting and recruitable endothelial capacity. This study offers new insights in different aspects of endothelial function in pregnancy, since L-FMC reflects an adaptation in HP that is absent in PE.
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Affiliation(s)
- Dominique Mannaerts
- Research Group ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Belgium; Department of Obstetrics and Gynaecology, Antwerp University Hospital, Belgium.
| | - Ellen Faes
- Research Group ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Belgium; Department of Obstetrics and Gynaecology, Antwerp University Hospital, Belgium
| | - Jerome Cornette
- Department of Obstetrics and Gynaecology, Erasmus M.C. Rotterdam, The Netherlands
| | - Wilfried Gyselaers
- Department of Obstetrics and Gynaecology, Ziekenhuis-Oost Limburg, Genk, Belgium
| | - Marc Spaanderman
- Department of Obstetrics and Gynaecology, MUMC Maastricht University, The Netherlands
| | - Inge Goovaerts
- Laboratory for Cellular and Molecular Cardiology and Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Tibor Stoop
- Laboratory for Cellular and Molecular Cardiology and Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Ella Roelant
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Yves Jacquemyn
- Research Group ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Belgium; Department of Obstetrics and Gynaecology, Antwerp University Hospital, Belgium
| | - Emeline M Van Craenenbroeck
- Laboratory for Cellular and Molecular Cardiology and Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; Research Group Cardiovascular Diseases, Translational Pathophysiological Research, University of Antwerp, Edegem, Belgium
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13
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Cole CA, Carlsten C, Koehle M, Brauer M. Particulate matter exposure and health impacts of urban cyclists: a randomized crossover study. Environ Health 2018; 17:78. [PMID: 30428890 PMCID: PMC6237024 DOI: 10.1186/s12940-018-0424-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/30/2018] [Indexed: 05/25/2023]
Abstract
BACKGROUND Cycling and other forms of active transportation provide health benefits via increased physical activity. However, direct evidence of the extent to which these benefits may be offset by exposure and intake of traffic-related air pollution is limited. The purpose of this study is to measure changes in endothelial function, measures of oxidative stress and inflammation, and lung function in healthy participants before and after cycling along a high- and low- traffic route. METHODS Participants (n = 38) bicycled for 1 h along a Downtown and a Residential designated bicycle route in a randomized crossover trial. Heart rate, power output, particulate matter air pollution (PM10, PM2.5, and PM1) and particle number concentration (PNC) were measured. Lung function, endothelial function (reactive hyperemia index, RHI), C-reactive protein, interleukin-6, and 8-hydroxy-2'-deoxyguanosine were assessed within one hour pre- and post-trial. RESULTS Geometric mean PNC exposures and intakes were higher along the Downtown (exposure = 16,226 particles/cm3; intake = 4.54 × 1010 particles) compared to the Residential route (exposure = 9367 particles/cm3; intake = 3.13 × 1010 particles). RHI decreased following cycling along the Downtown route and increased on the Residential route; in mixed linear regression models, the (post-pre) change in RHI was 21% lower following cycling on the Downtown versus the Residential route (-0.43, 95% CI: -0.79, -0.079) but RHI decreases were not associated with measured exposure or intake of air pollutants. The differences in RHI by route were larger amongst females and older participants. No consistent associations were observed for any of the other outcome measures. CONCLUSIONS Although PNC exposures and intakes were higher along the Downtown route, the lack of association between air pollutant exposure or intake with RHI and other measures suggests other exposures related to cycling on the Downtown route may have been influential in the observed differences between routes in RHI. TRIAL REGISTRATION ClinicalTrials.gov, NCT01708356 . Registered 16 October 2012.
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Affiliation(s)
- Christie A. Cole
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Christopher Carlsten
- Air Pollution Exposure Lab, Department of Medicine, University of British Columbia, 2775 Laurel Street 7th Floor, Vancouver, BC V5Z 1M9 Canada
| | - Michael Koehle
- School of Kinesiology and Division of Sport & Exercise Medicine, University of British Columbia, 2176 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
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14
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Lohr NL. Function over form: Is it time to use endothelial function to diagnose vascular diseases? Int J Cardiol 2018; 260:191-192. [DOI: 10.1016/j.ijcard.2018.02.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/03/2018] [Accepted: 02/27/2018] [Indexed: 12/01/2022]
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15
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Poredos P, Mavric A, Leben L, Poredos P, Jezovnik MK. Total Hip Replacement Provokes Endothelial Dysfunction. Angiology 2018; 69:871-877. [DOI: 10.1177/0003319718774660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surgery represents an increased risk of different perioperative complications. Endothelial function (EF) is a key mechanism responsible for cardiovascular homeostasis and is involved in thromboembolic complications. We aimed to follow changes of EF in an early postoperative period in patients undergoing total hip replacement (THR). Endothelial function was assessed noninvasively in 70 consecutive patients who underwent an elective THR under spinal anesthesia. Flow-mediated dilation (FMD) and low flow-mediated constriction capability of the brachial artery, which are indicators of EF were measured before the operation (baseline), 24 hours after the operative procedure, and 5 to 7 days postoperatively. Baseline FMD was 12.3% and decreased a day after surgery to 7.3% ( P < .001). After 5 to 7 days, it gradually increased to 9.2%. However, on average, it was lower than before surgery ( P < .001). The median duration of THR was 85.0 (65.0-100.0) minutes, the average hospital length of stay was 7 days. Total hip replacement is associated with an immediate decrease in FMD which remains significantly decreased 5 to 7 days after the surgery compared with the preoperative value. These results indicate that surgery provokes endothelial dysfunction and deteriorates cardiovascular homeostasis. This effect could be involved in cardiovascular complications in the postoperative period.
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Affiliation(s)
- Peter Poredos
- Department of Anaesthesiology and Perioperative Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ana Mavric
- Department of Vascular Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Lara Leben
- Department of Vascular Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Pavel Poredos
- Department of Vascular Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mateja Kaja Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, USA
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16
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Si D, Ni L, Wang Y, Liu J, Yang J, Yang P. A new method for the assessment of endothelial function with peripheral arterial volume. BMC Cardiovasc Disord 2018; 18:81. [PMID: 29728052 PMCID: PMC5935917 DOI: 10.1186/s12872-018-0821-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 04/26/2018] [Indexed: 11/24/2022] Open
Abstract
Background Currently, many methodological approaches have been developed to assess peripheral endothelial function. However, a development of the noninvasive and automated technique for routinely assessing endothelial function is still required. We evaluated the potential value of a new method to measure peripheral endothelial function with reactive hyperemia peripheral arterial volume (RH-PAV) in patients with chest pain. Methods We used a novel oximeter-like probe to detect the peripheral arterial volume (PAV) of the finger and compared it with brachial flow-mediated dilation (FMD) performed in 93 consecutive patients with chest pain. The RH-PAV index was defined as the ratio of the digital pulse volume during reactive hyperemia relative to the baseline. Results Ninety-three patients (53 men, 58 ± 5 years) completed the study, and 53 patients demonstrated coronary artery disease (CAD) following scheduled coronary angiography. There was a moderate linear relationship between PAV and FMD (r = 0.69, p < 0.01). Similar to FMD, PAV was more impaired in patients who have more cardiovascular risk factors (CRFs). The subjects with CAD had lower PAV and FMD, compared with those without CAD (1.05 ± 0.23 VS. 1.41 ± 0.37, p < 0.01; 6.7% ± 2.9% VS. 10.4% ± 2.9%, p < 0.01, respectively), and the relationships between FMD and PAV were also significant in both CAD (r = 0.54, p < 0.01) and non-CAD (r = 0.62, p < 0.01) patients. Conclusions Endothelial function of digital artery assessed with the novel PAV method demonstrated a profile similar to that of brachial artery measured with FMD. The hyperemia PAV was decreased by factors which were considered to impair endothelial function, suggesting that PAV has the potential to be a novel method to study endothelial function.
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Affiliation(s)
- Daoyuan Si
- Department of Cardiology, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, China-Japan Union Hospital of Jilin University, Xiantai Street NO.126, Changchun, Jilin, China
| | - Lujia Ni
- Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Yunfei Wang
- Department of Cardiology, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, China-Japan Union Hospital of Jilin University, Xiantai Street NO.126, Changchun, Jilin, China
| | - Jinsha Liu
- Department of Cardiology, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, China-Japan Union Hospital of Jilin University, Xiantai Street NO.126, Changchun, Jilin, China
| | - Jining Yang
- Department of Cardiology, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, China-Japan Union Hospital of Jilin University, Xiantai Street NO.126, Changchun, Jilin, China
| | - Ping Yang
- Department of Cardiology, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, China-Japan Union Hospital of Jilin University, Xiantai Street NO.126, Changchun, Jilin, China.
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17
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Mannaerts D, Faes E, Gielis J, Van Craenenbroeck E, Cos P, Spaanderman M, Gyselaers W, Cornette J, Jacquemyn Y. Oxidative stress and endothelial function in normal pregnancy versus pre-eclampsia, a combined longitudinal and case control study. BMC Pregnancy Childbirth 2018; 18:60. [PMID: 29482567 PMCID: PMC5827979 DOI: 10.1186/s12884-018-1685-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/12/2018] [Indexed: 12/13/2022] Open
Abstract
Background Pre-eclampsia (PE) is related to an impaired endothelial function. Endothelial dysfunction accounts for altered vascular reactivity, activation of the coagulation cascade and loss of vascular integrity. Impaired endothelial function originates from production of inflammatory and cytotoxic factors by the ischemic placenta and results in systemic oxidative stress (OS) and an altered bioavailability of nitric oxide (•NO). The free radical •NO, is an endogenous endothelium-derived relaxing factor influencing endothelial function. In placental circulation, endothelial release of •NO dilates the fetal placental vascular bed, ensuring feto-maternal exchange. The Endopreg study was designed to evaluate in vivo endothelial function and to quantify in vitro OS in normal and pre-eclamptic pregnancies. Methods/design The study is divided into two arms, a prospective longitudinal study and a matched case control study. In the longitudinal study, pregnant patients ≥18 years old with a singleton pregnancy will be followed throughout pregnancy and until 6 months post-partum. In the case control study, cases with PE will be compared to matched normotensive pregnant women. Maternal blood concentration of superoxide (O2•) and placental concentration of •NO will be determined using EPR (electron paramagnetic resonance). Endothelial function and arterial stiffness will be evaluated using respectively Peripheral Arterial Tonometry (PAT), Flow-Mediated Dilatation (FMD) and applanation tonometry. Placental expression of eNOS (endothelial NOS) will be determined using immune-histochemical staining. Target recruitment will be 110 patients for the longitudinal study and 90 patients in the case-control study. Discussion The results of Endopreg will provide longitudinal information on in vivo endothelial function and in vitro OS during normal pregnancy and PE. Adoption of these vascular tests in clinical practice potentially predicts patients at risk to develop cardiovascular events later in life after PE pregnancies. •NO, O2•− and eNOS measurements provide further inside in the pathophysiology of PE. Trial registration This trial has been registered on clinicaltrials.gov. ClinicalTrials.gov Identifier: NCT02603913. Registered October 2015.
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Affiliation(s)
- Dominique Mannaerts
- Departement of Obstetrics and Gynaecology, Antwerp University Hospital, Antwerp, Belgium.,ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium
| | - Ellen Faes
- Departement of Obstetrics and Gynaecology, Antwerp University Hospital, Antwerp, Belgium.,ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium
| | - Jan Gielis
- ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium
| | - Emeline Van Craenenbroeck
- Laboratory for Cellular and Molecular Cardiology and Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.,Research Group Cardiovascular Diseases, Translational Pathophysiological Research, University of Antwerp, Antwerp, Belgium
| | - Paul Cos
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
| | - Marc Spaanderman
- Departement of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wilfried Gyselaers
- Departement of Obstetrics and Gynecology, Ziekenhuis-Oost-Limburg (ZOL), Genk, Belgium
| | - Jerome Cornette
- Departement of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Yves Jacquemyn
- Departement of Obstetrics and Gynaecology, Antwerp University Hospital, Antwerp, Belgium. .,ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium. .,Department of Obstetrics and Gynaecology, Antwerp Surgical Training and Anatomy Research Centre (ASTARC), Antwerp University/Antwerp University Hospital, Antwerp, Belgium.
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18
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Stretching Exercises Improve Vascular Endothelial Dysfunction Through Attenuation of Oxidative Stress in Chronic Heart Failure Patients With an Implantable Cardioverter Defibrillator. J Cardiopulm Rehabil Prev 2017; 37:130-138. [PMID: 28225475 DOI: 10.1097/hcr.0000000000000229] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Endurance training improves oxidative stress and vascular endothelial dysfunction in patients with chronic heart failure (CHF). However, patients with CHF and an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) often avoid endurance training for fear of ICD shock. Recent studies have reported that stretching exercises enhance antioxidant activity and improve vascular responses. Therefore, we aimed to assess the effects of 4 weeks of stretching exercises on oxidative stress and vascular endothelial function in patients with CHF with an ICD or CRT-D. METHODS Fifty sedentary patients with CHF (78% males; mean age = 70 ± 9 years; left ventricular ejection fraction = 26% ± 8%) with an ICD or CRT-D were randomly divided into a group that performed 4 weeks of stretching exercises (stretching group) and a group that continued a sedentary lifestyle (control group). We compared the reactive hyperemia peripheral arterial tonometry (RH-PAT) index and blood parameters, such as von Willebrand factor (vWF), malondialdehyde-modified low-density lipoprotein cholesterol (MDA-LDL), reactive oxygen species (ROS), high-sensitivity C-reactive protein, pentraxin 3, and fibrinogen between the 2 groups before and after the 4-week study period. RESULTS In the stretching group, a significant increase in the RH-PAT index and significant decreases in vWF, MDA-LDL, ROS, and fibrinogen concentrations were observed after the study compared with before (all P < .05). No significant changes were observed in the control group. CONCLUSION Four weeks of stretching exercises improved vascular endothelial dysfunction through attenuation of oxidative stress in sedentary patients with CHF with an ICD or CRT-D.
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19
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Bergstrand S, Morales MA, Coppini G, Larsson M, Strömberg T. The relationship between forearm skin speed-resolved perfusion and oxygen saturation, and finger arterial pulsation amplitudes, as indirect measures of endothelial function. Microcirculation 2017; 25. [PMID: 29044805 DOI: 10.1111/micc.12422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 10/11/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Endothelial function is important for regulating peripheral blood flow to meet varying metabolic demands and can be measured indirectly during vascular provocations. In this study, we compared the PAT finger response (EndoPAT) after a 5-minutes arterial occlusion to that from forearm skin comprehensive microcirculation analysis (EPOS). METHODS Measurements in 16 subjects with varying cardiovascular risk factors were carried out concurrently with both methods during arterial occlusion, while forearm skin was also evaluated during local heating. RESULTS Peak values for EPOS skin Perfconv and speed-resolved total perfusion after the release of the occlusion were significantly correlated to the EndoPAT RHI (ρ = .68, P = .007 and ρ = .60, P = .025, respectively), mainly due to high-speed blood flow. During local heating, EPOS skin oxygen saturation, SO2, was significantly correlated to RHI (ρ = .62, P = .043). This indicates that SO2 may have diagnostic value regarding endothelial function. CONCLUSIONS We have demonstrated for the first time a significant relationship between forearm skin microcirculatory perfusion and oxygen saturation and finger PAT. Both local heating and reactive hyperemia are useful skin provocations. Further studies are needed to understand the precise regulation mechanisms of blood flow and oxygenation during these tests.
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Affiliation(s)
- Sara Bergstrand
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | | | - Marcus Larsson
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Tomas Strömberg
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
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20
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Mannaerts D, Faes E, Goovaerts I, Stoop T, Cornette J, Gyselaers W, Spaanderman M, Van Craenenbroeck EM, Jacquemyn Y. Flow-mediated dilation and peripheral arterial tonometry are disturbed in preeclampsia and reflect different aspects of endothelial function. Am J Physiol Regul Integr Comp Physiol 2017; 313:R518-R525. [PMID: 28794106 DOI: 10.1152/ajpregu.00514.2016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 12/26/2022]
Abstract
Endothelial function and arterial stiffness are known to be altered in preeclamptic pregnancies. Previous studies have shown conflicting results regarding the best technique for assessing vascular function in pregnancy. In this study, we made a comprehensive evaluation of in vivo vascular function [including flow-mediated dilatation (FMD), peripheral arterial tonometry (PAT), and arterial stiffness] in preeclamptic patients and compared them with normal pregnancies. In addition, we assessed the relation between vascular function and systemic inflammation. Fourteen patients with preeclampsia (PE) and 14 healthy pregnant controls were included. Endothelial function was determined by FMD and PAT and arterial stiffness by carotid-femoral pulse-wave velocity and augmentation index. Systemic inflammation was assessed using mean platelet volume (MPV) and neutrophil-lymphocyte ratio (NLR). The reactive hyperemia index, assessed using PAT, is decreased at the third trimester compared with the first trimester in a normal, uncomplicated pregnancy (P = 0.001). Arterial stiffness is significantly higher in PE versus normal pregnancy (P < 0.001). Endothelial function, obtained by FMD, is deteriorated in PE versus normal pregnancy (P = 0.015), whereas endothelial function assessment by PAT is improved in PE versus normal pregnancy (P = 0.001). Systemic inflammation (MPV and NLR) increases during normal pregnancy. FMD and PAT are disturbed in PE. Endothelial function, assessed by FMD and PAT, shows distinct results. This may indicate that measurements with FMD and PAT reflect different aspects of endothelial function and that PAT should not be used as a substitute for FMD as a measure of endothelial function in pregnancy.
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Affiliation(s)
- Dominique Mannaerts
- Research Group, Antwerp Surgical Training, Anatomy & Research Center, University of Antwerp, Antwerp, Belgium; .,Department of Obstetrics and Gynaecology, Antwerp University Hospital, Antwerp, Belgium
| | - Ellen Faes
- Research Group, Antwerp Surgical Training, Anatomy & Research Center, University of Antwerp, Antwerp, Belgium.,Department of Obstetrics and Gynaecology, Antwerp University Hospital, Antwerp, Belgium
| | - Inge Goovaerts
- Laboratory of Cellular and Molecular Cardiology and Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Tibor Stoop
- Laboratory of Cellular and Molecular Cardiology and Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Jerome Cornette
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Wilfried Gyselaers
- Department of Obstetrics and Gynaecology, Ziekenhuis-Oost Limburg, Genk, Belgium
| | - Marc Spaanderman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands; and
| | - Emeline M Van Craenenbroeck
- Laboratory of Cellular and Molecular Cardiology and Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.,Research Group Cardiovascular Diseases, Translational Pathophysiological Research, University of Antwerp, Antwerp, Belgium
| | - Yves Jacquemyn
- Research Group, Antwerp Surgical Training, Anatomy & Research Center, University of Antwerp, Antwerp, Belgium.,Department of Obstetrics and Gynaecology, Antwerp University Hospital, Antwerp, Belgium
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Chandra D, Gupta A, Strollo PJ, Fuhrman CR, Leader JK, Bon J, Slivka WA, Shoushtari AH, Avolio J, Kip KE, Reis S, Sciurba FC. Airflow Limitation and Endothelial Dysfunction. Unrelated and Independent Predictors of Atherosclerosis. Am J Respir Crit Care Med 2017; 194:38-47. [PMID: 26771278 DOI: 10.1164/rccm.201510-2093oc] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
RATIONALE Lower FEV1 is associated with increased prevalence of atherosclerosis; however, causal mechanisms remain elusive. OBJECTIVES To determine if systemic endothelial dysfunction mediates the association between reduced FEV1 and increased atherosclerosis. METHODS Brachial artery endothelial function, pulmonary function, coronary artery calcium, and carotid plaque were assessed in 231 Pittsburgh SCCOR (Specialized Centers for Clinically Oriented Research) study participants; peripheral arterial endothelial function, pulmonary function, and coronary artery calcium were assessed in 328 HeartSCORE (Heart Strategies Concentrating on Risk Evaluation) study participants. MEASUREMENTS AND MAIN RESULTS Lower FEV1 was independently associated with increased atherosclerosis in both cohorts (per 25% lower % predicted FEV1: odds ratio [OR], 1.76; 95% confidence interval [CI], 1.30-2.40; P < 0.001 for carotid plaque in SCCOR participants) (per 25% lower % predicted FEV1: OR, 1.35; 95% CI, 1.02-1.77; P = 0.03 for coronary artery calcium in HeartSCORE participants). Similarly, reduced endothelial function was independently associated with increased atherosclerosis in both cohorts (per SD lower endothelial function: OR, 1.30; 95% CI, 1.01-1.67; P = 0.04 for carotid plaque in SCCOR participants) (per SD lower endothelial function: OR, 1.38; 95% CI, 1.09-1.76; P = 0.008 and OR, 1.41; 95% CI, 1.07-1.86; P = 0.01 for coronary artery calcium in SCCOR and HeartSCORE participants, respectively). However, there was no association between endothelial dysfunction and FEV1, FEV1/FVC, low-attenuation area/visual emphysema, and diffusing capacity in SCCOR participants, and between endothelial dysfunction and FEV1 or FEV1/FVC in HeartSCORE participants (all P > 0.05). Adjusting the association between FEV1 and atherosclerosis for endothelial dysfunction had no impact. CONCLUSIONS Endothelial dysfunction does not mediate the association between airflow limitation and atherosclerosis. Instead, airflow limitation and endothelial dysfunction seem to be unrelated and mutually independent predictors of atherosclerosis.
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Affiliation(s)
| | | | | | | | | | | | | | - Ali Hakim Shoushtari
- 3 Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Jennifer Avolio
- 3 Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Kevin E Kip
- 4 College of Nursing, University of South Florida, Tampa, Florida
| | - Steven Reis
- 1 Department of Medicine.,3 Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; and
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Abstract
Previous studies have shown that the intake of freeze-dried strawberry powder (FDSP) improves select markers of cardiovascular health in adults with cardiovascular risk factors; however, whether these improvements can be observed in at-risk adolescents is unknown. A randomised, double-blind, cross-over study enrolled twenty-five overweight or obese males, aged 14-18 years, to consume 50 g of a FDSP or a control powder, daily for 1 week. Before and after each test period, measures of microvascular function, plasma nitrate/nitrite, platelet reactivity and blood lipids were collected at baseline and acutely 1 h after FDSP intake. Acute plasma nitrate/nitrite levels increased 1 h after consuming the FDSP during Study Visit 1 before daily FDSP intake (P<0·001) and during Study Visit 2 after 1 week of FDSP intake (P<0·001) compared with control powder intake. As a group, fasting nitrate/nitrite levels did not significantly change after 1 week of control or FDSP intake. However, for those individuals where fasting nitrate levels increased after short-term FDSP intake compared with controls, an increase in reactive hyperaemia index (RHI) was observed (P=0·014), whereas RHI was unchanged in those individuals who did not have a significant increase in nitrate (P=0·396). Taken together, these data support the concept that strawberries can provide vascular health benefits to heavier adolescent males.
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23
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Mueller UM, Walther C, Adam J, Fikenzer K, Erbs S, Mende M, Adams V, Linke A, Schuler G. Endothelial Function in Children and Adolescents Is Mainly Influenced by Age, Sex and Physical Activity - An Analysis of Reactive Hyperemic Peripheral Artery Tonometry. Circ J 2017; 81:717-725. [PMID: 28190797 DOI: 10.1253/circj.cj-16-0994] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND As adolescents rarely experience cardiovascular events, surrogate markers of atherosclerosis are useful to justify and monitor effects of primary prevention and therapy of risk factors. Endothelial function assessed by reactive hyperemic peripheral arterial tonometry (RH-PAT) resulting in a reactive hyperemic index (RHI) is a noninvasive method with limited data for use in children and adolescents.Methods and Results:We performed a total of 931 RHI measurements in 445 high-school students, aged 10-17 years, over a time period of 5 years. Students were randomized by class to 60 min physical exercise (PE) at school daily (intervention group), or 2 units of 45-min PE weekly (control group). To characterize the factors influencing the RHI, anthropometry, cardiopulmonary exercise testing, blood cholesterol and quality of life were assessed and used to build mixed linear models. Main influential factors were age, with an increase of RHI from 1.53±0.42 in the youngest to 1.96±0.59 in the oldest students, sex, with higher values in girls, and physical activity. This increase adjusted by age and sex was estimated as 0.11 [0.08, 0.14] per year. RHI was higher in the intervention group by 0.09 [-0.05, 0.23] in comparison with the control group. CONCLUSIONS If RH-PAT is used in research or as a clinical tool in adolescents, the shown age- and sex-dependence of RHI have to be taken in account.
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Affiliation(s)
- Ulrike M Mueller
- Department of Internal Medicine/Cardiology, University Leipzig - Heart Center
| | - Claudia Walther
- Department of Internal Medicine/Cardiology, University Leipzig - Heart Center.,Department of Cardiology, Kerckhoff Heart Center
| | - Jennifer Adam
- Department of Internal Medicine/Cardiology, University Leipzig - Heart Center
| | - Kati Fikenzer
- Department of Internal Medicine/Cardiology, University Leipzig - Heart Center
| | - Sandra Erbs
- Department of Internal Medicine/Cardiology, University Leipzig - Heart Center
| | | | - Volker Adams
- Department of Internal Medicine/Cardiology, University Leipzig - Heart Center
| | - Axel Linke
- Department of Internal Medicine/Cardiology, University Leipzig - Heart Center
| | - Gerhard Schuler
- Department of Internal Medicine/Cardiology, University Leipzig - Heart Center
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24
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Vascular function in asthmatic children and adolescents. Respir Res 2017; 18:17. [PMID: 28095859 PMCID: PMC5240276 DOI: 10.1186/s12931-016-0488-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 12/10/2016] [Indexed: 12/02/2022] Open
Abstract
Background Epidemiological studies have demonstrated an increased incidence of cardiovascular events in patients with bronchial asthma, but little is known about the relationship between asthma and vascular function. The purpose of this study was to evaluate endothelial function and arterial stiffness in children and adolescents with asthma. Methods A cross-sectional controlled study was designed. Measurements of endothelial function and arterial stiffness in asthmatic (13.6 ± 0.6 years) and control groups (14.9 ± 0.7 years) were taken by the non-invasive peripheral arterial tonometry (EndoPAT2000) determined by using the natural logarithm of the reactive hyperemia index (LnRHI) and the augmentation index (AIx@75%), respectively. Patients with asthma were also administered two questionnaires to evaluate asthma control and quality of life. Exercise functional capacity was evaluated using the Shuttle Walking Test (SWT). Only male participants were included in the present study. Results LnRHI and the walked distance during the SWT were similar between groups (p = 0.23 and p = 0.50, respectively). AIx@75% was significantly higher in the asthmatic group (-7.75 ± 1.7) compared to the control group (-15.25 ± 1.8), p < 0.04. In the control group, the LnRHI correlated positively with baseline systolic blood pressure (r = 0.53, p = 0.02) and mean arterial pressure (r = 0.50, p = 0.03), age (r = 0.61, p = 0.007), weight (r = 0.63, p = 0.004) and height (r = 0.56, p = 0.015). Besides that LnRHI correlated with FVC (r = 0.69, p = 0.002), FEV1, (r = 0.53, p = 0.03) and negatively with Tiffeneau index (FEV1/FVC%, r = −0.49 p = 0.04). The LnRHI of the asthmatic group did not correlate with the different variables evaluated. Conclusion The increased AIx@75% without changes in LnRHI in asthmatic patients could mean that an early detection of vascular impairment may precede endothelial dysfunction, and that different mechanisms may contribute to the pathogenesis and progression of cardiovascular events in this population. A large prospective and randomized controlled study should be done to evaluate the physiopathological mechanisms underlying the association between arterial stiffness and asthma. Electronic supplementary material The online version of this article (doi:10.1186/s12931-016-0488-3) contains supplementary material, which is available to authorized users.
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25
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Venturi E, Pinnola S, Morizzo C, Boldrini B, Rossi M, Trifirò S, Tricò D, Natali A. Clinical Phenotype and Microvascular Dynamics of Subjects with Endothelial Dysfunction as Assessed by Peripheral Tonometry. Microcirculation 2016; 23:230-9. [PMID: 26800496 DOI: 10.1111/micc.12268] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/18/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the characteristics and the determinants of ED, as measured by PAT. METHODS We measured basal and post-ischemic digital pulse amplitude (EndoPAT(®)) in a mixed outpatient population of 206 diabetic and 101 non-diabetic subjects, of whom 50% with clinically manifest CVD, undergoing to an extensive clinical, biochemical, and vascular phenotype characterization. RESULTS The major characteristics of ED (tertile 1 vs 3), in addition to lower post-ischemic vasodilatory reserve (34 vs 203%), were a 3-fold higher baseline pulse amplitude and a delayed (60 second) peak response. The main determinant of this response was the baseline pulse amplitude (Stβ = -0.59), which in turn was influenced by age (Stβ = 0.13), central obesity (Stβ = 0.27) and inversely by HDL cholesterol (Stβ = -0.17), and systolic blood pressure (Stβ = -0.19). No association was observed with cardiovascular risk factors, previous cardiovascular event or extent of atherosclerosis (ABI and IMT, PWV). Most of the variability in baseline pulse amplitude remained unexplained (r(2) = 0.14). CONCLUSIONS ED, as detected by PAT in a population enriched with subjects at risk for CVD neither reflects the burden of classical risk factors (under treatment) nor the severity of atherosclerosis. Aside from central obesity and HDL cholesterol, most of the factors responsible for this ED remain unknown.
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Affiliation(s)
- Elena Venturi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Pinnola
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carmela Morizzo
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Beatrice Boldrini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Monica Rossi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Trifirò
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Domenico Tricò
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Natali
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Jarrete AP, Zanesco A, Delbin MA. Assessment of endothelial function by flow-mediated dilation in diabetic patients: Effects of physical exercise. MOTRIZ: REVISTA DE EDUCACAO FISICA 2016. [DOI: 10.1590/s1980-65742016000100001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Angelina Zanesco
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Brazil
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27
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Abstract
Acute Kawasaki disease (KD) is diagnosed and treated by pediatricians, but decades later, these individuals are presenting to adult cardiologists with a variety of cardiovascular sequelae, including myocardial ischemia and infarction, congestive heart failure secondary to myocardial fibrosis, and claudication because of vascular insufficiency from thrombosed peripheral arteries. There are no clinical trials to guide management, interventions, and medical therapy in this patient population. This review summarizes the emerging information regarding evaluation of the cardiovascular status of adults decades after childhood KD.
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Affiliation(s)
- Lori B Daniels
- Division of Cardiology, Department of Medicine, University of California, San Diego
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28
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Peripheral Endothelial (Dys)Function, Arterial Stiffness and Carotid Intima-Media Thickness in Patients after Kawasaki Disease: A Systematic Review and Meta-Analyses. PLoS One 2015; 10:e0130913. [PMID: 26161871 PMCID: PMC4498761 DOI: 10.1371/journal.pone.0130913] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/25/2015] [Indexed: 01/22/2023] Open
Abstract
Background Kawasaki disease (KD) is a systemic pediatric vasculitis. Its main complication is the development of coronary arterial aneurysms (CAA), causing an increased risk for ischemia and myocardial infarction. It is unclear whether KD patients, apart from the presence of CAA, have an increased cardiovascular disease (CVD) risk due to the previous systemic vasculitis. The aim of this study was to systematically review and meta-analyse the literature regarding surrogate markers for CVD risk in KD patients. Methods Medline and Embase were searched for articles comparing endothelial dysfunction (flow-mediated dilation, nitroglycerin-mediated dilation and peripheral arterial tonometry), vascular stiffness (stiffness index, pulse wave velocity) and carotid intima-media thickness (cIMT) between patients and controls. Two investigators assessed the articles for eligibility and evaluated quality. Results Thirty studies were included. For all outcomes, moderate to high heterogeneity between studies was found. Most studies reported a decreased flow-mediated dilation in the whole KD- and CAA-positive group compared to controls, while data on CAA-negative patients were conflicting. The stiffness index was increased in the majority of studies evaluating the whole KD- and CAA-positive group, but not in most studies on CAA-negative patients. Mean cIMT was neither significantly increased in the whole KD-group nor in the CAA-positive group nor in most studies studying CAA-negative patients. Studies measuring maximum cIMT were conflicting. Conclusion Literature suggests that surrogate markers for CVD risk in KD patients are increased in CAA-positive but not in CAA-negative patients. This may indicate that CAA-positive patients should be monitored for CVD in later life. The results of this review have to be interpreted with care due to substantial heterogeneity between studies and methodological limitations, as well as the lack of long-term follow-up studies.
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SØNDERGAARD ES, FONNES S, GÖGENUR I. Endothelial dysfunction after non-cardiac surgery: a systematic review. Acta Anaesthesiol Scand 2015; 59:140-6. [PMID: 25348615 DOI: 10.1111/aas.12426] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 09/17/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND More than 50% of patients with increased troponin levels after non-cardiac surgery have an impaired endothelial function pre-operatively. Non-invasive markers of endothelial function have been developed for the assessment of endothelial dysfunction. The aim of this paper was to systematically review the literature to evaluate the association between non-cardiac surgery and non-invasive markers of endothelial function. METHODS A systematic search was conducted in MEDLINE, EMBASE and Cochrane Library Database according to the PRISMA guidelines. Endothelial dysfunction was described only with non-invasive measurements done both pre- and post-operatively and published in English. All types of non-cardiac surgery and both men and women of all ages were included. RESULTS We found 1722 eligible studies in our search, and of these, five studies fulfilled our inclusion and exclusion criteria. Endothelial function was disturbed in patients after non-cardiac surgery. Three studies found a significant decrease in the endothelial function immediately after surgery (2 and 24 h post-operatively). Two studies found that patients with previous endothelial dysfunction and scheduled for surgery (renal transplantation and vascular surgery respectively) had an improvement in endothelial dysfunction 1 month after surgery. CONCLUSION Endothelial function changes in relation to surgery. Assessment of endothelial function by non-invasive measures has the potential to guide clinicians in the prevention or treatment of post-operative myocardial damage.
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Affiliation(s)
| | - S. FONNES
- Centre of Perioperative Optimization; Department of Gastroenterology; Herlev Hospital; University of Copenhagen; Herlev Denmark
| | - I. GÖGENUR
- Department of Surgery; Køge Hospital; University of Copenhagen; Køge Denmark
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30
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Stirban A, Tschöpe D. Vascular Effects of Dietary Advanced Glycation End Products. Int J Endocrinol 2015; 2015:836498. [PMID: 26089897 PMCID: PMC4451780 DOI: 10.1155/2015/836498] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/01/2014] [Indexed: 01/11/2023] Open
Abstract
Evidence has accumulated lately demonstrating that advanced glycation end products (AGEs) play an important role in the development of diabetic and cardiovascular complications as well as the development of other chronic diseases. AGEs originating from diet have a significant contribution to the AGEs body pool and therefore dietary interventions aiming at reducing AGEs load are believed to exert health promoting effects. This review summarizes the evidence from clinical studies regarding effects of dietary AGEs on the vascular system, highlighting also the different aspects of vascular tests. It also advocates an extension of dietary recommendations towards the promotion of cooking methods that reduce dietary AGEs in consumed foods.
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Affiliation(s)
- Alin Stirban
- Profil Institute for Metabolic Research, Hellersbergstraße 9, 41460 Neuss, Germany
- *Alin Stirban:
| | - Diethelm Tschöpe
- Diabetes Clinic, Heart and Diabetes Center NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany
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31
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Johansson PI, Bergström A, Aachmann-Andersen NJ, Meyer MAS, Ostrowski SR, Nordsborg NB, Olsen NV. Effect of acute hypobaric hypoxia on the endothelial glycocalyx and digital reactive hyperemia in humans. Front Physiol 2014; 5:459. [PMID: 25505423 PMCID: PMC4241839 DOI: 10.3389/fphys.2014.00459] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/07/2014] [Indexed: 12/11/2022] Open
Abstract
Introduction: Hypoxia is associated with increased capillary permeability. This study tested whether acute hypobaric hypoxia involves degradation of the endothelial glycocalyx. Methods: We exposed 12 subjects to acute hypobaric hypoxia (equivalent to 4500 m for 2–4 h) and measured venous blood concentrations of biomarkers reflecting endothelial and glycocalyx degradation (catecholamines, syndecan-1, soluble CD40 ligand, protein C, soluble thrombomodulin, tissue-type plasminogen activators, histone-complexed DNA fragments, and nitrite/nitrate). Endothelial function was assessed by the hyperemic response to brachial artery occlusion by peripheral arterial tonometry. Results: Compared with normoxic baseline levels, hypoxia increased concentrations of syndecan-1 from 22 (95% confidence interval: 17–27) to 25 (19–30) ng/ml (p < 0.02) and protein C from 76 (70–83)% to 81 (74–88)% (p < 0.02). Nitrite/nitrate decreased from 23 (18–27) μM at baseline to 19 (14–24) μM and 18 (14–21) μM in hypoxia and recovery, respectively (p < 0.05). Other biomarkers remained unchanged. The post-occlusion/pre-occlusion ratio (reactive hyperemia index, RHI) decreased from 1.80 (1.52–2.07) in normoxia to 1.62 (1.28–1.96) after 2–4 h of hypobaric hypoxia and thereafter increased to 2.43 (1.99–2.86) during normoxic recovery (p < 0.01). Conclusions: The increase in syndecan-1 and protein C suggests that acute hypobaric hypoxia produces a minor degree of glycocalyx degradation and overall cellular damage. After hypoxia RHI rebounded to higher than baseline levels suggesting improved endothelial functionality.
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Affiliation(s)
- Pär I Johansson
- Section for Transfusion Medicine, Capital Region Blood Bank, The Diagnostic Centre, Copenhagen University Hospital (Rigshospitalet) Copenhagen, Denmark ; Department of Surgery, University of Texas Medical School Houston, TX, USA
| | - Anita Bergström
- Department of Neuroanaesthesia, The Neuroscience Centre, Copenhagen University Hospital (Rigshospitalet) Copenhagen, Denmark
| | | | - Martin A S Meyer
- Section for Transfusion Medicine, Capital Region Blood Bank, The Diagnostic Centre, Copenhagen University Hospital (Rigshospitalet) Copenhagen, Denmark
| | - Sisse R Ostrowski
- Section for Transfusion Medicine, Capital Region Blood Bank, The Diagnostic Centre, Copenhagen University Hospital (Rigshospitalet) Copenhagen, Denmark
| | - Nikolai B Nordsborg
- Department of Nutrition, Exercise and Sport, University of Copenhagen Copenhagen, Denmark
| | - Niels V Olsen
- Department of Neuroanaesthesia, The Neuroscience Centre, Copenhagen University Hospital (Rigshospitalet) Copenhagen, Denmark ; BrainLab, Department of Neuroscience and Pharmacology, University of Copenhagen Copenhagen, Denmark
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