Usefulness of colour tissue Doppler imaging in assessing aortic elastic properties in Type 1 diabetic patients

Relationship between Retinal Nerve Fiber Layer Thickness and Aortic Distensibility in Peripheral Arterial Disease Patients

Aim and objective

To evaluate the relationship between aortic distensibility (AD) and aortic stiffness B index (ASBI) with retinal nerve fiber layer (RNFL) thickness measured with HD-OCT in peripheral arterial disease (PAD) patients.

Materials and methods

Twenty-six PAD patients and 22 age-matched healthy control were enrolled. Subjects with PAD were classified into two groups. Patients with diabetes (DM) or hypertension (HT) comprised group I (n = 18) and without DM or HT comprised group II (n = 8). Color Doppler imaging was performed on all patients and PAD was diagnosed by using the ankle-brachial index (ABI). Retinal nerve fiber layer thickness values between control and PAD patients and correlations between RNFL thickness and aortic stiffness parameters (AD and ASBI) were evaluated.

Results

The inferior-nasal and inferior-temporal quadrant were the thickest in healthy subjects and the PAD group. Retinal nerve fiber layer thickness significantly decreased in superior-nasal, temporal, inferior-nasal quadrants in group I than healthy subjects (p < 0.001, p = 0.005, p < 0.001). Temporal and inferior-nasal quadrant thicknesses were statistically significantly thinner in group II than controls (p = 0.02, p < 0.001). The nasal RNFL quadrant was significantly thinner in group I than group II (p = 0.014). The correlation between RNFL thickness and aortic elasticity parameters in each group was not found to be significant.

Conclusion and clinical significance

Isolated PAD without DM or HT may lead to localized RNFL loss in temporal and inferior-nasal quadrants. Aortic elasticity parameters did not seem to be correlated with RNFL thickness in PAD.

How to cite this article

Kumova D, Aktas Z, Eyiol A, et al. Relationship between Retinal Nerve Fiber Layer Thickness and Aortic Distensibility in Peripheral Arterial Disease Patients. J Curr Glaucoma Pract 2021;15(2):86–90.

Aortic Elasticity Evaluated by Pulsed Tissue Doppler Imaging of the Ascending Aorta in Different Diseases: A Systematic Review

Several methods have been applied for the evaluation of aortic elasticity. Pulsed tissue Doppler imaging of the ascending aorta is a noninvasive method applied for the evaluation of aortic elasticity in wide variety of diseases which are reviewed in this study. A comprehensive systematic literature search was carried out in November 2019 using the English databases including PubMed, Scopus, Science Direct, and Embase. All references of eligible articles and published reviews on tissue Doppler imaging were searched for relevant publications. Data were extracted according to predefined criteria (including country of study origin, patient population, number of patients in case and control groups, and results of aortic elasticity evaluation in the specific patient groups compared with controls). Two independent reviewers extracted the data, and the results were checked, compared, and edited by the third reviewer. No formal assessment of the statistics of the primary data was made. The results showed that decreased aortic elasticity is not only present in cardiovascular diseases but also can be identified in diseases of other systems that affect cardiovascular system.

Increased aortic stiffness index in patients with type 1 diabetes without cardiovascular disease compared to controls

PURPOSE

Increased arterial stiffness is an early sign of endothelial dysfunction. Nevertheless, measures of the elastic properties of the aortic root in patients with type 1 diabetes are still lacking. The aim of this study was to compare aortic root stiffness index in type 1 diabetes and healthy controls.

METHODS

Ninety-three patients with type 1 diabetes without cardiovascular diseases were recruited and compared to 33 healthy controls. Aortic root elastic properties were estimated by measuring the systolic and diastolic diameters on M-mode acquisition.

RESULTS

None of the subjects showed alterations of either systolic or diastolic echocardiographic parameters. Patients with type 1 diabetes had a very low prevalence of chronic complications and their metabolic control was good. Significantly increased aortic stiffness index was found in type 1 diabetes compared to controls, and the same different pattern was found in men and women. The presence of type 1 diabetes and increased pulse pressure was significantly associated with aortic stiffness index in a multivariate linear analysis.

CONCLUSION

This study strongly suggests that patients with type 1 diabetes develop aortic root stiffness in the absence of cardiovascular diseases. This alteration may be part of a more generalized arterial dysfunction in type 1 diabetes.

The role of type 2 diabetes mellitus on hypertensive-related aortic stiffness

BACKGROUND

Hypertension is strongly related to arterial stiffness in a cause-effect fashion. Diabetes mellitus is also thought to determine vascular damage, mostly by means of advanced glycosylation end-products (AGEs). Aim of our study was to study the role of type 2 diabetes mellitus (T2DM) as regard ascending aortic elastic properties in hypertensive patients.

METHODS

We prospectively enrolled outpatients with hypertension (n = 99) and type 2 diabetes mellitus plus hypertension (n = 42) without cardiovascular events. They underwent a transthoracic echocardiography to measure aortic diameters, aortic elastic properties (ie, compliance, distensibility, stiffness index, Peterson's elastic modulus, pulse wave velocity, M-mode strain), tissue Doppler imaging (TDI) to calculate diastolic (E' and A') and systolic (S') velocities, and tissue strain. Multivariable analysis was run to assess the association between T2DM and these variables after correcting for possible confounders (age, sex, body mass index [BMI], dyslipidemia).

RESULTS

The two groups did not differ as regards age, sex, BMI, and blood pressure. However, T2DM patients were more likely to be dyslipidemic (43% vs 71%, P = .003). Aortic diameters were similar in the two groups, but the aortic elastic properties significantly more impaired in T2DM group. At multivariable analysis, stiffness index, Peterson's elastic modulus, the TDI waves, and the tissue strain remained associated with the co-presence of T2DM and hypertension.

CONCLUSION

Our data suggest that people suffering from both T2DM and hypertension have more impaired aortic elastic properties than those hypertensive alone. Considering the prognostic role of aortic stiffness, these patients may benefit from a closer follow-up.

Expression of CD4+ CD28null T lymphocytes in children and adolescents with type 1 diabetes mellitus: Relation to microvascular complications, aortic elastic properties, and carotid intima media thickness

BACKGROUND

Cardiovascular risk in type 1 diabetes mellitus (T1DM) is associated with endothelial dysfunction, inflammation, and altered immunity. CD4⁺ CD28^null T-cells are a subset of long-lived cytotoxic CD4⁺ T-lymphocytes with proatherogenic and plaque-destabilizing properties. We hypothesized that the frequency of CD4⁺ CD28^null T-cells may be altered in T1DM and related to vascular complications.

AIM

To assess the percentage of CD4⁺ CD28^null T-lymphocytes in children and adolescents with T1DM and their relation to vascular structure and glycemic control.

METHODS

Totally 100 patients with T1DM were divided into 2 groups according to the presence of microvascular complications and compared with 50 healthy controls. CD4⁺ CD28^null T-lymphocytes were analyzed using flow cytometry. Aortic elastic properties and carotid intima media thickness (CIMT) were assessed.

RESULTS

Aortic stiffness index and CIMT were significantly higher among patients compared with healthy controls while aortic strain and distensibility were decreased. The percentage of CD4⁺ CD28^null T-cells was significantly higher in patients with and without microvascular complications compared with controls. High frequency of CD4⁺ CD28^null T-cells was found among patients with microalbuminuria or peripheral neuropathy. Patients with CD4⁺ CD28^null T-cells ≥10% had higher HbA1c, urinary albumin creatinine ratio, aortic stiffness, and CIMT. CD4⁺ CD28^null T-cells were positively correlated to HbA1c, aortic stiffness index, and CIMT.

CONCLUSIONS

Changes in aortic elastic properties and increased CIMT among young patients with T1DM may enable the recognition of preclinical cardiac impairment. The correlation between CD4⁺ CD28^null T-cells and assessed parameters of vascular structure highlights the role of altered immune response in the occurrence of diabetic vascular complications.

Assessment of the elasticity properties of the ascending aorta in patients with subclinical hypothyroidism by tissue Doppler imaging

OBJECTIVE: We aimed to investigate whether aortic elastic properties were affected in subclinical hypothyroidism (SCH) by using tissue Doppler imaging (TDI). SUBJECTS AND METHODS: Forty-three patients with newly diagnosed SCH and forty-eight healthy controls were included to the study. Systolic and diastolic diameters of the ascending aorta were measured by M-mode transthoracic echocardiography, and the upper wall velocities of ascending aorta and mitral annulus velocities were measured by TDI. Aortic stiffness index (ASI) and aortic distensibility were computed using the formulas accepted in literature. RESULTS: The clinical and demographic features of both groups were comparable. Aortic distensibility was significantly lower, and ASI was significantly higher in SCH patients than in controls. Systolic aortic upper wall velocity (Sao) was also significantly lower in SCH patients. Early (Eao) and late diastolic aortic upper wall (Aao) velocities did not differ between the two groups. Mitral annulus (Sm, Em, and Am) velocities were also similar between the groups. Sao was negatively correlated with ASI, and positively correlated with aortic distensibility. TSH level was positively correlated with ASI, total cholesterol and low-density lipoprotein-cholesterol, and negatively correlated with aortic distensibility and Sao. CONCLUSIONS: In this study, our results showed that SCH is associated with impaired elasticity of the ascending aorta. Elastic properties of the ascending aorta can be directly evaluated by the reproducibly measurement of the upper wall movements of the ascending aorta by TDI in SCH patients.

Mitigation of diabetes-related complications in implanted collagen and elastin scaffolds using matrix-binding polyphenol

There is a major need for scaffold-based tissue engineered vascular grafts and heart valves with long-term patency and durability to be used in diabetic cardiovascular patients. We hypothesized that diabetes, by virtue of glycoxidation reactions, can directly crosslink implanted scaffolds, drastically altering their properties. In order to investigate the fate of tissue engineered scaffolds in diabetic conditions, we prepared valvular collagen scaffolds and arterial elastin scaffolds by decellularization and implanted them subdermally in diabetic rats. Both types of scaffolds exhibited significant levels of advanced glycation end products (AGEs), chemical crosslinking and stiffening -alterations which are not favorable for cardiovascular tissue engineering. Pre-implantation treatment of collagen and elastin scaffolds with penta-galloyl glucose (PGG), an antioxidant and matrix-binding polyphenol, chemically stabilized the scaffolds, reduced their enzymatic degradation, and protected them from diabetes-related complications by reduction of scaffold-bound AGE levels. PGG-treated scaffolds resisted diabetes-induced crosslinking and stiffening, were protected from calcification, and exhibited controlled remodeling in vivo, thereby supporting future use of diabetes-resistant scaffolds for cardiovascular tissue engineering in patients with diabetes.

Wall motion velocities of ascending aorta measured by tissue Doppler imaging in obese children

BACKGROUND

Obesity is associated with the development of early cardiovascular abnormalities such as atherosclerotic lesions. Arterial stiffness may be an indicator of early vascular changes signaling the development of vascular disease. The objective of the current study was to screen aortic elastic properties with tissue Doppler imaging in obese children.

METHODS

We examined 37 obese children and 30 age- and sex-matched normal subjects. Anthropometric measurements and metabolic risk profile were assessed in a physical examination and with blood taking. The subjects were divided into two subgroups: those with and without metabolic syndrome. Internal aortic systolic and diastolic diameters by M-mode echocardiography and aortic systolic upper-wall tissue velocity by tissue Doppler imaging were measured 3 cm above the aortic valve. Aortic distensibility and aortic stiffness index were calculated using accepted formulae.

RESULTS

Aortic stiffness parameters and both tissue Doppler peak systolic and diastolic velocities differed significantly in obese children compared to controls. Among the subgroups, children with metabolic syndrome had a lower aortic stiffness index, aortic distensibility and tissue Doppler velocities. However, only peak diastolic velocities significantly differed between obese children without metabolic syndrome and controls. Homeostatic model scores, diastolic blood pressures and pulse pressures were the strongest to correlate with peak diastolic velocity (r=-0.88, P < 0.001, r=-0.62, P= 0.001 and, r= 0.55, P= 0.001, respectively).

CONCLUSIONS

Tissue Doppler imaging is a feasible and sensitive method to identify aortic stiffness in obese children. Reduced aortic diastolic velocity is the most prominent early vascular change detected in obese children before metabolic syndrome occurs.

Diabetes mellitus and cerebrovascular disease: which are the actual data?

Cerebrovascular disease (CeVD) represents a major cause of morbidity and mortality worldwide. Diabetes mellitus (DM) represents an independent risk factor for CeVD. The aim of the present review is to describe the epidemiology of CeVD in patients with DM and to explain how DM and diabetic autonomic neuropathy can increase the risk of CeVD. The prevention and management of CeVD in the diabetic population are also analyzed.