1
|
Sołtysiak J, Skowrońska B, Maćkowiak-Lewandowicz K, Blumczyński A, Elżbieta K, Ostalska-Nowicka D, Zachwieja J. Ambulatory blood pressure parameters and their association with albuminuria in adolescents with type 1 diabetes mellitus. Pediatr Nephrol 2024:10.1007/s00467-024-06416-3. [PMID: 38864872 DOI: 10.1007/s00467-024-06416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 04/26/2024] [Accepted: 05/16/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND This study aimed to evaluate the blood pressure (BP) status, including arterial stiffness parameters, hemodynamic indicators, circadian profile, and its association with albuminuria in adolescents with type 1 diabetes mellitus (DM1). METHODS The analysis included 46 patients, with diabetes duration of 7.38 ± 3.48 years. Ambulatory blood pressure monitoring (ABPM) was conducted using an oscillometric device, the Mobil-O-Graph, which is a Pulse Wave Analysis Monitor. RESULTS Hypertension (HT) was diagnosed in 31 adolescents (67% of patients), primarily due to isolated nocturnal BP (21 cases, 68% of HT cases). The HT group exhibited significantly increased diastolic load (DL). Pulse wave velocity (PWV, a measure of arterial stiffness) values showed a strong correlation with both peripheral systolic BP (r = 0.954) and central systolic BP (r = 0.838). Additionally, non-dipping status was found in 61% of the HT group. Urinary albumin excretion (UAE) was positively correlated with diastolic BP (particularly nocturnal) peripheral and central BP, DL, heart rate, augmentation index (AIx@75), and nocturnal total vascular resistance (TVR). Diastolic non-dippers exhibited a significant increase in UAE. CONCLUSIONS Hypertension is a common complication in adolescents with type 1 diabetes mellitus, primarily caused by elevated nocturnal diastolic BP. Albuminuria is mainly associated with diastolic BP, especially during the nocturnal period and in cases of diastolic non-dipping status. The association of UAE with AIx@75 and nocturnal TVR suggests the presence of early-stage vascular disease in diabetic adolescents.
Collapse
Affiliation(s)
- Jolanta Sołtysiak
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572, Poznan, Poland.
| | - Bogda Skowrońska
- Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, 60-572, Poznan, Poland
| | - Katarzyna Maćkowiak-Lewandowicz
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572, Poznan, Poland
| | - Andrzej Blumczyński
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572, Poznan, Poland
| | - Kaczmarek Elżbieta
- Department of Bioinformatics and Computational Biology, Poznan University of Medical Sciences, 60-572, Poznan, Poland
| | - Danuta Ostalska-Nowicka
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572, Poznan, Poland
| | - Jacek Zachwieja
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572, Poznan, Poland
| |
Collapse
|
2
|
Godoy-Leite M, Santos FGCD, Penido EAR, Ribeiro KA, Dos Santos LM, Rodrigues-Machado MDG, Rezende BA. Impact of social isolation during COVID-19 on anthropometric data, quality of life, baseline physical activity and aortic pulse wave parameters in children and adolescents in two independent samples. Ital J Pediatr 2023; 49:154. [PMID: 37981678 PMCID: PMC10659065 DOI: 10.1186/s13052-023-01558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/05/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND The social restrictions resulting from the COVID-19 pandemic had a great impact on the routine of children and adolescents, with important consequences such as sleep, eating, and psychological/psychiatric disorders. Even though there are no studies on the subject, it is possible that these changes in habit and routine have also affected arterial stiffness (AS) in this population, which is an important predictor of cardiovascular risk. This study aimed to assess possible changes in AS, anthropometry, and quality of life (QoL) resulting from the COVID-19 pandemic in children and adolescents. METHODS A controlled observational cross-sectional study was performed with 193 children and adolescents aged 9 to 19 years, allocated into two groups: before the pandemic (BPG) and one year after the pandemic (APG), matched by age and sex. Cardiovascular parameters were measured non-invasively by brachial artery oscillometry with a portable device. The main AS indices evaluated were the augmentation index (AIx) and pulse wave velocity (PWV) derived from the aortic pulse wave. QoL was assessed using the Paediatric Quality of Life Inventory version 4.0 (PedsQL 4.0). RESULTS Regarding QoL, the APG showed a worsening in emotional (p = 0.002) and school-related (p = 0.010) aspects. There was no statistically significant difference for most anthropometric parameters, except for the hip circumference, which was higher in the APG group (p < 0.001). The main predictor of AS in the paediatric population, AIx@75, was shown to be increased in the APG group (p < 0.001). Other cardiovascular parameters were also different, such as peripheral (p = 0.002) and central (p = 0.003) diastolic blood pressure, stroke volume (p = 0.010), and total vascular resistance (p = 0.002), which were shown to be decreased in the APG group, while the heart rate was increased (p < 0.001). CONCLUSIONS Our results show that routine changes resulting from the period of social isolation increased cardiovascular risk in children and adolescents, evident by the increase in AIx@75, which is considered to be an important marker of cardiovascular risk in the paediatric population.
Collapse
Affiliation(s)
- Mariana Godoy-Leite
- School of Medical Sciences of Minas Gerais, 275, Alameda Ezequiel Dias, Belo Horizonte, 30130-110, Brazil
| | | | | | - Kennad Alves Ribeiro
- School of Medical Sciences of Minas Gerais, 275, Alameda Ezequiel Dias, Belo Horizonte, 30130-110, Brazil
| | - Luzia Maria Dos Santos
- School of Medical Sciences of Minas Gerais, 275, Alameda Ezequiel Dias, Belo Horizonte, 30130-110, Brazil
| | | | - Bruno Almeida Rezende
- School of Medical Sciences of Minas Gerais, 275, Alameda Ezequiel Dias, Belo Horizonte, 30130-110, Brazil.
| |
Collapse
|
3
|
Nogueira JFL, Teixeira-Viana FC, Barboza-Silva BL, Mendes-Pinto D, Rodrigues-Machado MDG. Advanced Levels of Chronic Venous Insufficiency are Related to an Increased in Arterial Stiffness. Ann Vasc Surg 2023; 96:365-373. [PMID: 37003361 DOI: 10.1016/j.avsg.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Chronic venous insufficiency (CVI) is characterized by progressive inflammatory changes. Inflammatory damage occurs in the veins, adjacent tissues, and can lead to structural changes in the arteries. The aim of this study is to analyze whether the degree of CVI is associated with arterial stiffness. METHODS Cross-sectional study including patients with CVI classified by clinical, etiological, anatomical, and pathophysiological classification (CEAP) 1 to 6. We performed correlation between the degree of CVI, central and peripheral arterial pressure, and arterial stiffness measured by brachial artery oscillometry. RESULTS We evaluated 70 patients, 53 of whom were women with a mean age of 54.7 years. Patients with advanced degrees of venous insufficiency CEAP 4,5,6, had higher levels of systolic, diastolic, central, and peripheral arterial pressures compared to those with early stages (CEAP 1,2,3). The CEAP 4,5,6 group had higher arterial stiffness indices than the CEAP 1,2,3 group: pulse wave velocity (PWV) 9.3 m/s vs. 7.0 m/s, P < 0.001; augmentation pressure (AP) 8.0 mm Hg vs. 6.3 mm Hg; P = 0.04. There was a positive correlation between the degree of venous insufficiency measured by the venous clinical severity score, villalta score and CEAP classification, and the arterial stiffness indices (Spearman's coefficient = 0.62 for PWV and CEAP, P < 0.01). The factors influencing PWV were age, peripheral systolic arterial pressure (SAPp), and AP. CONCLUSIONS There is a correlation between the degree of venous disease and arterial structural changes characterized by arterial pressure and stiffness indices. Degenerative changes secondary to venous insufficiency are associated with impairment of the arterial system, which has implications for the development of cardiovascular disease.
Collapse
Affiliation(s)
- João Flávio Lima Nogueira
- Post-Graduate Program in Health Sciences, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; University Hospital of the Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Flávia Costa Teixeira-Viana
- Post-Graduate Program in Health Sciences, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruna Lorena Barboza-Silva
- Post-Graduate Program in Health Sciences, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Daniel Mendes-Pinto
- Department of Vascular Surgery, Hospital Felicio Rocho, Belo Horizonte, Minas Gerais, Brazil
| | | |
Collapse
|
4
|
Santos FGCD, Godoy-Leite M, Penido EAR, Ribeiro KA, da Gloria Rodrigues-Machado M, Rezende BA. Eating behaviour, quality of life and cardiovascular risk in obese and overweight children and adolescents: a cross-sectional study. BMC Pediatr 2023; 23:299. [PMID: 37328794 PMCID: PMC10276388 DOI: 10.1186/s12887-023-04107-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Childhood obesity is a major cardiovascular risk factor because it predisposes individuals to comorbidities that are implicated in an increased risk of cardiovascular events. Its origin may be related to poor eating habits, such as the intake of foods of low nutritional value or inadequate eating behaviours related to emotional factors. This work aims to evaluate the relationship between the total body mass of children and adolescents and its association with eating habits, quality of life (QoL), and possible changes in early markers of cardiovascular risk. METHODS This was a cross-sectional observational study that evaluated anthropometric and cardiovascular parameters, QoL, and eating behaviour in 181 children and adolescents aged between 5 and 13 years. Participants were stratified according to BMI/age into three groups (Adequate Weight, Overweight, and Obesity). Anthropometry included weight, height, waist and hip circumferences, waist-hip ratio, and waist-height ratio. QoL was assessed using the Peds-QL 4.0 questionnaire, and eating behaviour was assessed using the Children's Eating Behaviour Questionnaire (CEBQ). Cardiovascular parameters were assessed using the Mobil-O-Graph® device, which measures the pulse wave velocity (PWV) and augmentation index (AIx@75) to estimate arterial stiffness (AS), which is considered an early marker of cardiovascular disease. RESULTS In addition to the increase in anthropometric measurements (p < 0.001), the Obesity group exhibited behaviour related to food intake (p < 0.05). When analysing QoL, a worsening in the social domain was also observed in the Obesity group (p < 0.05). However, PWV and AIx@75 did not differ between groups. CONCLUSIONS Eating behaviour is related to the development of childhood obesity. However, early markers of cardiovascular risk related to AS did not change as a function of total body mass in the children evaluated.
Collapse
Affiliation(s)
| | - Mariana Godoy-Leite
- Programa de Pós-Graduação em Ciências da Saúde - Faculdade Ciências Médicas- MG, Belo Horizonte, MG, Brasil
| | | | - Kennad Alves Ribeiro
- Programa de Pós-Graduação em Ciências da Saúde - Faculdade Ciências Médicas- MG, Belo Horizonte, MG, Brasil
| | | | - Bruno Almeida Rezende
- Programa de Pós-Graduação em Ciências da Saúde - Faculdade Ciências Médicas- MG, Belo Horizonte, MG, Brasil.
| |
Collapse
|
5
|
Salomão LP, Magalhães GS, da Silva JFP, Dos Santos LM, Gomes Moura IC, Rezende BA, Rodrigues-Machado MG. Factors associated with arterial stiffness assessed by pulse pressure amplification in healthy children and adolescents: a cross-sectional study. BMC Pediatr 2023; 23:154. [PMID: 37009891 PMCID: PMC10069089 DOI: 10.1186/s12887-023-03942-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/06/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Increasing evidence suggests that reducing pulse pressure amplification (PPA) plays an important role in pathogenesis and progression of cardiovascular disease. This is a cross-sectional, observational, and analytical study in which we evaluated the associated factors with a greater chance of reducing PPA in 136 healthy children and adolescents aged 8 to 19 years old stratified by gender and age group. METHODS Arterial stiffness and vascular and hemodynamic parameters were non-invasively measured using Mobil-O-Graph® (IEM, Stolberg, Germany), a cuff-based oscillometric device. PPA was expressed as the peripheral-to-central pulse pressure ratio (PPp / PPc). Participants with PPA < 1.49 were considered as part of the arterial stiffness group. RESULTS In a univariate model, the increase in total vascular resistance, the reflection coefficient and the augmentation pressure were more likely to have arterial stiffness in all groups. The factors most likely to have arterial stiffness (as assessed by the reduction of the PPA) in the multivariate model were increasing age, the reflection coefficient and cardiac index in the total sample, male group and child and adolescent groups. In addition to age in the female group, cardiac output, stroke volume, and AIx@75 were the factors most likely to present arterial stiffness. CONCLUSIONS The results show for the first time in children and adolescents that the factors most likely to reduce PPA are related to the reflection wave, which determines aortic pressures and, therefore, left ventricular afterload.
Collapse
Affiliation(s)
- Leticia Pereira Salomão
- Programa de Pós-Graduação em Ciências da Saúde - Faculdade Ciências Médicas-MG, Alameda: Ezequiel Dias, n 275. Bairro: Centro, CEP 30130-110, Belo Horizonte/MG, Brasil
| | - Giselle Santos Magalhães
- Programa de Pós-Graduação em Ciências da Saúde - Faculdade Ciências Médicas-MG, Alameda: Ezequiel Dias, n 275. Bairro: Centro, CEP 30130-110, Belo Horizonte/MG, Brasil
| | - José Felippe Pinho da Silva
- Programa de Pós-Graduação em Ciências da Saúde - Faculdade Ciências Médicas-MG, Alameda: Ezequiel Dias, n 275. Bairro: Centro, CEP 30130-110, Belo Horizonte/MG, Brasil
| | - Luzia Maria Dos Santos
- Programa de Pós-Graduação em Ciências da Saúde - Faculdade Ciências Médicas-MG, Alameda: Ezequiel Dias, n 275. Bairro: Centro, CEP 30130-110, Belo Horizonte/MG, Brasil
| | - Isabel Cristina Gomes Moura
- Programa de Pós-Graduação em Ciências da Saúde - Faculdade Ciências Médicas-MG, Alameda: Ezequiel Dias, n 275. Bairro: Centro, CEP 30130-110, Belo Horizonte/MG, Brasil
| | - Bruno Almeida Rezende
- Programa de Pós-Graduação em Ciências da Saúde - Faculdade Ciências Médicas-MG, Alameda: Ezequiel Dias, n 275. Bairro: Centro, CEP 30130-110, Belo Horizonte/MG, Brasil
| | - Maria Glória Rodrigues-Machado
- Programa de Pós-Graduação em Ciências da Saúde - Faculdade Ciências Médicas-MG, Alameda: Ezequiel Dias, n 275. Bairro: Centro, CEP 30130-110, Belo Horizonte/MG, Brasil.
| |
Collapse
|
6
|
Bittencourt JC, Scheinbein GHA, de Oliveira Junior WC, Bassi RL, Moura LB, Correa ALD, de Lima Bernardes RG, Freitas LS, Lemos JC, Gonçalves GKN, Rodrigues-Machado MDG. Arterial stiffness indices, pulse wave velocity and central systolic blood pressure, are able to discriminate between obese and non-obese children. Eur J Pediatr 2023; 182:1403-1415. [PMID: 36680578 PMCID: PMC9862226 DOI: 10.1007/s00431-023-04807-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/09/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023]
Abstract
The objectives of this study were to verify, first, if arterial stiffness indices can discriminate between obese and healthy children. Second, to evaluate arterial stiffness index predictors and hemodynamic parameters in obese children. Arterial stiffness indices evaluated were pulse wave velocity (PWV), central systolic blood pressure (SBPc), and central pulse pressure (PPc). A cross-sectional, descriptive, comparative study design was used. The sample consisted of 78 normal-weight children (8.1 ± 1.96 years) and 58 obese children (9.0 ± 1.87 years). PWV, PPc, and SBPc were significantly higher in the group of obese children than in the control group. The ROC curve analysis showed that maximum PWV and SBPc sensitivity and specificity in differentiating obese from non-obese children occurred at 4.09 m/s and 86.17 mmHg, respectively. PPc did not exhibit a discriminatory capacity between the two groups. Peripheral systolic blood pressure (SBPp), peripheral pulse pressure (PPp), and PPc (R2 = 0.98) were predictors of increased PWV. Augmentation pressure, PPp, and reflection coefficient (R2 = 0.873) were predictors of PPc. Age, augmentation index, total vascular resistance, cardiac index, and mean fat percentage (R2 = 0.801) were predictors of SBPc. CONCLUSION This study shows for the first time that PWV > 4.09 m/s and SBPc > 86.17 mmHg are cut-off points associated with a higher risk of obesity. These results indicate that the simple, rapid, and noninvasive measurement of arterial stiffness adds prognostic information regarding cardiovascular risk, in addition to increased body mass index. WHAT IS KNOWN • Overweight and obesity are strongly associated with comorbidities que contribute to the development of cardiovascular diseases. WHAT IS NEW • This is the first study to show that PWV and SBPc can discriminate obese from non-obese children. These results show that, in addition to an increased BMI, a simple, rapid, and noninvasive measurement of arterial stiffness adds prognostic information on cardiovascular risk.
Collapse
Affiliation(s)
- Juliana Cabral Bittencourt
- Faculty of Medical Sciences of Minas Gerais (FCM-MG), Post-Graduate Program in Health Sciences, Belo Horizonte, MG Brazil
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Helleputte S, Spronck B, Sharman JE, Van Bortel L, Segers P, Calders P, Lapauw B, De Backer T. Central blood pressure estimation in type 1 diabetes: impact and implications of peripheral calibration method. J Hypertens 2023; 41:115-121. [PMID: 36214535 DOI: 10.1097/hjh.0000000000003308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Peripheral blood pressure (BP) waveforms are used for noninvasive central BP estimation. Central BP could assist in cardiovascular risk assessment in patients with type 1 diabetes mellitus (T1DM). However, correct calibration of peripheral BP waveforms is important to accurately estimate central BP. We examined differences in central BP estimated by radial artery tonometry depending on which brachial BP (SBP/DBP vs. MAP/DBP) is used for calibration of the radial waveforms, for the first time in T1DM. METHODS A cross-sectional study in T1DM patients without known cardiovascular disease. Radial artery BP waveforms were acquired using applanation tonometry ( SphygmoCor ) for the estimation of central SBP, central pulse pressure (PP) and central augmentation pressure, using either brachial SBP/DBP or MAP/DBP for the calibration of the radial pressure waveforms. RESULTS Fifty-four patients (age: 46 ± 9.5 years; T1DM duration: 27 ± 8.8 years) were evaluated. Central BP parameters were significantly higher when brachial MAP/DBP-calibration was used compared with brachial SBP/DBP-calibration (7.5 ± 5.04, 7.5 ± 5.04 and 1.5 ± 1.36 mmHg higher central SBP, central PP and central augmentation pressure, respectively, P < 0.001). CONCLUSION In patients with T1DM, there are significant differences in central BP values estimated with radial artery tonometry, depending on the method used for calibration of the radial waveforms. Brachial MAP/DBP-calibration resulted in consistently higher central BP as compared to using brachial SBP/DBP, leading to patient re-stratification. Hence, the accuracy of noninvasive estimation of central BP by radial tonometry is dependent on calibration approach, and this problem must be resolved in validation studies using an invasive reference standard to determine which method best estimates true central BP.
Collapse
Affiliation(s)
- Simon Helleputte
- Faculty of Medicine and Health Sciences, Ghent University, Ghent
- Fonds Wetenschappelijk Onderzoek (FWO) Vlaanderen, Brussels, Belgium
| | - Bart Spronck
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Luc Van Bortel
- Unit of Clinical Pharmacology, Department of Basic and Applied Medical Sciences
| | | | - Patrick Calders
- Faculty of Medicine and Health Sciences, Ghent University, Ghent
| | - Bruno Lapauw
- Faculty of Medicine and Health Sciences, Ghent University, Ghent
- Department of Endocrinology
| | - Tine De Backer
- Faculty of Medicine and Health Sciences, Ghent University, Ghent
- Unit of Clinical Pharmacology, Department of Basic and Applied Medical Sciences
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
8
|
Christoforidis A, Georeli I, Dimitriadou M, Galli-Tsinopoulou A, Stabouli S. Arterial stiffness indices in children and adolescents with type 1 diabetes mellitus: A meta-analysis. Diabetes Metab Res Rev 2022; 38:e3555. [PMID: 35675380 DOI: 10.1002/dmrr.3555] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/16/2022] [Accepted: 03/21/2022] [Indexed: 11/09/2022]
Abstract
AIMS Cardiovascular disease (CVD) represents the most frequent cause of morbidity and mortality among patients with type 1 diabetes mellitus (T1DM). Our aim was to review the evidence and conduct a meta-analysis assessing measures of arterial stiffness by pulse wave velocity (PWV) and augmentation index (AIx) in children and adolescents with T1DM compared to healthy controls. METHODS PubMed and the Cochrane Library were searched for relevant studies published up to 10 May 2021. RESULTS Twenty-one studies were finally included in the meta-analysis. The T1DM group had significantly higher carotid to femoral PWV levels than that of the control group (mean difference [d]: 0.53 CI: 0.35-0.71, P < 0.00001) but with a fair heterogeneity (I 2:73%). By omitting one study with marked heterogeneity, mean difference in cfPWV remained significantly increased in the T1DM group compared to the control group (mean difference [d]: 0.37 CI: 0.27-0.48, P < 0.00001) but with improved heterogeneity (I2 = 26%). Regarding Aix, the T1DM group had a significantly higher AI@75 index than that of the control group (mean difference [d]: 0.28 CI: 0.17-0.39, P < 0.00001) and with no heterogeneity (I 2 = 8%). CONCLUSIONS Youths with T1DM show increased arterial stiffness, either as increased carotid-femoral pulse wave velocity or increased augmentation index, early in their course of life compared to healthy controls. PROSPERO REGISTRATION NUMBER CRD42021253236.
Collapse
Affiliation(s)
| | - Irene Georeli
- Department of Paediatric, Aristotle University, Ippokration General Hospital, Thessaloniki, Greece
| | - Meropi Dimitriadou
- Department of Paediatric, Aristotle University, Ippokration General Hospital, Thessaloniki, Greece
| | | | - Stella Stabouli
- Department of Paediatric, Aristotle University, Ippokration General Hospital, Thessaloniki, Greece
| |
Collapse
|
9
|
Rossi-Monteiro EM, Sefair LR, Lima MC, Nascimento MFL, Mendes-Pinto D, Anschuetz L, Rodrigues-Machado MG. Pediatric obstructive sleep-disordered breathing is associated with arterial stiffness. Eur J Pediatr 2022; 181:725-734. [PMID: 34557975 DOI: 10.1007/s00431-021-04238-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 01/14/2023]
Abstract
The association between obstructive sleep-disordered breathing (oSDB) and arterial stiffness, an independent predictor of cardiovascular outcomes, is not well established in children. This study compared cardiovascular parameters between healthy and oSDB children and aimed to identify predictors of arterial stiffness indices in children with oSDB. Cross-sectional study realized in a tertiary hospital from June 2018 to January 2020. Forty-eight children (3 to 10 years old) with clinical diagnosis of oSDB and indication for adenotonsillectomy and 24 controls were evaluated. Cardiovascular parameters were measured non-invasively by brachial artery oscillometry with a portable device. The main arterial stiffness indices assessed were augmentation index and pulse wave velocity, both derived from the aortic pulse wave. In the oSDB group, the questionnaires Obstructive Sleep Apnea-18 (OSA-18) and Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0) were applied. The oSDB group had higher values of reflection coefficient (p = 0.044) and augmentation index (p = 0.003) than the control group. Stepwise multiple regression analysis revealed that age, female sex, reflection coefficient, and systolic volume were independent predictors of augmentation index. Higher pulse wave velocity values were associated with worse quality of life assessed by PedsQL 4.0 questionnaire. There was no association with OSA-18. The vascular and hemodynamic parameters were similar in both groups.Conclusion: Children with oSDB have increased augmentation index, an independent predictor of cardiovascular outcomes. The early identification of subclinical cardiovascular changes reinforces the importance of treating the disease, as well as changing lifestyle habits, to prevent complications in adulthood. What is Known: • The association between oSDB and cardiovascular risk in adults is well described in the literature. • Children with oSDB, regardless of their weight or sex, have higher PWV values when compared to non-snoring children. What is New: • Children with oSDB have augmented arterial stiffness, evidenced by the increase in AIx@75, measured non-invasively by brachial artery oscillometry with a portable device. • Low quality of life and therefore a high disease burden in children with oSDB may be a risk factor for arterial stiffness.
Collapse
Affiliation(s)
- Eduardo Machado Rossi-Monteiro
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais - FCM-MG, MG, Belo Horizonte, Brazil.,Department of Otorhinolaryngology, Hospital Felício Rocho, Belo Horizonte, MG, Brazil
| | | | - Marcos Correia Lima
- Department of Otorhinolaryngology, Hospital Felício Rocho, Belo Horizonte, MG, Brazil
| | | | - Daniel Mendes-Pinto
- Department of Vascular Surgery, Hospital Felício Rocho, Belo Horizonte, MG, Brazil
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Maria Glória Rodrigues-Machado
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais - FCM-MG, MG, Belo Horizonte, Brazil.
| |
Collapse
|
10
|
Association Between Central-Peripheral Blood Pressure Amplification and Structural and Functional Cardiac Properties in Children, Adolescents, and Adults: Impact of the Amplification Parameter, Recording System and Calibration Scheme. High Blood Press Cardiovasc Prev 2021; 28:185-249. [PMID: 33620672 DOI: 10.1007/s40292-021-00440-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/03/2020] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Systolic blood pressure (SBPA) and pulse pressure amplification (PPA) were quantified using different methodological and calibration approaches to analyze (1) the association and agreement between different SBPA and PPA parameters and (2) the association between these SBPA and PPA parameters and left ventricle (LV) and atrium (LA) structural and functional characteristics. METHODS In 269 healthy subjects, LV and LA parameters were echocardiography-derived. SBPA and PPA parameters were quantified using: (1) different equations (n = 9), (2) methodological approaches (n = 3): brachial sub-diastolic (Mobil-O-Graph®) and supra-systolic oscillometry (Arteriograph®) and aortic diameter waveform re-calibration (RCD; ultrasonography), and (3) using three different calibration schemes: systo-diastolic (SD), calculated mean (CM) and oscillometric mean (OscM). RESULTS SBPA and PPA parameters obtained with different equations, techniques, and calibration schemes show a highly variable association level (negative, non-significant, and/or positive) among them. The association between SBPA and PPA with cardiac parameters were highly variable (negative, non-significant, or positive associations). Differences in BPA parameter data between approaches were more sensitive to the calibration method than to the device used. Both, SBPA and PPA obtained with brachial sub-diastolic technique and calibrated to CM or OscM showed higher levels of association with LV and LA structural characteristics. CONCLUSIONS Our data show that many of the parameters that assume to quantify the same phenomenon of BPA are not related to each other in the different age groups. Both, SBPA and PPA obtained with brachial sub-diastolic technique and calibrated to CM or OscM showed higher levels of association with LV and LA structural characteristics.
Collapse
|
11
|
Cerit MN, Sendur HN, Bolayır B, Cerit ET, Cindil E, Yaşım Aktürk M, Baloş Törüner F, Özhan Oktar S. Evaluation of common carotid artery in type 1 diabetes mellitus patients through speckle tracking carotid strain ultrasonography. Diagn Interv Radiol 2021; 27:195-205. [PMID: 33599210 DOI: 10.5152/dir.2021.20025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE We aimed to evaluate the effectiveness of speckle tracking carotid strain (STCS) technique, which enables measurement of arterial stiffness and strain parameters, in the detection of early atherosclerotic findings in type 1 diabetes mellitus (T1DM). METHODS We prospectively enrolled 30 T1DM patients and 30 age- and sex-matched control participants with no history of cardiovascular disease. All study population underwent carotid ultrasonography. Radial and circumferential movement of the common carotid artery (CCA) in the transverse plane as the well as the radial movement of the CCA in the longitudinal plane were calculated automatically by using the STCS method. In addition, the strain (%), strain rate (per second), and peak circumferential and radial displacements (mm) were calculated. Arterial stiffness parameters, such as elastic modulus, distensibility, arterial compliance, and β-stiffness index, were calculated using the radial measurements. The mean value of the carotid intima media thickness (CIMT) was calculated semi-automatically for each CCA, in the longitudinal plane. We also analyzed the patients' overall body composition. RESULTS T1DM and control groups were compared in terms of strain and stiffness parameters and no statistically significant difference was found (p > 0.05). CIMT was higher in diabetic patients than in the control group (p = 0.039). In both groups, age was correlated with all arterial stiffness and strain parameters (p < 0.05). The duration of diabetes was also correlated with β-stiffness index, distensibility, and elastic modulus in the longitudinal plane (p < 0.05). In the diabetic group, abdominal fat ratio, whole body fat ratio, and fat mass were correlated with radial and circumferential displacement and strain parameters in transverse plane, and radial displacement in longitudinal plane (p < 0.05, for each). Diabetic patients were divided into subgroups according to the presence of nephropathy and dyslipidemia. Although no significant difference was found between the groups in terms of CIMT, patients with nephropathy had higher values for transverse and longitudinal elastic modulus, pulse-wave velocity, and longitudinal β-stiffness index, as well as lower values for longitudinal arterial compliance and distensibility, compared with patients without nephropathy (p < 0.05). Also, patients with dyslipidemia had higher longitudinal β-stiffness and elastic modulus values compared with patients without dyslipidemia (p < 0.05). CONCLUSION STCS ultrasonography is an effective, easy, and noninvasive method for evaluating the arterial elasticity. It may provide an early assessment of atherosclerosis in patients with T1DM, especially in the presence of nephropathy and dyslipidemia; thus, together with CIMT measurement, it may be used more frequently to detect subclinical damage and stratify atherosclerosis.
Collapse
Affiliation(s)
- Mahi Nur Cerit
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Halit Nahit Sendur
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Başak Bolayır
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Emetullah Cindil
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Müjde Yaşım Aktürk
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Füsun Baloş Törüner
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Suna Özhan Oktar
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
12
|
dos Santos LM, Gomes IC, Pinho JF, Neves-Alves CM, Magalhães GS, Campagnole-Santos MJ, Rodrigues-Machado MDG. Predictors and reference equations for augmentation index, an arterial stiffness marker, in healthy children and adolescents. Clinics (Sao Paulo) 2021; 76:e2350. [PMID: 33503191 PMCID: PMC7798126 DOI: 10.6061/clinics/2021/e2350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/29/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To investigate predictors and propose reference equations for the augmentation index normalized to 75 bpm heart rate (AIx@75) in healthy children and adolescents. METHODS This was a cross-sectional, observational study involving 134 healthy children and adolescents aged 9 to 19 years old. Participants were categorized into child (n=53) and adolescent (n=81) groups, as well as into male (n=69) and female (n=65) groups. We evaluated AIx@75, vascular and hemodynamic parameters, anthropometric data, physical activity profile, and quality of life (Peds-QL4.0; physical, emotional, social and school domains). RESULTS The predictors of AIx@75 in the whole sample were age, peripheral diastolic blood pressure (pDBP), mean arterial pressure, pulse pressure amplification (PPA), systolic volume (SV), cardiac index (CI), and pulse wave velocity (PWV; R2=80.47%). In the male group, the predictors of AIx@75 were SV, CI, total vascular resistence (TVR), and PWV (R2=78.56%), while in the female group, they were pDBP, PPA, SV, and PWV (R2=82.45%). In the children, they were pDBP, PPA, SV, and PWV (R2=79.17%), while in the adolescents, they were body mass index, pDBP, PPA, SV, TVR, and PWV (R2=81.57%). CONCLUSION In the present study, we used a representative sample from Belo Horizonte to establish normality values of AIx@75. We also identified, for the first time, independent predictors of AIx@75 in healthy children and adolescents categorized by sex and age. Determining AIx@75 reference equations may facilitate the early diagnosis of preclinical atherosclerosis and allow an objective measure of the vascular effects of therapeutic interventions aimed at modifying cardiovascular risk factors.
Collapse
Affiliation(s)
- Luzia Maria dos Santos
- Programa de Pos-Graduacao em Ciencias da Saude, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, MG, BR
| | - Isabel Cristina Gomes
- Programa de Pos-Graduacao em Ciencias da Saude, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, MG, BR
| | - José Felippe Pinho
- Programa de Pos-Graduacao em Ciencias da Saude, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, MG, BR
| | - Claudia Marotta Neves-Alves
- Programa de Pos-Graduacao em Ciencias da Saude, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, MG, BR
| | - Giselle Santos Magalhães
- Programa de Pos-Graduacao em Ciencias da Saude, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, MG, BR
| | - Maria José Campagnole-Santos
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR
| | - Maria da Glória Rodrigues-Machado
- Programa de Pos-Graduacao em Ciencias da Saude, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, MG, BR
- *Corresponding author. E-mail:
| |
Collapse
|
13
|
Ansell SKD, Jester M, Tryggestad JB, Short KR. A pilot study of the effects of a high-intensity aerobic exercise session on heart rate variability and arterial compliance in adolescents with or without type 1 diabetes. Pediatr Diabetes 2020; 21:486-495. [PMID: 31951305 DOI: 10.1111/pedi.12983] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 11/28/2022] Open
Abstract
Arterial compliance and autonomic regulation are predictors of cardiovascular disease. In adults, both are altered chronically by type 1 diabetes (T1D) and acutely by exercise; however, the effects of T1D and exercise are less clear in adolescents. We measured short-term effects of a high-intensity aerobic interval exercise session on cardiovascular and metabolic variables in normal weight adolescents with T1D or without T1D (Control). Energy expenditure (EE), heart rate variability (HRV), arterial compliance, and blood pressure (BP) were measured before exercise (baseline) and three times over 105 minutes postexercise. The T1D and control groups had similar cardiorespiratory fitness and accelerometer-measured physical activity. The T1D group had higher EE and fat oxidation throughout the trial, but postexercise changes were similar between groups. HRV transiently declined following exercise in both groups, but the T1D group had lower HRV at baseline. Among the measures of arterial compliance, the augmentation index declined postexercise while carotid-femoral pulse wave velocity and large artery elastic index remained unchanged. Central and brachial BP were unchanged following exercise until the final measurement, when a small increase occurred. However, arterial compliance and BP did not differ between groups. These results demonstrate that normal weight adolescents with T1D have impaired autonomic function and increased EE and fat oxidation compared to peers without diabetes who have similar levels of fitness and physical activity. However, acute cardiometabolic responses to exercise are normal in T1D with adequate glycemic control. Changes in arterial compliance and BP may take longer to emerge in relatively healthy adolescents with T1D.
Collapse
Affiliation(s)
- Shai Konnar D Ansell
- Section of Diabetes & Endocrinology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Megan Jester
- College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.,College of Nursing, University of Colorado Denver, Denver, Colorado
| | - Jeanie B Tryggestad
- Section of Diabetes & Endocrinology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kevin R Short
- Section of Diabetes & Endocrinology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| |
Collapse
|
14
|
Keiser T, Gaser D, Peters C, Oberhoffer-Fritz R, Kesting S, von Luettichau I. Short-Term Consequences of Pediatric Anti-cancer Treatment Regarding Blood Pressure, Motor Performance, Physical Activity and Reintegration Into Sports Structures. Front Pediatr 2020; 8:463. [PMID: 32850561 PMCID: PMC7431623 DOI: 10.3389/fped.2020.00463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/02/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Cardiovascular diseases in childhood cancer survivors are known late sequelae following treatment. Arterial stiffness, pulse wave velocity (PWV) and central systolic blood pressure (cSBP) are potential predictors to assess the status of cardiovascular health. Frequent inpatient stays and reduced physical activity (PA) during treatment can lead to noticeable impairments regarding motor skills and physical performance. The present study examined parameters of cardiovascular health, motor performance and the status of integration into sports structures shortly after cessation of treatment. Methods: A cross-sectional, monocentric study was conducted from April to June 2019. Participants (6-18 yrs, mixed cancer entities) during maintenance therapy and follow-up care were recruited. Peripheral and central systolic/diastolic blood pressure (pSBP, pDBP, cSBP) and PWV were assessed using the Mobil-O-Graph®. The MOON test (MOtor performance in pediatric ONcology) was used to scale motor performance. PA levels and status of integration into sports structures were assessed with a questionnaire referring to the KiGGS study. All measured data were compared to published reference values. Results: Forty participants (11.3 ± 3.8 years, 50% female) were recruited 1.6 ± 1.8 years post-treatment. PSBP (z-score: 0.87 ± 0.67, p = 0.003), pDBP (0.83 ± 1.94, p = 0.033) and cSBP (≥8 years: 0.60 ± 1.29, p = 0.011) were significantly increased compared to reference values. PWV was also elevated, but not significantly. Motor performance was reduced in almost all motor abilities. Thirty-six percent of the examined group did not participate in physical education at school to the full extent. Only 17% reported 1 hour of daily moderate-to-vigorous PA as recommended for children and adolescents by the World Health Organization. Half of the participants were active sports club members before treatment, but one third did not resume their former membership. Conclusion: Increased cardiovascular parameters and impaired motor performance shortly after cessation of treatment, physical inactivity, and low rates of integration into regular sports programs highlight the support needed. Young cancer patients should receive early support in coping with physical limitations preferably soon after diagnosis. Motor deficits could be reduced by applying targeted interventions. Furthermore, a regular sports therapy program during in- and outpatient care could increase engagement in PA to possibly counteract risk factors and improve cardiovascular health.
Collapse
Affiliation(s)
- Tina Keiser
- Department of Sports Medicine and Exercise, Justus-Liebig University Gießen, Gießen, Germany
| | - Dominik Gaser
- Department of Sport and Health Sciences, Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany.,Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Christiane Peters
- Department of Sport and Health Sciences, Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany
| | - Renate Oberhoffer-Fritz
- Department of Sport and Health Sciences, Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany
| | - Sabine Kesting
- Department of Sport and Health Sciences, Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany.,Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Irene von Luettichau
- Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, TUM School of Medicine, Technical University of Munich, Munich, Germany
| |
Collapse
|
15
|
Chambers MA, Shaibi GQ, Kapadia CR, Vander Wyst KB, Campos A, Pimentel J, Gonsalves RF, Sandweiss BM, Olson ML. Epicardial adipose thickness in youth with type 1 diabetes. Pediatr Diabetes 2019; 20:941-945. [PMID: 31294894 DOI: 10.1111/pedi.12893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Epicardial adipose thickness (EAT) is increased in adults with type 1 diabetes (T1D) and is thought to contribute to cardiovascular disease (CVD) in this population. Given that CVD risk factors emerge early in life, the purpose of this study was to identify whether EAT is increased in pediatric patients with T1D compared with non-diabetic controls. METHODS Anthropometric data, blood pressure (BP), and EAT were evaluated in 20 youth with T1D and 20 age, sex, and body mass index (BMI) matched healthy controls between the ages of 5 and 18 years. RESULTS EAT was 18.5% higher among youth with T1D compared to healthy controls (1.65 ± 0.44 mm vs 1.37 ± 0.27 mm, P = .02). In the entire cohort, EAT was correlated with age (r = 0.71, P < .001), BMI (r = .69, P < .001), waist circumference (r = 0.60, P < .001), systolic BP (r = .34, P = .03), and diastolic BP (r = 0.41, P = .009). Among youth with T1D, there were no significant correlations between EAT and HbA1c (r = -0.16, P = .50), insulin dose (r = .09, P = .71), or duration of disease (r = 0.06, P = .82). CONCLUSIONS Youth with T1D exhibited significantly higher EAT compared to controls. Increased EAT was associated with adiposity and BP, but not duration of disease, insulin dose, or glycemic control. Increased EAT may represent a pathophysiologic mechanism leading to premature CVD in pediatric patients with T1D.
Collapse
Affiliation(s)
- Melissa A Chambers
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona
| | - Gabriel Q Shaibi
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona.,Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| | - Chirag R Kapadia
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona
| | | | - Amanda Campos
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona.,Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| | - Janiel Pimentel
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona.,Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| | - Robert F Gonsalves
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona
| | - Bryan M Sandweiss
- Children's Heart Center for Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Micah L Olson
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona.,Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| |
Collapse
|
16
|
Podgórski M, Szatko K, Stańczyk M, Pawlak-Bratkowska M, Fila M, Bieniek E, Tkaczyk M, Grzelak P, Łukaszewski M. Two-Dimensional Speckle Tracking Versus Applanation Tonometry in Evaluation of Subclinical Atherosclerosis in Children with Type 1 Diabetes Mellitus. Med Sci Monit 2019; 25:7289-7294. [PMID: 31562737 PMCID: PMC6784626 DOI: 10.12659/msm.916466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Patients with type 1 diabetes mellitus (T1DM) often develop atherosclerosis at an early age. In the subclinical stage of the process, minimal/non-morphological changes can be noticed, but the arterial wall function can be impaired. Applanation tonometry allows to assess the arterial tree stiffness; however, the Two-Dimensional Speckle Tracking (2DST) is an increasingly accepted alternative. This study evaluated arterial wall stiffness using these 2 techniques in children with T1DM. Material/Methods We performed applanation tonometry and carotid arteries sonography with evaluation of the carotid intima-media thickness (cIMT) and use of the 2DST in 50 children with T1DM and in 50 healthy sex- and age-matched controls. We also assessed the reliability of 2DST in 10 random subjects. Results Children with T1DM had increased arterial wall stiffness, which was confirmed by tonometry (PWV: p=0.0386) and 2DST (Strain: p=0.0004; Strain rate: p=0.0081). There was no significant difference in cIMT between groups (0.45±0.06 vs. 0.43±0.05, p=0.073 in children with T1DM and controls, respectively). 2DST presented good intraclass correlation coefficient between researchers and within a single researcher. Conclusions Children with T1DM presenting with subclinical stage of atherosclerosis were found to have arterial wall stiffening. The 2DST, the same as applanation tonometry, allows to recognize this condition but in a more accessible and reproducible manner.
Collapse
Affiliation(s)
- Michał Podgórski
- Department of Diagnostic Imaging, Polish Mothers' Memorial Hospital Research Institute, Łódź, Poland
| | - Katarzyna Szatko
- Department of Diagnostic Imaging, Polish Mothers' Memorial Hospital Research Institute, Łódź, Poland
| | - Małgorzata Stańczyk
- Department of Pediatrics and Immunology with Nephrology Unit, Polish Mothers' Memorial Hospital Research Institute, Łódź, Poland
| | - Monika Pawlak-Bratkowska
- Department of Pediatrics and Immunology with Nephrology Unit, Polish Mothers' Memorial Hospital Research Institute, Łódź, Poland
| | - Michał Fila
- Department of Neurology, Polish Mothers' Memorial Hospital Research Institute, Łódź, Poland
| | - Ewa Bieniek
- Department of Endocrinology and Metabolic Diseases, Polish Mothers' Memorial Hospital Research Institute, Łódź, Poland
| | - Marcin Tkaczyk
- Department of Pediatrics and Immunology with Nephrology Unit, Polish Mothers' Memorial Hospital Research Institute, Łódź, Poland
| | - Piotr Grzelak
- Department of Diagnostic Imaging, Polish Mothers' Memorial Hospital Research Institute, Łódź, Poland
| | - Maciej Łukaszewski
- Department of Diagnostic Imaging, Polish Mothers' Memorial Hospital Research Institute, Łódź, Poland
| |
Collapse
|