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Mangiacapra F, Bressi E, Viscusi MM, Creta A, Di Gioia G, Capuano M, Colaiori I, Di Sciascio G, Ussia GP, Grigioni F. Non-INvasive Functional and Anatomic vascular evaluation for the prediction of coronary artery disease: The NINFA study. Int J Cardiol 2020; 322:16-22. [PMID: 32798626 DOI: 10.1016/j.ijcard.2020.08.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/01/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Endothelial function, as assessed with flow-mediated dilatation (FMD), and carotid intima-media thickness (IMT) correlate with the presence and extent of coronary artery disease (CAD). We investigated the incremental value of a combined evaluation of FMD and IMT in predicting the presence of CAD over traditional cardiovascular risk factors. METHODS A total of 497 consecutive patients undergoing elective coronary angiography were enrolled in this study. Brachial artery FMD and ultrasound-based carotid IMT were evaluated prior to angiography. CAD was defined as the presence of a ≥ 50% stenosis in at least one coronary artery. SYNTAX score was also calculated. Patients were categorized based on the presence of FMD and IMT values below or above gender-specific median. RESULTS Patients with both low FMD and high IMT presented the highest prevalence of CAD, number of diseased vessels, and SYNTAX score. At multivariate analysis, the combination of low FMD and high IMT was the strongest predictor of CAD (OR 3.63, 95% CI 2.19-6.02; p < .001). At ROC curve analysis, the addition of FMD and IMT to a model of traditional risk factors improved the predictive power for the presence of CAD (area under the curve [AUC] of risk factors model 0.715; AUC of risk factors + FMD + IMT 0.780; p < .001). The addition of FMD and IMT to the model of risk factors correctly reclassified 24.9% of patients. CONCLUSIONS A combined evaluation of endothelial function and subclinical atherosclerosis at the carotid artery level improves the ability of traditional risk factors to identify patients with CAD.
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Affiliation(s)
- Fabio Mangiacapra
- Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy.
| | - Edoardo Bressi
- Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy
| | | | - Antonio Creta
- Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy
| | - Giuseppe Di Gioia
- Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy
| | | | - Iginio Colaiori
- Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy
| | | | - Gian Paolo Ussia
- Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy
| | - Francesco Grigioni
- Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy
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Vascular, cardiac and renal target organ damage associated to arterial hypertension: which noninvasive tools for detection? J Hum Hypertens 2020; 34:420-431. [DOI: 10.1038/s41371-020-0307-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/04/2020] [Accepted: 01/27/2020] [Indexed: 01/16/2023]
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Joseph PN, Dorn J, Violanti JM, Andrew ME, Riley WA. Examining the Brachial Artery Reactivity Curve Measured by B-Mode Ultrasound in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Pilot Study. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/154431670502900404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brachial artery reactivity was assessed in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Pilot Study using B-mode ultrasound. Carotid artery intima-media thickness (CIMT), a known subclinical predictor of cardiovascular disease, also was examined in relation to brachial artery reactivity. A continuous scan was performed on the artery for 8 min (1 min of baseline, 4 min of cuff inflation at 40 mmHg greater than systolic pressure, 3 min after cuff release). The sample for analysis (n = 78; 43 men, 35 women) consisted of active-duty police officers from a larger sample in the BCOPS pilot study. Means and standard deviations (SDs) stratified by gender were calculated, along with Pearson's correlations between brachial variables, and with CIMT. Arterial diameters (baseline, pre-cuff release, peak) were significantly different ( p < 0.001) between men and women. Peak arterial dilation occurred at 50.77 ± 21.97 sec (49.67 ± 20.22 cardiac cycles) after cuff deflation in men, and 44.66 ± 24.07 sec (44.57 ± 20.36 cardiac cycles) after cuff deflation in women. Mean common carotid artery IMT and mean maximum IMT of all carotid sites were significantly correlated ( p < 0.01) in men (r = 0.691) and women (r = 0.450). Brachial reactivity measures were inversely correlated with CIMT in women, and in contrast, positively correlated in men.
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Affiliation(s)
- Parveen Nedra Joseph
- Department of Social and Preventive Medicine, School of Public Health and Health Professions, State University of New York University at Buffalo
| | - Joan Dorn
- Department of Social and Preventive Medicine, School of Public Health and Health Professions, State University of New York University at Buffalo
| | - John M. Violanti
- Department of Social and Preventive Medicine, School of Public Health and Health Professions, State University of New York University at Buffalo
| | - Michael E. Andrew
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Ward A. Riley
- B-Mode Ultrasound Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Abstract
Hypertension is a major risk factor for cardiovascular diseases. Optimizing blood pressure results in an overall health outcome. Over the years, the gut microbiota has been found to play a significant role in host metabolic processes, immunity, and physiology. Dietary strategies have therefore become a target for restoring disturbed gut microbiota to treat metabolic diseases. Probiotics and their fermented products have been shown in many studies to lower blood pressure by suppressing nitrogen oxide production in microphages, reducing reactive oxygen species, and enhancing dietary calcium absorption. Other studies have shown that hypertension could be caused by many factors including hypercholesterolemia, chronic inflammation, and inconsistent modulation of the renin-angiotensin system. This review discusses the antihypertensive roles of probiotics and their fermented products via the reduction of serum cholesterol levels, anti-inflammation, and inhibition of angiotensin-converting enzyme. The ability of recombinant probiotics to reduce high blood pressure has also been discussed.
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Ishikawa T, Seki K. The association between oxidative stress and endothelial dysfunction in early childhood patients with Kawasaki disease. BMC Cardiovasc Disord 2018; 18:30. [PMID: 29426283 PMCID: PMC5807819 DOI: 10.1186/s12872-018-0765-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 01/31/2018] [Indexed: 12/22/2022] Open
Abstract
Background Oxidative stress has recently been shown to play an important role in the development of arteriosclerosis in patients with Kawasaki disease (KD); however, no study has investigated this association in early childhood patients with KD. In this study, we evaluated prospectively the association between the levels of oxidative stress and the endothelial function in early childhood patients with KD. Methods We compared the derivatives of reactive oxygen metabolites (ROM), flow-mediated dilatation (FMD), and biological characteristics in a population of 50 children: 10 patients with KD and coronary artery lesions (CAL) (group 1), 15 KD patients without CAL (group 2), and 25 healthy age- and sex-matched children (group 3). Results The median age of all KD children at study enrollment was 6.8 (IQR 4.4–8.2) years. ROM levels were significantly higher in group 1 (p < 0.001) and group 2 (p = 0.004) than in group 3. The %FMD of group 1 (p < 0.001) and group 2 (p = 0.026) was significantly lower than that of group 3. There was a significant negative correlation between ROM and %FMD (r = − 0.60, p < 0.001). A multiple linear regression analysis identified ln-ROM (standardized coefficient = − 0.403, p = 0.043) and total fever duration (standardized coefficient = − 0.413, p = 0.038) as significant determinants of %FMD in the patients with KD. Conclusions Our study suggests that oxidative stress is strongly associated with endothelial dysfunction in early childhood patients with KD. Furthermore, we found that the longer the fever duration, the higher the risk of oxidative stress-induced endothelial dysfunction in these children.
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Affiliation(s)
- Takamichi Ishikawa
- Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
| | - Keigo Seki
- Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
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Bots ML, Evans GW, Tegeler CH, Meijer R. Carotid Intima-media Thickness Measurements: Relations with Atherosclerosis, Risk of Cardiovascular Disease and Application in Randomized Controlled Trials. Chin Med J (Engl) 2017; 129:215-26. [PMID: 26830994 PMCID: PMC4799550 DOI: 10.4103/0366-6999.173500] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Advances in the field of carotid ultrasound have been incremental, resulting in a steady decrease in measurement variability. Improvements in edge detection algorithms point toward increasing automation of CIMT measurements. The major advantage of CIMT is that it is completely noninvasive and can be repeated as often as required. It provides a continuous measure since all subjects have a measurable carotid wall. It is also relatively inexpensive to perform, and the technology is widely available. A graded relation between raising LDL cholesterol and increased CIMT is apparent. Increased CIMT has been shown consistently to relate the atherosclerotic abnormalities elsewhere in the arterial system. Moreover, increased CIMT predicts future vascular events in both populations from Caucasian ancestry and those from Asian ancestry. Furthermore, lipid‑lowering therapy has been shown to affect CIMT progression within 12–18 months in properly designed trials with results congruent with clinical events trials. In conclusion, when one wants to evaluate the effect of a pharmaceutical intervention that is to be expected to beneficially affect atherosclerosis progression and to reduce CV event risk, the use of CIMT measurements over time is a valid, suitable, and evidence‑based choice.
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Affiliation(s)
- Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Bilora F, Zanon E, Casonato A, Bertomoro A, Petrobelli F, Cavraro M, Campagnolo E, Girolami A. Type IIB von Willebrand Disease: Role of Qualitative Defects in Atherosclerosis and Endothelial Dysfunction. Clin Appl Thromb Hemost 2016; 13:384-90. [PMID: 17911189 DOI: 10.1177/1076029607303613] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective. To verify whether a hereditary bleeding tendency, such as von Willebrand disease (vWD) type IIB, protects against the onset of atherosclerosis. Participants and Methods. Twenty-four patients with vWD type IIB and 24 healthy controls, matched for common atherosclerotic risk factors. All patients were evaluated by color Doppler ultrasound of the common carotid, carotid bifurcation, common femoral artery, brachial artery, and abdominal aorta, investigating intima-media thickness (IMT) and presence of plaques in each arterial district. Flow mediated dilation (FMD) of the brachial artery was used to test endothelial function. Results. vWD type IIB patients presented no significant difference in IMT in any arterial district. FMD showed no differences between the 2 groups. Conclusions. The quantitative clotting defect characteristic of vWD type IIB does not seem to protect against atherosclerosis.
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Affiliation(s)
- Franca Bilora
- Clinica Medica II, Università di Padova, Padova, Italy.
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Wu K, Su X, Li G, Zhang N. Antioxidant Carbocysteine Treatment in Obstructive Sleep Apnea Syndrome: A Randomized Clinical Trial. PLoS One 2016; 11:e0148519. [PMID: 26849119 PMCID: PMC4743936 DOI: 10.1371/journal.pone.0148519] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 01/17/2016] [Indexed: 01/22/2023] Open
Abstract
Objective This study aimed to examine the effects of carbocysteine in OSAS patients. Methods A total of 40 patients with moderate to severe obstructive sleep apnea syndrome (OSAS) were randomly divided into two groups. One group was treated with 1500 mg carbocysteine daily, and the other was treated with continuous positive airway pressure (CPAP) at night. Before treatment and after 6 weeks of treatment, all patients underwent polysomnography and completed questionnaires. Treatment compliance was compared between the two groups. Plasma was collected for various biochemical analyses. Endothelial function was assessed with ultrasound in the carbocysteine group. Results The proportion of patients who fulfilled the criteria for good compliance was higher in the carbocysteine group (n = 17) than in the CPAP group (n = 11; 100% vs. 64.7%). Compared with baseline values, the carbocysteine group showed significant improvement in their Epworth Sleepiness Scale score (10.18±4.28 vs. 6.82±3.66; P≤0.01), apnea-hypopnea index (55.34±25.03 vs. 47.56±27.32; P≤0.01), time and percentage of 90% oxygen desaturation (12.66 (2.81; 50.01) vs. 8.9 (1.41; 39.71); P≤0.01), and lowest oxygen saturation level (65.88±14.86 vs. 70.41±14.34; P≤0.01). Similar changes were also observed in the CPAP group. The CPAP group also showed a decreased oxygen desaturation index and a significant increase in the mean oxygen saturation after treatment, but these increases were not observed in the carbocysteine group. Snoring volume parameters, such as the power spectral density, were significantly reduced in both groups after the treatments. The plasma malondialdehyde level decreased and the superoxide dismutase and nitric oxide levels increased in both groups. The endothelin-1 level decreased in the CPAP group but did not significantly change in the carbocysteine group. Ultrasonography showed that the intima-media thickness decreased (0.71±0.15 vs. 0.66±0.15; P≤0.05) but that flow-mediated dilation did not significantly change in the carbocysteine group. Conclusions Oral carbocysteine slightly improves sleep disorders by attenuating oxidative stress in patients with moderate to severe OSAS. Carbocysteine may have a role in the treatment of OSAS patients with poor compliance with CPAP treatment. However, the efficiency and feasibility of carbocysteine treatment for OSAS needs further evaluation. Trial Registration ClinicalTrials.gov NCT02015598
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Affiliation(s)
- Kang Wu
- Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The 1 Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaofen Su
- Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The 1 Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guihua Li
- Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The 1 Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Nuofu Zhang
- Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The 1 Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- * E-mail:
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Aslan AN, Keleş T, Ayhan H, Kasapkara HA, Akçay M, Durmaz T, Sarı C, Baştuğ S, Çakır B, Bozkurt E. The Relationship between Epicardial Fat Thickness and Endothelial Dysfunction in Type I Diabetes Mellitus. Echocardiography 2015; 32:1745-53. [PMID: 25916257 DOI: 10.1111/echo.12960] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND AIM Epicardial adipose tissue (EAT) is a new independent marker of coronary artery disease (CAD). The aim of this study was to investigate the relationship between epicardial fat thickness (EFT) and endothelial dysfunction (ED) in patients with type I diabetes mellitus (TIDM). METHODS AND RESULTS Seventy-six type I diabetic patients (diabetes duration 11.7 ± 8,1 years, aged 30.6 ± 10 years; female/male: 38/38) and 36 healthy controls were enrolled into the study. Fasting plasma glucose (FPG), lipid panel, glycosylated hemoglobin (HbA1C), high-sensitive C-reactive protein (hsCRP), and fibrinogen levels were determined. EFT was measured via two-dimensional (2D) M-mode echocardiography. Endothelial function was assessed as flow-mediated dilatation (FMD) at the brachial artery using high-resolution ultrasound. EFT was significantly higher in patients compared to controls (3.56 ± 0.48 mm vs. 3.03 ± 0.48 mm, P < 0.001). In addition, significant differences were observed between the patient and control groups in terms of FMD (6.70% ± 1.63 vs. 9.99% ± 1.84, respectively, P < 0.001). EFT was shown to be correlated negatively with FMD (r: -0.94, P < 0.001) and positively with hsCRP (r: 0.41, P < 0.001) and fibrinogen (r: 0. 31, P = 0.007). Multiple regression analysis showed EFT to be an independent factor influencing the endothelial function. CONCLUSION There was inverse relationship between EFT and endothelial function in this study. EFT measured easily by transthoracic echocardiography may be a useful parameter in the assessment of patients with TIDM.
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Affiliation(s)
- Abdullah Nabi Aslan
- Department of Cardiology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Telat Keleş
- Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Hüseyin Ayhan
- Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Hacı Ahmet Kasapkara
- Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Murat Akçay
- Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Tahir Durmaz
- Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Cenk Sarı
- Department of Cardiology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Serdal Baştuğ
- Department of Cardiology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Bekir Çakır
- Department of Endocrinology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Engin Bozkurt
- Department of Cardiology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
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Triantafyllidi H, Pavlidis G, Trivilou P, Ikonomidis I, Tzortzis S, Xenogiannis I, Schoinas A, Lekakis J. The Association of Elevated HDL Levels With Carotid Atherosclerosis in Middle-Aged Women With Untreated Essential Hypertension. Angiology 2015; 66:904-10. [DOI: 10.1177/0003319715572679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
High-density lipoprotein cholesterol (HDL-C), a negative risk factor, is positively associated with a decreased risk of coronary heart disease. We investigated the association between high HDL-C levels and target organ damage (TOD) in never treated women with hypertension. We measured HDL-C levels in 117 women followed by estimation of TODs, that is, pulse wave velocity, microalbuminuria, left ventricular mass index, coronary flow reserve, and carotid intima–media thickness (cIMT). Women were divided into 2 groups (HDLH and HDLL), regarding HDL-C quartiles (upper quartile vs the first 3 lower quartiles). In HDLH group (HDL ≥70 mg/dL), cIMT was nonindependently, negatively related to HDL-C (ρ = −.42, P < .05). Using receiver –operating characteristic curve (ROC) analysis in the HDLH group, we concluded that the cutoff value of HDL ≥76.5 mg/dL moderately predicted the absence of carotid atherosclerosis (area under the curve: 0.77, P = .02; confidence interval: 0.57-0.97; sensitivity 73% and specificity 67%). Increased HDL-C may predict the absence of carotid atherosclerosis in middle-age women with untreated essential hypertension and consequently contribute to total cardiovascular risk estimation and treatment planning.
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Affiliation(s)
- Helen Triantafyllidi
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - George Pavlidis
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Paraskevi Trivilou
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Ignatios Ikonomidis
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Stavros Tzortzis
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Iosif Xenogiannis
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Antonios Schoinas
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - John Lekakis
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
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Sandoo A, Kitas GD. A methodological approach to non-invasive assessments of vascular function and morphology. J Vis Exp 2015. [PMID: 25741637 PMCID: PMC4354622 DOI: 10.3791/52339] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The endothelium is the innermost lining of the vasculature and is involved in the maintenance of vascular homeostasis. Damage to the endothelium may predispose the vessel to atherosclerosis and increase the risk for cardiovascular disease. Assessments of peripheral endothelial function are good indicators of early abnormalities in the vascular wall and correlate well with assessments of coronary endothelial function. The present manuscript details the important methodological steps necessary for the assessment of microvascular endothelial function using laser Doppler imaging with iontophoresis, large vessel endothelial function using flow-mediated dilatation, and carotid atherosclerosis using carotid artery ultrasound. A discussion on the methodological considerations for each of the techniques is also presented, and recommendations are made for future research.
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Affiliation(s)
- Aamer Sandoo
- School of Sport, Health and Exercise Sciences, Bangor University; Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital;
| | - George D Kitas
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital; Arthritis Research UK Epidemiology Unit, University of Manchester
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Associations among cerebral microbleeds, cerebral large-artery diseases and endothelial function. Chin Med J (Engl) 2014. [DOI: 10.1097/00029330-201409200-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Bruno RM, Bianchini E, Faita F, Taddei S, Ghiadoni L. Intima media thickness, pulse wave velocity, and flow mediated dilation. Cardiovasc Ultrasound 2014; 12:34. [PMID: 25148901 PMCID: PMC4154051 DOI: 10.1186/1476-7120-12-34] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/18/2014] [Indexed: 12/16/2022] Open
Abstract
The identification of vascular alterations at the sub-clinical, asymptomatic stages are potentially useful for screening, prevention and improvement of cardiovascular risk stratification beyond classical risk factors.Increased intima-media thickness of the common carotid artery is a well-known marker of early atherosclerosis, which significantly correlates with the development of cardiovascular diseases. More recently, other vascular parameters evaluating both structural and functional arterial proprieties of peripheral arteries have been introduced, for cardiovascular risk stratification and as surrogate endpoints in clinical trials. Increased arterial stiffness, which can be detected by applanation tonometry as carotid-femoral pulse wave velocity, has been shown to predict future cardiovascular events and to significantly improve risk stratification.Finally, earlier vascular abnormalities such as endothelial dysfunction in the peripheral arteries, detected as reduced flow-mediated dilation of the brachial artery, are useful in the research setting and as surrogate endpoints in clinical trials and have also been suggested for their possible clinical use in the future.This manuscript will briefly review clinical evidence supporting the use of these different vascular markers for cardiovascular risk stratification, focusing on the correct methodology, which is a crucial issue to address in order to promote their use in future for routine clinical practice.
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Affiliation(s)
- Rosa Maria Bruno
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Francesco Faita
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical & Experimental Medicine, University of Pisa, Via Roma, 67 560110 Pisa, Italy
| | - Lorenzo Ghiadoni
- Department of Clinical & Experimental Medicine, University of Pisa, Via Roma, 67 560110 Pisa, Italy
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Sandoo A, Hodson J, Douglas KM, Smith JP, Kitas GD. The association between functional and morphological assessments of endothelial function in patients with rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther 2014; 15:R107. [PMID: 24010810 PMCID: PMC3979143 DOI: 10.1186/ar4287] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 03/28/2013] [Accepted: 09/06/2013] [Indexed: 01/13/2023] Open
Abstract
Introduction Patients with rheumatoid arthritis (RA) are at an increased risk for cardiovascular disease (CVD). One of the earliest manifestations of CVD is endothelial dysfunction (ED), which can lead to functional and morphological vascular abnormalities. Several non-invasive assessments of vascular function and morphology can be utilised to assess vascular health, but little is known about the association between each of these assessments in patients with RA, and they tend to be used interchangeably in the literature. The objective of the present study was to examine associations between measures of vascular function and morphology in patients with RA. Methods A total of 201 RA patients (155 females, median (25th to 75th percentile) age: 67 (59 to 73)) underwent assessments of microvascular endothelium-dependent and endothelium-independent function (laser Doppler imaging with iontophoresis of acetylcholine and sodium-nitroprusside respectively), macrovascular endothelium-dependent and endothelium-independent function (flow-mediated dilatation and glyceryl-trinitrate-mediated dilation respectively), and vascular morphology (pulse wave analysis, carotid intima-media thickness (cIMT), and carotid plaque). Results Spearman's correlations revealed that from the functional parameters, only macrovascular endothelium-independent function was inversely associated with cIMT (-0.294 (P < 0.001)) after applying the Bonferroni correction for multiple comparisons. For carotid plaque, t tests showed that macrovascular endothelium-independent function was lower in patients with plaque than without (15.5 ± 8.3 vs. 23.1 ± 9.1%, P = 0.002, respectively). Conclusions With the exception of macrovascular endothelium-independent function, all other measures of vascular function were not associated with vascular morphology. This suggests that different assessments of vascular function and morphology in patients with RA reflect quite distinct mechanisms and phases of the atherosclerotic process and should not be used interchangeably.
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Evaluation of Endothelial Function by Flow Mediated Dilation: Methodological Issues and Clinical Importance. High Blood Press Cardiovasc Prev 2014; 22:17-22. [DOI: 10.1007/s40292-014-0047-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/26/2014] [Indexed: 01/08/2023] Open
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Diomedi M, Scacciatelli D, Misaggi G, Balestrini S, Balucani C, Sallustio F, Di Legge S, Stanzione P, Silvestrini M. Increased Common Carotid Artery Wall Thickness Is Associated with Rapid Progression of Asymptomatic Carotid Stenosis. J Neuroimaging 2013; 24:473-8. [DOI: 10.1111/jon.12068] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Marina Diomedi
- Stroke Unit; Neuroscience Department; Tor Vergata University of Rome
- IRCCS; Santa Lucia Foundation; Rome
| | - Daria Scacciatelli
- Center for Biostatistics and Bioinformatics; Tor Vergata University of Rome; Rome
| | - Giulia Misaggi
- Stroke Unit; Neuroscience Department; Tor Vergata University of Rome
| | | | - Clotilde Balucani
- Neurological Clinic; Marche Polytechnic University; Ancona
- Department of Neurology; SUNY Downstate Medical Center; Brooklyn NY
| | | | - Silvia Di Legge
- Stroke Unit; Neuroscience Department; Tor Vergata University of Rome
| | - Paolo Stanzione
- Stroke Unit; Neuroscience Department; Tor Vergata University of Rome
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Lind L. Flow-mediated vasodilation was found to be an independent predictor of changes in the carotid plaque status during a 5-year follow-up. J Atheroscler Thromb 2013; 21:161-8. [PMID: 24126123 DOI: 10.5551/jat.18572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM It has previously been shown that flow-mediated vasodilation is a predictor of the progression of the intima-media thickness (IMT). In the present study, the degree of endothelium-dependent vasodilation in both resistance and conduit arteries was evaluated as a predictor of the IMT and plaque progression. METHODS In the population-based Prospective Study of the Vasculature in Uppsala Seniors(PIVUS) trial(1,016 subjects all 70 years of age), the invasive forearm technique using acetylcholine administered in the brachial artery (resistance artery, EDV) and the brachial artery ultrasound technique with measurement of flow-mediated dilatation (conduit artery, FMD) were evaluated. The IMT and number of carotid arteries with plaques (0, 1 or 2) were recorded using ultrasound at the baseline investigation and the follow-up visit conducted five years later. RESULTS A total of 760 subjects had valid measurements of the IMT and carotid artery plaques at both the investigations conducted at 70 and 75 years of age. Neither the FMD nor EDV significantly predicted the change in IMT over five years. However, the FMD, but not EDV, was associated with the change in carotid plaque burden during the follow-up period, independent of classical risk factors, such as gender, waist circumference, fasting blood glucose, systolic and diastolic blood pressure, HDL- and LDL-cholesterol, serum triglycerides, BMI and smoking (OR 0.81 for a 1 SD change in FMD, 95%CI 0.68 to 0.95, p=0.010). CONCLUSIONS The FMD was found to be a predictor of changes in the carotid plaque status, but not IMT, during the 5-year follow-up period, independent of classical cardiovascular risk factors.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, University Hospital, Uppsala University
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Ishikawa T, Iwashima S. Endothelial dysfunction in children within 5 years after onset of Kawasaki disease. J Pediatr 2013; 163:1117-21. [PMID: 23759425 DOI: 10.1016/j.jpeds.2013.04.046] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/03/2013] [Accepted: 04/23/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate endothelial function in children within 5 years after the onset of Kawasaki disease (KD). STUDY DESIGN A total of 46 children were enrolled prospectively as follows: 9 patients with KD and coronary artery lesions composed group 1, 15 patients with KD but without coronary artery lesions composed group 2, and 22 healthy age- and sex-matched children composed group 3. Flow-mediated dilatation (FMD) of the brachial artery, intima-media thickness of the common carotid artery, and biologic characteristics were compared among the 3 groups. Differences in the factors associated with endothelial function after KD were examined as well. RESULTS The mean age of the study group was 6.5 ± 1.7 years. The patients with KD were studied at a median interval of 3.3 years (IQR, 2.0-4.4 years) from the onset of disease. The percent FMD (%FMD) was significantly lower in group 1 patients (median, 4.4%; IQR, 2.6%-5.7%) compared with both group 2 (median, 9.1%; IQR 6.6%-10.7%; P < .01) and group 3 (median, 11.1%; IQR, 10.1%-13.9%, P < .01). The %FMD was statistically significantly lower in group 2 compared with group 3 (P < .05). There were no significant differences in the intima-media thickness among the 3 groups. There was a significant negative correlation between %FMD and the total duration of fever (r = -0.50; P = .013). CONCLUSION The children with KD already had arterial endothelial dysfunction within 5 years after the onset of illness. The longer the duration of fever, the greater the risk of inflammation-induced endothelial dysfunction.
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Affiliation(s)
- Takamichi Ishikawa
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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Simultaneous assessment of endothelial function and morphology in the brachial artery using a new semiautomatic ultrasound system. Hypertens Res 2013; 36:691-7. [DOI: 10.1038/hr.2013.35] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 01/08/2013] [Accepted: 01/14/2013] [Indexed: 11/09/2022]
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Watanabe T, Takemura M, Sato M, Matsunami H, Seishima M, Shimizu K, Matsuoka T. Clinical significance of brachial flow-mediated dilation in patients with rheumatoid arthritis. Int J Rheum Dis 2013; 17:26-33. [DOI: 10.1111/1756-185x.12021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Tsuneo Watanabe
- Department of Sports Medicine and Sports Science; Gifu University Graduate School of Medicine; Gifu Japan
| | - Masao Takemura
- Department of Informative Clinical Medicine; Gifu University Graduate School of Medicine; Gifu Japan
| | - Masao Sato
- Department of Orthopaedic Surgery; Gifu University Graduate School of Medicine; Gifu Japan
| | | | - Mitsuru Seishima
- Department of Informative Clinical Medicine; Gifu University Graduate School of Medicine; Gifu Japan
| | - Katsuji Shimizu
- Department of Orthopaedic Surgery; Gifu University Graduate School of Medicine; Gifu Japan
| | - Toshio Matsuoka
- Department of Sports Medicine and Sports Science; Gifu University Graduate School of Medicine; Gifu Japan
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Glycemic variability is associated with subclinical atherosclerosis in Chinese type 2 diabetic patients. Cardiovasc Diabetol 2013; 12:15. [PMID: 23316958 PMCID: PMC3561287 DOI: 10.1186/1475-2840-12-15] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/03/2013] [Indexed: 01/15/2023] Open
Abstract
Background The contribution of glycemic variability to macrovascular complications remains unclear. We therefore investigated the association between glycemic variability and cervical and/or intracranial atherosclerosis in Chinese type 2 diabetic patients. Methods We conducted a cross-sectional study in 216 type 2 diabetic patients with a hemoglobin A1c of 8.3 ± 1.7% and a median diabetes duration of 9.0 years. The standard deviation of blood glucose values (SDBG) and the mean amplitude of glycemic excursion (MAGE) were calculated from continuous glucose monitoring system data for assessing glycemic variability while 24h mean blood glucose (MBG) was calculated for measuring overall blood glucose level. Magnetic resonance angiography (MRA) was used to detect cervical and/or intracranial plaque, and ultrasonography was used to quantify carotid intima-media thickness (IMT) as an index of subclinical atherosclerosis. Results One hundred and fifty-three patients (70.8%) presented with cervical and/or intracranial lesions on MRA among 216 patients in the study. Elder age, increased systolic blood pressure, increased MBG and elevated low density lipoprotein cholesterol were independent contributors to plaque formation. In patients without stenosis (n = 63), SDBG (r = 0.412, P = 0.001) and MAGE (r = 0.365, P = 0.005) were both correlated with carotid IMT and these relationships remained significant in multiple linear regression analysis (multiple R2 = 0.314 for the model including SDBG and multiple R2 = 0.268 for the model including MAGE). However, SDBG and MAGE were not significantly different among patients with different stenosis degrees. Conclusions Glycemic variability is associated with subclinical atherosclerosis in Chinese type 2 diabetic patients.
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Irace C, Carallo C, Loprete A, Tripolino C, Scavelli F, Gnasso A. Delayed flow-mediated vasodilation and carotid atherosclerosis. Eur J Clin Invest 2013; 43:49-55. [PMID: 23145798 DOI: 10.1111/eci.12016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In a previous study, we identified temporally distinct postischaemic flow-mediated dilation (FMD) patterns comparing the standard clinical measurement time of 50s postcuff release with measurement at 2 min. The comparison revealed a cohort with the highest FMD at 50s (Early FMD), another cohort with the highest FMD at 2 min (Late FMD) and a third cohort with no FMD (Absent FMD). The aim of this study was to examine whether these temporally distinct FMD patterns associated with different degrees of carotid atherosclerosis. MATERIALS AND METHODS One hundred and twenty-four free-living white subjects, participating in a cardio-vascular disease prevention campaign, were enrolled. FMD was measured at 50s, 2 min and 3 min after forearm ischaemia. The intima-media thickness (IMT) of the common carotid artery was measured, and the artery was evaluated for the presence and number of carotid plaques. RESULTS Fifty-seven subjects had Early FMD, 34 had Late FMD and 33 had Absent FMD. The three groups were comparable for age, sex and cardiovascular risk factors. The number of plaques in the carotid arteries, and IMT, increased progressively from Early, to Late, and to Absent FMD (P < 0·03), indicating that the FMD pattern is an independent predictive variable for IMT and carotid atherosclerosis. CONCLUSIONS The present study demonstrates that temporal patterns associated with the degree of atherosclerosis of the carotid arteries. Patients with delayed vasodilation (Late FMD) had a higher degree of atherosclerosis than those with early vasodilation (Early FMD), and subjects with no postischaemic vasodilation (Absent FMD) had the most atherosclerosis.
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Affiliation(s)
- Concetta Irace
- Dipartimento di Medicina Sperimentale e Clinica G. Salvatore, Magna Graecia University, Catanzaro, Italy.
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Oz F, Elitok A, Bilge AK, Mercanoglu F, Oflaz H. Relationship Between Brachial Artery Flow-Mediated Dilation, Carotid Artery Intima-Media Thickness and Coronary Flow Reserve in Patients With Coronary Artery Disease. Cardiol Res 2012; 3:214-221. [PMID: 28348690 PMCID: PMC5358134 DOI: 10.4021/cr219w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2012] [Indexed: 12/17/2022] Open
Abstract
Background The aim of this study was to assess the relationship between brachial artery flow mediated dilation (FMD), carotid artery intima-media thickness (IMT) and coronary flow reserve (CFR) in patients with coronary artery disease (CAD). Methods Fifty patients with coronary artery disease, except left anterior descending artery (LAD), who showed no cardiac symptoms and 45 control subjects underwent assessment of brachial artery FMD, carotid artery intima-media thickness by high-resolution ultrasound. In addition, transthoracic second harmonic Doppler echocardiography was used to measure CFR. Results All of the parameters were found to be correlated with each other. CFR correlated with brachial artery FMD (r = 0.232, P < 0.05) and with carotid IMT (r = -0.403, P < 0.001). Carotid IMT correlated with brachial artery FMD (r = -0.211, P < 0.05). Conclusion Transthoracic CFR correlated with well-established noninvasive predictors of atherosclerosis and we suggest that it can be used as a surrogate for coronary atherosclerosis.
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Affiliation(s)
- Fahrettin Oz
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ali Elitok
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Kaya Bilge
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Fehmi Mercanoglu
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Huseyin Oflaz
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Abstract
OBJECTIVES Although hypertension has been shown to be one of the most important risk factors for atherosclerosis, data about the presence of subclinical atherosclerosis in normotensive offspring with parental history of hypertension are scarce. Accordingly, the current study was designated to evaluate flow-mediated dilatation and aortic stiffness, which are early signs of atherosclerosis in young subjects with parental history of hypertension. METHODS A total of 140 [corrected] healthy, non-obese subjects in the age group of 18-22 years were included in this study and divided into two groups. The first group included 70 offspring of hypertensive parents and the second group included 70 offspring of normotensive parents as controls. In all subjects, endothelium-dependent and endothelium-independent vasodilatation of the brachial artery and aortic elastic parameters were investigated using high-resolution Doppler echocardiography. RESULTS Offspring of hypertensive parents demonstrated higher values of aortic stiffness (7.1 plus or minus 1.88 and 6.42 plus or minus 1.56, respectively) but lower distensibility (9.47 plus or minus 1.33 and 11.8 plus or minus 3.36 square centimetres per dyne per 106) and flow-mediated dilatation (4.57 plus or minus 1.3 versus 6.34 plus or minus 0.83 percent, p equals 0.0001, respectively) than offspring of hypertensive parents. CONCLUSION We observed blunted endothelium-dependent dilatation and aortic stiffness in offspring of hypertensive parents compared with offspring of normotensive [corrected] parents. This is evident in the absence of overt hypertension and other diseases, suggesting that parental history of hypertension is a risk for subclinical atherosclerosis and it may contribute to the progression to hypertension and overt atherosclerosis in later life.
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Yang HB, Wang Y, Dong MM. Effect of Han-uvulopalatopharyngoplasty on flow-mediated dilatation in patients with moderate or severe obstructive sleep apnea syndrome. Acta Otolaryngol 2012; 132:769-72. [PMID: 22656189 DOI: 10.3109/00016489.2011.653672] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Flow-mediated dilatation (FMD) is decreased in patients with moderate or severe obstructive sleep apnea syndrome (OSAS), and Han-uvulopalatopharyngoplasty (H-UPPP) can improve FMD. OBJECTIVE To evaluate FMD in patients with moderate or severe OSAS and observe the effect of H-UPPP on FMD in these patients. METHODS Forty-nine patients who were first diagnosed with moderate or severe OSAS by polysomnography (PSG) and had no other diseases served as the experimental group, and 35 individuals with normal PSG as the control group. FMD was measured with high-resolution B-mode ultrasonography in the two groups. PSG and FMD were again performed in the experimental group 6 months after H-UPPP. RESULTS FMD was significantly lower in the experimental group than in the control group (6.5 ± 2.1% vs 11.2 ± 2.9%, p < 0.01). FMD was significantly improved 6 months after H-UPPP compared with preoperative FMD (9.7 ± 2.7% vs 6.5 ± 2.1%, p < 0.01).
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Affiliation(s)
- Hai-bo Yang
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, China
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27
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Hays AG, Kelle S, Hirsch GA, Soleimanifard S, Yu J, Agarwal HK, Gerstenblith G, Schär M, Stuber M, Weiss RG. Regional coronary endothelial function is closely related to local early coronary atherosclerosis in patients with mild coronary artery disease: pilot study. Circ Cardiovasc Imaging 2012; 5:341-8. [PMID: 22492483 DOI: 10.1161/circimaging.111.969691] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary endothelial function is abnormal in patients with established coronary artery disease and was recently shown by MRI to relate to the severity of luminal stenosis. Recent advances in MRI now allow the noninvasive assessment of both anatomic and functional (endothelial function) changes that previously required invasive studies. We tested the hypothesis that abnormal coronary endothelial function is related to measures of early atherosclerosis such as increased coronary wall thickness. METHODS AND RESULTS Seventeen arteries in 14 healthy adults and 17 arteries in 14 patients with nonobstructive coronary artery disease were studied. To measure endothelial function, coronary MRI was performed before and during isometric handgrip exercise, an endothelial-dependent stressor, and changes in coronary cross-sectional area and flow were measured. Black blood imaging was performed to quantify coronary wall thickness and indices of arterial remodeling. The mean stress-induced change in cross-sectional area was significantly higher in healthy adults (13.5%±12.8%, mean±SD, n=17) than in those with mildly diseased arteries (-2.2%±6.8%, P<0.0001, n=17). Mean coronary wall thickness was lower in healthy subjects (0.9±0.2 mm) than in patients with coronary artery disease (1.4±0.3 mm, P<0.0001). In contrast to healthy subjects, stress-induced changes in cross-sectional area, a measure of coronary endothelial function, correlated inversely with coronary wall thickness in patients with coronary artery disease (r=-0.73, P=0.0008). CONCLUSIONS There is an inverse relationship between coronary endothelial function and local coronary wall thickness in patients with coronary artery disease but not in healthy adults. These findings demonstrate that local endothelial-dependent functional changes are related to the extent of early anatomic atherosclerosis in mildly diseased arteries. This combined MRI approach enables the anatomic and functional investigation of early coronary disease.
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Affiliation(s)
- Allison G Hays
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
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Brodmann M, Hafner F, Gary T, Seinost G, Pilger E. Impaired endothelial-dependent and endothelium-independent vasodilatation in patients with thromboangiitis obliterans. Clin Appl Thromb Hemost 2012; 19:33-6. [PMID: 22311632 DOI: 10.1177/1076029611435093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Endothelial dysfunction is the key process in the development of atherosclerosis. The aim of our study was to evaluate endothelial dysfunction measured by the noninvasive technique of Celermajer that plays a role in the pathogenesis of thrombangitis obliterans. METHODS A total of 36 patients with thrombangitiis obliterans ([TAO]; mean age 44.9 ± 1.3 years) were compared with 30 healthy individuals (mean age 36.1 ± 1.8 years). High frequency ultrasound was used to measure changes in response to reactive hyperemia (leading to flow-mediated endothelium-dependent dilatation) and in response to 0.4 mg sublingual nitroglycerin ([NTG]; leading to NTG-induced, endothelium-independent dilatation). RESULTS Patients with TAO showed a lower but statistically not significant flow-mediated dilatation and a statistically significant reduced NTG-induced vasodilatation than the control group. CONCLUSION Our results suggest that both mechanisms play a role in patients with TAO, the endothelium-independent impaired vasodilatation even in a more significant way than the impaired endothelium-dependent vasodilatation.
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Affiliation(s)
- M Brodmann
- Department of Internal Medicine, Division of Angiology, Medical University Graz, Graz, Austria.
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Koyoshi R, Miura SI, Kumagai N, Shiga Y, Mitsutake R, Saku K. Clinical Significance of Flow-Mediated Dilation, Brachial Intima-Media Thickness and Pulse Wave Velocity in Patients With and Without Coronary Artery Disease. Circ J 2012; 76:1469-75. [DOI: 10.1253/circj.cj-11-1283] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rie Koyoshi
- Department of Cardiology, Fukuoka University School of Medicine
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine
| | - Naoko Kumagai
- Department of Cardiology, Fukuoka University School of Medicine
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine
| | - Ryoko Mitsutake
- Department of Cardiology, Fukuoka University School of Medicine
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine
- Department of Advanced Therapeutics for Cardiovascular Disease, Fukuoka University School of Medicine
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NIROOMAND OSCUII HANIEH, TAFAZZOLI-SHADPOUR MOHAMMAD, GHALICHI FARZAN. BIOMECHANICAL ANALYSIS OF WALL REMODELING IN ELASTIC ARTERIES WITH APPLICATION OF FLUID–SOLID INTERACTION METHODS. J MECH MED BIOL 2011. [DOI: 10.1142/s0219519407002418] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The effects of age-related hypertrophic remodeling of the thoracic aortic wall on mechanical stresses are quantified using the fluid–solid interaction method. Boundary conditions include physiological flow and pressure waves. Fluid and solid governing equations are solved using the loose coupling method. The results show alteration of hemodynamic and wall mechanical parameters by the remodeling process, including reduction in maximum circumferential stress and lower shear stress fluctuation with smaller portion of negative value and smaller maximum value. Such characteristics are indicators of the reduction of risk of endothelial injury. Remodeling causes elevation of the stress phase angle, an indicator of interaction between shear and circumferential stresses that causes triggering of endothelial cell proliferation, which is necessary for coverage of extra surface required by remodeling. The improvement by remodeling is limited by age-related structural changes such as elastin dysfunction and disorganization of structural components.
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Affiliation(s)
- HANIEH NIROOMAND OSCUII
- Faculty of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | | | - FARZAN GHALICHI
- Biomedical Engineering Group, Sahand University of Technology, Tabriz, Iran
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Koivistoinen T, Virtanen M, Hutri-Kähönen N, Lehtimäki T, Jula A, Juonala M, Moilanen L, Aatola H, Hyttinen J, Viikari JSA, Raitakari OT, Kähönen M. Arterial pulse wave velocity in relation to carotid intima-media thickness, brachial flow-mediated dilation and carotid artery distensibility: the Cardiovascular Risk in Young Finns Study and the Health 2000 Survey. Atherosclerosis 2011; 220:387-93. [PMID: 21871623 DOI: 10.1016/j.atherosclerosis.2011.08.007] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 07/11/2011] [Accepted: 08/01/2011] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Increased arterial pulse wave velocity (PWV) is a strong predictor of cardiovascular events and mortality. The data regarding the relationships between PWV and other indices of vascular damage is limited and partly controversial. We conducted the present study to examine PWV in relation to non-invasive measures of early atherosclerosis (brachial flow-mediated dilation [FMD], carotid intima-media thickness [IMT]) and local arterial stiffness (carotid artery distensibility [Cdist]). METHODS The study population consisted of 1754 young adults (aged 30-45 years, 45.5% males) participating in the Cardiovascular Risk in Young Finns Study (YFS), and of 336 older adults (aged 46-76 years, 43.2% males) participating in the Health 2000 Survey. FMD was measured only in the YFS cohort. FMD, IMT and Cdist were assessed by ultrasound, and PWV was measured using the whole-body impedance cardiography device. RESULTS In young adults, FMD and IMT were not associated with PWV independently of cardiovascular risk factors. Moreover, FMD status was not found to modulate the association between cardiovascular risk factors and PWV. In older adults, PWV and IMT were directly and independently associated (β=1.233, p=0.019). In both cohorts, PWV was inversely related with Cdist, and this relation remained significant (p<0.04) in models adjusted for cardiovascular risk factors. CONCLUSIONS The current findings suggest that PWV reflects a different aspect of vascular damage than FMD or IMT in young adults, whereas in older adults the information provided by PWV and IMT may be, to some extent, similar as regards subclinical vascular damage. The present observations also suggest that PWV and Cdist represent, at least in part, a similar adverse vascular wall process.
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Affiliation(s)
- Teemu Koivistoinen
- Department of Clinical Physiology, University of Tampere and Tampere University Hospital, FI-33521, Tampere, Finland.
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Peters SAE, Grobbee DE, Bots ML. Carotid intima–media thickness: a suitable alternative for cardiovascular risk as outcome? ACTA ACUST UNITED AC 2011; 18:167-74. [PMID: 21568017 DOI: 10.1177/1741826710389400] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surrogate markers for cardiovascular disease might be of great value in observational research, clinical trials, and clinical practice. Carotid intima-media thickness (CIMT) is probably the most commonly used marker for atherosclerotic disease as an alternative for cardiovascular morbidity and mortality. A suitable marker for atherosclerosis, however, should meet several criteria before it can be validly used. METHODS AND RESULTS We reviewed the literature following a set of criteria for a surrogate marker. These include a comparison with a 'gold standard'; adequate reproducibility; cross-sectional relations with established risk factors and prevalent disease; relations with severity of atherosclerosis elsewhere in the arterial system; relations with the occurrence with future events; ability for a biomarker to change over time; ability to be affected by interventions over time; and relations between change over time in biomarker level and change in risk. A large number of studies from a variety of populations provide evidence for the validity of CIMT as a suitable measure of atherosclerotic disease. Data on the relation between change in CIMT and change in risk, however, is much sparser. CONCLUSION CIMT progression meets the criteria of a surrogate for cardiovascular disease endpoints and may be considered as a valid alternative for cardiovascular events as outcome. Further studies should examine the association between changes in CIMT and changes in risk for future events.
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Affiliation(s)
- Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands.
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Vedovetto V, Bilora F, Chemello L, Cavalletto L, Rossato A, Veronese F, Gottardo A, Pagnan A. Alterazioni neurovascolari nell’epatite cronica C: uno studio caso-controllo. ITALIAN JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.itjm.2010.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Bassareo PP, Fanos V, Puddu M, Demuru P, Cadeddu F, Balzarini M, Mercuro G. Reduced brachial flow-mediated vasodilation in young adult ex extremely low birth weight preterm: a condition predictive of increased cardiovascular risk? J Matern Fetal Neonatal Med 2011; 23 Suppl 3:121-4. [PMID: 20925458 DOI: 10.3109/14767058.2010.506811] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Sporadic data present in literature report how preterm birth and low birth weight constitute the risk factors for the development of cardiovascular diseases in later life. AIM To assess the presence of potential alterations to endothelial function in young adults born preterm at extremely low birth weight (<1000 g; ex ELBW). METHOD Thirty-two ex-ELBW subjects (10 males [M] and 22 females [F], aged 17-28 years, mean [+/- DS] 20.1 +/- 2.5 years) were compared with 32 healthy, age-matched subjects born at term (C, 9 M and 23 F). EXCLUSION CRITERIA 1) pathological conditions known to affect endothelial function; 2) administration of drugs known to affect endothelial function. Endothelial function was assessed by non-invasive finger plethysmography, previously validated by the US Food and Drug Administration (Endopath; Itamar Medical Ltd., Cesarea, Israel). RESULTS Endothelial function was significantly reduced in ex-ELBW subjects compared to C (1.94 +/- 0.37 vs. 2.68 +/- 0.41, p < 0.0001). Moreover, this function correlated significantly with gestational age (r = 0.56, p < 0.0009) and birth weight (r = 0.63, p < 0.0001). CONCLUSIONS The results obtained reveal a significant decrease in endothelial function of ex-ELBW subjects compared to controls, underlining a probable correlation with preterm birth and low birth weight. Taken together, these results suggest that an ELBW may underlie the onset of early circulatory dysfunction predictive of increased cardiovascular risk.
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Affiliation(s)
- P P Bassareo
- Department of Cardiovascular and Neurological Sciences, University of Cagliari, Policlinico Universitario, S.S. 554, Bivio di Sestu, Monserrato, Cagliari, Italy.
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Ritt M, Harazny JM, Ott C, Raff U, Schneider MP, Michelson G, Schmieder RE. Basal nitric oxide activity is an independent determinant of arteriolar structure in the human retinal circulation. J Hypertens 2011; 29:123-9. [DOI: 10.1097/hjh.0b013e3283406940] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nardi F, Verna E, Secco GG, Rognoni A, Sante Bongo A, Iraghi G, Bertuol S, Lupi A. Variant angina associated with coronary artery endothelial dysfunction and myocardial bridge: a case report and review of the literature. Intern Med 2011; 50:2601-6. [PMID: 22041365 DOI: 10.2169/internalmedicine.50.6086] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The association of variant angina (VA) and myocardial bridges is a rare finding. We describe a case of VA with recurrent coronary spasm triggered by different stimuli at the site of a myocardial bridge. The interplay of endothelial dysfunction, coronary vasoconstriction and myocardial bridging was detected by intracoronary acetylcholine test and IVUS. We speculate that mechanical stimulation at the bridge site caused endothelial dysfunction and enhanced local susceptibility to vasoconstrictor stimuli. Variant angina should always be suspected in cases of ST-elevation acute coronary syndrome without any significant angiographic coronary stenosis.
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Gunes Y, Tuncer M, Guntekin U, Ceylan Y, Simsek H, Sahin M, Yildirim M. The relation between the color M-mode propagation velocity of the descending aorta and coronary and carotid atherosclerosis and flow-mediated dilatation. Echocardiography 2010; 27:300-5. [PMID: 20486958 DOI: 10.1111/j.1540-8175.2009.01019.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Common carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilatation (FMD) have correlated with coronary atherosclerosis. Recently, the color M-mode-derived propagation velocity of descending thoracic aorta (AVP) was shown to be associated with coronary artery disease (CAD). METHODS CIMT, FMD, and AVP were measured in 92 patients with CAD and 70 patients having normal coronary arteries (NCA) detected by coronary angiography. Patients with acute myocardial infarction, renal failure or hepatic failure, aneurysm of aorta, severe valvular heart disease, left ventricular ejection fraction <40%, atrial fibrillation, frequent premature beats, left bundle branch block, and inadequate echocardiographic image quality were excluded. RESULTS Compared to patients with normal coronary arteries, patients having CAD had significantly lower AVP (29.9 +/- 8.1 vs. 47.5 +/- 16.8 cm/sec, P < 0.001) and FMD (5.3 +/- 1.9 vs. 11.4 +/- 5.8%, P < 0.001) and higher CIMT (0.94 +/- 0.05 vs. 0.83 +/- 0.14 mm, P < 0.001) measurements. There were significant correlations between AVP and CIMT (r =-0.691, P < 0.001), AVP and FMD (r = 0.514, P < 0.001) and FMD and CIMT (r =-0.530, P < 0.001). CONCLUSIONS The transthoracic echocardiographic determination of the color M-mode propagation velocity of the descending aorta is a simple practical method and correlates well with the presence of carotid and coronary atherosclerosis and brachial endothelial function.
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Affiliation(s)
- Yilmaz Gunes
- Cardiology Department, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey. mail:
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Unverdorben M, von Holt K, Winkelmann BR. Smoking and atherosclerotic cardiovascular disease: part III: functional biomarkers influenced by smoking. Biomark Med 2010; 3:807-23. [PMID: 20477716 DOI: 10.2217/bmm.09.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Smoking cigarettes induces rapidly occurring and reversible functional changes in the cardiovascular system, which precede morphologic changes. These functional changes are also related to atherosclerotic disease development and thus may qualify as prognostic parameters in chronic smokers. As opposed to smoking-induced morphologic changes functional alterations occur and revert within minutes, thus, allowing for the detection of smoking-induced effects on the cardiovascular system within minutes following exposure to mainstream smoke. Some alterations represent 'direct' changes (e.g., endothelial function), others reflect changes in a different organ system (e.g., the autonomous nervous system influencing heart rate variability), while some represent the sum of alterations in many organs and systems (e.g., exercise performance influenced by the autonomous nervous and by endothelial and cardiac function). Since a specific functional parameter usually changes with at least one or several others, caution should be exercised when trying to establish a direct cause relationship between the alteration of a single parameter and a clinical outcome.
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Affiliation(s)
- Martin Unverdorben
- Clinical Research Institute, Center for Cardiovascular Diseases, Heinz-Meise-Strasse 100, 36199 Rotenburg an der Fulda, Germany.
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Soltesz P, Bereczki D, Szodoray P, Magyar MT, Der H, Csipo I, Hajas A, Paragh G, Szegedi G, Bodolay E. Endothelial cell markers reflecting endothelial cell dysfunction in patients with mixed connective tissue disease. Arthritis Res Ther 2010; 12:R78. [PMID: 20459625 PMCID: PMC2911856 DOI: 10.1186/ar2999] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 02/22/2010] [Accepted: 05/06/2010] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The aim of the present study was to investigate the association between cardiovascular risk factors and endothelial dysfunction in patients with mixed connective tissue disease (MCTD) and to determine which biomarkers are associated with atherosclerotic complications, such as cardiovascular disease. METHODS Fifty MCTD patients and 38 healthy age-matched and sex-matched controls were enrolled in this study. In order to describe endothelial dysfunction, we assessed flow-mediated dilation (FMD), nitrate-mediated dilation (NMD) and carotid artery intima-media thickness (IMT). We investigated FMD of the brachial artery after reactive hyperemia and NMD after sublingual nitroglycerin administration, while the IMT of the common carotid artery was determined by ultrasound. Anti-U1 ribonucleoprotein (anti-U1RNP) antibodies, anti-cardiolipin (anti-CL) antibodies, anti-endothelial cell antibody (AECA) and endothelial cell markers, such as soluble thrombomodulin (TM) and von Willebrand factor antigen (vWFAg), were assessed. RESULTS The endothelium-dependent vasodilation (FMD) was significantly impaired in patients with MCTD, as compared with controls (%FMD: 4.7+/-4.2% vs. 8.7+/-5.0%; P<0.001), while the percentage NMD did not differ (%NMD: 14.3+/-6.6% vs. 17.1+/-6.7%; P=0.073). Mean carotid IMT values were higher in patients than in controls (IMT: MCTD, 0.64+/-0.13 mm vs. controls, 0.53+/-0.14 mm; P<0.001). FMD negatively correlated with disease duration, the levels of apolipoprotein A1, the paraoxonase-1 activity, and systolic blood pressure in MCTD patients. The percentage FMD was significantly lower in MCTD patients with cardiovascular diseases (CVD), than in those without CVD (%FMD: 3.5+/-2.9 vs. 5.8+/-4.8, P<0.0002), while percentage NMD did not differ between patients with and without CVDs. Serum levels of autoantibodies (anti-U1RNP, AECA and anti-CL) were significantly higher in MCTD patients and differed between MCTD patients with and without CVD. Endothelial cell markers such as soluble TM (12.2+/-8.1 ng/ml vs. 3.2+/-1.3 ng/ml; P<0.001) and vWFAg (224.1+/-115% vs. 89.4+/-27.1%, P<0.001) were the highest in MCTD patients with CVD. CONCLUSIONS FMD is a reliable sensitive marker of endothelial cell dysfunction in MCTD. Beside the traditional risk factors, anti-U1RNP, AECA and anti-CL antibodies may be important not only in the pathogenesis of MCTD but in the induction of endothelial cell activation, and may play crucial roles in the development of early atherosclerosis in MCTD.
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Affiliation(s)
- Pal Soltesz
- 3rd Department of Medicine, Medical and Health Science Center, University of Debrecen, Moricz Zs. Str. 22, Debrecen 4032, Hungary
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University of Budapest, Balassa Str. 6, Budapest 1083, Hungary
| | - Peter Szodoray
- Institute of Immunology, Rikshospitalet, University of Oslo, Sognsvannsveien Str. 20, Oslo 0027, Norway
| | - Maria T Magyar
- Department of Neurology, Medical and Health Science Center, University of Debrecen, Moricz Zs. Str. 22, Debrecen 4032, Hungary
| | - Henrietta Der
- 3rd Department of Medicine, Medical and Health Science Center, University of Debrecen, Moricz Zs. Str. 22, Debrecen 4032, Hungary
| | - Istvan Csipo
- 3rd Department of Medicine, Medical and Health Science Center, University of Debrecen, Moricz Zs. Str. 22, Debrecen 4032, Hungary
| | - Agota Hajas
- 3rd Department of Medicine, Medical and Health Science Center, University of Debrecen, Moricz Zs. Str. 22, Debrecen 4032, Hungary
| | - Gyorgy Paragh
- 1st Department of Medicine, Medical and Health Science Center, University of Debrecen, Nagyerdei Str. 98, Debrecen 4032, Hungary
| | - Gyula Szegedi
- 3rd Department of Medicine, Medical and Health Science Center, University of Debrecen, Moricz Zs. Str. 22, Debrecen 4032, Hungary
| | - Edit Bodolay
- 3rd Department of Medicine, Medical and Health Science Center, University of Debrecen, Moricz Zs. Str. 22, Debrecen 4032, Hungary
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Konrad T, Franke S, Schneider F, Bär F, Vetter G, Winkler K. Nocturnal blood pressure but not insulin resistance influences endothelial function in treated hypertensive patients. J Hum Hypertens 2010; 25:18-24. [DOI: 10.1038/jhh.2010.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Tzortzis S, Ikonomidis I, Lekakis J, Papadopoulos C, Triantafyllidi H, Parissis J, Trivilou P, Paraskevaidis I, Anastasiou-Nana M, Kremastinos DT. Incremental predictive value of carotid intima–media thickness to arterial stiffness for impaired coronary flow reserve in untreated hypertensives. Hypertens Res 2010; 33:367-73. [DOI: 10.1038/hr.2010.2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Guntekin U, Gunes Y, Gunes A, Ceylan Y, Gumrukcuoglu HA, Yucel Y, Simsek H, Tuncer M. Noninvasive Assessment of Atherosclerosis in Patients with Isolated Hypertension. Echocardiography 2010; 27:155-60. [DOI: 10.1111/j.1540-8175.2009.00987.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Iijima K, Hashimoto H, Hashimoto M, Son BK, Ota H, Ogawa S, Eto M, Akishita M, Ouchi Y. Aortic arch calcification detectable on chest X-ray is a strong independent predictor of cardiovascular events beyond traditional risk factors. Atherosclerosis 2009; 210:137-44. [PMID: 20006335 DOI: 10.1016/j.atherosclerosis.2009.11.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 10/30/2009] [Accepted: 11/09/2009] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Arterial calcification makes the management of hemodynamics more difficult. Some reports have previously shown that simple assessment of aortic calcification using plain radiography is associated with cardiovascular (CV) events; however, these studies simply assessed whether aortic calcification was present or absent only, without considering its extent. Here, we evaluated validity of grading aortic arch calcification (AAC) to predict new CV events. METHODS AND RESULTS We retrospectively reviewed chest X-rays in 239 asymptomatic out-patients who underwent measurement of endothelial function at the 1994-2000 without past history of CV events. The extent of AAC was divided into four grades (0-3). Among these subjects, the follow-up of CV events in 209 patients was completed. At baseline, AAC grade was positively related to age, pulse pressure, diabetes and renal dysfunction. Impairment of endothelial function, as determined by flow-mediated dilation (FMD), was also correlated to increasing AAC grade. Fifty-seven CV events in total occurred during a mean follow-up period of 69+/-45 months. With multivariate adjustment, Kaplan-Meier analysis showed that the incidence was significantly higher in patients with higher AAC grade (grades 2 and 3) than in those with grade 0 or 1 (p<0.01, log-rank test). Two kinds of multivariate Cox-proportional hazards analyses showed the predictive values of AAC grade were significant (hazard ratio, 2.49; p=0.01, 2.56; p<0.01, respectively), and the predictive power was superior to that of renal dysfunction or FMD. In addition, the prediction was valuable even in patients without CKD. CONCLUSIONS AAC detectable on chest X-ray is a strong independent predictor of CV events beyond traditional risk factors including endothelial dysfunction. Risk stratification by assessment of AAC may provide important information for management of atherosclerotic disease.
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Affiliation(s)
- Katsuya Iijima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Versari D, Daghini E, Virdis A, Ghiadoni L, Taddei S. Endothelial dysfunction as a target for prevention of cardiovascular disease. Diabetes Care 2009; 32 Suppl 2:S314-21. [PMID: 19875572 PMCID: PMC2811443 DOI: 10.2337/dc09-s330] [Citation(s) in RCA: 359] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Daniele Versari
- Department of Internal Medicine, University of Pisa, Pisa, Italy
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Stapleton CH, Green DJ, Cable NT, George KP. Flow-mediated dilation and intima-media thickness of the brachial and axillary arteries in individuals with and without inducible axillary artery compression. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1443-1451. [PMID: 19616367 DOI: 10.1016/j.ultrasmedbio.2009.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 02/25/2009] [Accepted: 03/26/2009] [Indexed: 05/28/2023]
Abstract
The presence of axillary artery aneurysm and/or thrombus in overhead throwing athletes has been linked, theoretically, with the finding of compression by the humeral head induced by a diagnostic arm maneuver. However, whether this intermittent compression is incidental or of pathological significance has yet to be determined. Flow-mediated vasodilation (FMD), intima-media thickness (IMT) and maximum vasodilatory capacity were measured locally (3rd portion of the axillary artery) and downstream (brachial artery) in individuals previously tested for inducible axillary artery compression (compressor group [COMP]: n=8, mean (SD) age: 23 (4) y; "noncompressor" control group [NONCOMP]: n=8, 26 (4) y). A high-resolution ultrasound machine recorded arterial diameter and blood flow velocity. A rapid inflation/deflation pneumatic cuff placed distal to the site of measurement induced reactive hyperemia. Custom-designed wall tracking software with synchronized Doppler waveform analysis detected changes in arterial diameter, blood flow velocity and shear rate from baseline to 3min after cuff deflation. Glyceryl trinitrate and/or ischemic hand grip exercises were administered to induce maximum vasodilation. No significant differences in FMD, IMT or maximum vasodilator capacity were observed between groups at the axillary artery. However, the downstream brachial FMD response was significantly diminished in the COMP group (6.38 [3.28]%) compared with the NONCOMP group (10.38 [2.74]%; p=0.006) despite a comparable shear rate between groups (COMP: 81.92 (44.55) s(-1); NONCOMP: 83.18 (40.02) s(-1); p=0.961). Pooled data revealed a significant negative relationship (r=-0.52, p=0.038) between the FMD response and degree of arterial compression. These results suggest a chronic change in downstream vascular function in individuals demonstrating clinically significant inducible axillary artery compression.
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Affiliation(s)
- C H Stapleton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK.
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Lind L, Andersson J, Hansen T, Johansson L, Ahlström H. Atherosclerosis measured by whole body magnetic resonance angiography and carotid artery ultrasound is related to arterial compliance, but not to endothelium-dependent vasodilation - the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Clin Physiol Funct Imaging 2009; 29:321-9. [DOI: 10.1111/j.1475-097x.2009.00871.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ghosh P, Kumar A, Kumar S, Aggarwal A, Sinha N, Misra R. Subclinical atherosclerosis and endothelial dysfunction in young South-Asian patients with systemic lupus erythematosus. Clin Rheumatol 2009; 28:1259-65. [PMID: 19618302 DOI: 10.1007/s10067-009-1228-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 06/09/2009] [Accepted: 06/29/2009] [Indexed: 01/05/2023]
Abstract
Patients with systemic lupus erythematosus (SLE), especially Asian Indians, are at increased risk of developing premature atherosclerosis. To find out the prevalence and predictors of carotid intima-medial thickness (IMT) and brachial artery flow-mediated dilatation (FMD). Endothelial dysfunction was assessed by FMD in brachial artery and IMT was measured in common carotid artery in SLE patients and healthy controls. Sixty SLE patients (mean age 31 +/- 9 years) and 38 healthy controls (mean age 34 +/- 6 years) were included. The IMT was higher in SLE patients as compared to controls (0.49 +/- 0.08 mm vs. 0.39 +/- 0.05 mm, p < 0.0001). SLE and damage were independent predictors of abnormal IMT. FMD was impaired in SLE patients compared to controls (9.97% vs. 18.97%, p < 0.00001). None of the classical cardiovascular risk factors were predictors of FMD or abnormal IMT. Indian patients with SLE have higher prevalence of subclinical atherosclerosis and endothelial dysfunction. Presence of damage was associated with abnormal IMT in SLE patients.
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Affiliation(s)
- Parasar Ghosh
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Hamada T, Murata T, Narita K, Takahashi T, Wada Y, Kimura H, Yoshida H. The clinical significance of abnormal diurnal blood pressure variation in healthy late middle‐aged and older adults. Blood Press 2009; 17:134-40. [DOI: 10.1080/08037050802162839] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Comparison of two mathematical models for the study of vascular reactivity. Comput Biol Med 2009; 39:579-89. [DOI: 10.1016/j.compbiomed.2008.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 05/27/2008] [Accepted: 12/08/2008] [Indexed: 11/18/2022]
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Holewijn S, den Heijer M, Swinkels DW, Stalenhoef AFH, de Graaf J. Brachial artery diameter is related to cardiovascular risk factors and intima-media thickness. Eur J Clin Invest 2009; 39:554-60. [PMID: 19453648 DOI: 10.1111/j.1365-2362.2009.02152.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous reports showed inconsistent results about the potential role of flow-mediated dilatation (FMD) in cardiovascular(CV) risk prediction. Few data are available about the role of nitroglycerin-mediated dilatation (NMD), but recently, brachial artery diameter(BAD) appeared to have predictive value in CV risk prediction.We determined the relation of FMD, BAD and NMD with known CV risk factors and intima-media thickness (IMT), a well-established surrogate marker of atherosclerosis, in a community-based population, the Nijmegen Biomedical Study (NBS). MATERIALS AND METHODS FMD, BAD and NMD were measured in the brachial, and IMT in the common carotid artery ultrasononically in 337 participants, aged 50-70 years. Traditional clinical and biochemical parameters were determined. RESULTS Both FMD and NMD were not correlated with most CV risk factors or prevalent CVD. However, both IMT and BAD did show significant correlations with CV risk factors. In accordance, both IMT and BAD were significantly correlated with prevalent CVD (r=0.62 and r=-0.37, respectively) . Furthermore, FMD was not correlated with IMT and did hardly (R2=1.1%) improve the prediction of IMT by CV risk factors in regression analysis. However, both BAD and NMD did correlate with IMT (r=-0.29 and r=0.25, respectively). CONCLUSION In our study, FMD and NMD were not related to known CV risk factors and prevalent CVD, and FMD was not correlated with IMT, a surrogate marker of atherosclerosis. Most intriguingly, BAD was significantly correlated with some CV risk factors, prevalent CVD and IMT. So, BAD is a potential valuable tool in CV risk prediction in middle-aged low-risk populations, whereas FMD is not.
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Affiliation(s)
- S Holewijn
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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