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Wu TW, Wu YJ, Chou CL, Cheng CF, Lu SX, Wang LY. Hemodynamic parameters and diabetes mellitus in community-dwelling middle-aged adults and elders: a community-based study. Sci Rep 2024; 14:12032. [PMID: 38797773 PMCID: PMC11128448 DOI: 10.1038/s41598-024-62866-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
Hemodynamic parameters have been correlated with stroke, hypertension, and arterial stenosis. While only a few small studies have examined the link between hemodynamics and diabetes mellitus (DM). This case-control study enrolled 417 DM patients and 3475 non-DM controls from a community-based cohort. Peak systolic velocity (PSV), end-diastolic velocity (EDV), blood flow velocity (MFV), pulsatility index (PI), and the resistance index (RI) of the common carotid arteries were measured by color Doppler ultrasonography. Generalized linear regression analyses showed that as compared to the non-DM controls, the age-sex-adjusted means of PSV, EDV, and MFV were - 3.28 cm/sec, - 1.94 cm/sec, and - 2.38 cm/sec, respectively, lower and the age-sex-adjusted means of RI and PI were 0.013 and 0.0061, respectively, higher for the DM cases (all p-values < 0.0005). As compared to the lowest quartiles, the multivariable-adjusted ORs of DM for the highest quartiles of PSV, EDV, MFV, RI, and PI were 0.59 (95% confidence interval [CI] 0.41-0.83), 0.45 (95% CI 0.31-0.66), 0.53 (95% CI 0.37-0.77), 1.61 (95% CI 1.15-2.25), and 1.58 (95% CI 1.12-2.23), respectively. More importantly, the additions of EDV significantly improved the predictabilities of the regression models on DM. As compared to the model contained conventional CVD risk factors alone, the area under the receiver operating curve (AUROC) increased by 1.00% (95% CI 0.29-1.73%; p = 0.0059) and 0.80% (95% CI 0.15-1.46%; p = 0.017) for models that added EDV in continuous and quartile scales, respectively. Additionally, the additions of PSV and MFV also significantly improved the predictabilities of the regression models (all 0.01 < p-value < 0.05). This study reveals a significant correlation between DM and altered hemodynamic parameters. Understanding this relationship could help identify individuals at higher risk of DM and facilitate targeted preventive strategies to reduce cardiovascular complications in DM patients.
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Affiliation(s)
- Tzu-Wei Wu
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Jhong-Jheng Rd., San-Jhih District, New Taipei City, Taiwan.
| | - Yih-Jer Wu
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Jhong-Jheng Rd., San-Jhih District, New Taipei City, Taiwan
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chao-Liang Chou
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Jhong-Jheng Rd., San-Jhih District, New Taipei City, Taiwan
- Department of Neurology, MacKay Memorial Hospital, New Taipei City, Taiwan
| | - Chun-Fang Cheng
- Tamsui Health Station, Department of Health, New Taipei City Government, New Taipei City, Taiwan
| | - Shu-Xin Lu
- Department of Neurology, MacKay Memorial Hospital, New Taipei City, Taiwan
| | - Li-Yu Wang
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Jhong-Jheng Rd., San-Jhih District, New Taipei City, Taiwan.
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Xiang Y, Mendieta JB, Wang J, Paritala PK, Anbananthan H, Catano JAA, Fontanarosa D, Yarlagadda P, Li Z. Differences in Carotid Artery Geometry and Flow Caused by Body Postural Changes and Physical Exercise. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:820-830. [PMID: 36535833 DOI: 10.1016/j.ultrasmedbio.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/25/2022] [Accepted: 11/11/2022] [Indexed: 06/17/2023]
Abstract
Different body postures and physical exercises may lead to changes in arterial geometry and hemodynamics, which may be associated with the distribution of atherosclerosis lesions. This study was aimed at investigating potential geometric and hemodynamic changes of the carotid bifurcation in different body postures and after high-intensity interval training (HIIT) workouts. Three-dimensional vascular ultrasound (3DVUS) and Doppler ultrasound images were acquired for 21 healthy participants (aged 29 ± 6 y, 14 men and 7 women) in different body postures (sitting and three sleeping postures [supine, left lateral and right lateral]) and after physical exercises. The common carotid artery (CCA) and internal carotid artery (ICA) diameters of the left carotid artery were found to increase significantly from supine to left lateral (both p <0.05). CCA diameters (p < 0.05) and ICA/CCA diameter ratio (p < 0.01) of the left carotid artery changed significantly from supine to sitting. Significant differences in CCA peak systolic velocity (CCA PSV, p < 0.001), CCA end-diastolic velocity (CCA EDV, p < 0.001), CCA pulsatility index (CCA PI, p < 0.001) and maximum velocity-based wall shear stress at the CCA (WSS(max) at the CCA, p < 0.001) were identified in different postures. After physical exercises, significant increases were observed in the CCA diameter (p < 0.001), CCA PSV (p < 0.001), ICA PSV (p < 0.05), WSS(max) at the CCA (p < 0.001) and WSS(max) at the ICA (p < 0.05), as were significantly lower values of the CCA EDV (p < 0.01) and ICA/CCA PSV ratio (p < 0.05). Side-to-side differences were also detected in different postural change scenarios and after physical exercise; more significant differences were found to occur only in the left-sided carotid artery. Significant differences were identified under postural change and after physical exercise among healthy adults, suggesting that daily activity has an effect on the carotid bifurcation. These changes may be associated with formation and development of carotid atherosclerosis. Moreover, these side differences might be severe for patients and worth further attention in clinical practice.
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Affiliation(s)
- Yuqiao Xiang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jessica Benitez Mendieta
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jiaqiu Wang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Phani Kumari Paritala
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Haveena Anbananthan
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jorge Alberto Amaya Catano
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Davide Fontanarosa
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Prasad Yarlagadda
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zhiyong Li
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia; Faculty of Sports Science, Ningbo University, Ningbo, China.
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Hitomi Y, Masaki N, Ishinoda Y, Kagami K, Yasuda R, Toya T, Namba T, Nagatomo Y, Takase B, Adachi T. Effectiveness of pulsatility index of carotid Doppler ultrasonography to predict cardiovascular events. J Med Ultrason (2001) 2022; 49:95-103. [PMID: 34778938 DOI: 10.1007/s10396-021-01164-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/12/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The pulsatility index (PI) obtained from carotid ultrasonography is considered to be a marker of cerebrovascular resistance. However, the impact of PI on cardiovascular events has yet to be fully addressed. METHOD Fifty-four patients who underwent both carotid ultrasonography and coronary angiography were followed for 5.9 ± 3.2 years. The relationship between the incidence of cardiovascular events and PI was investigated. RESULT There were 10 (19%) deaths, four (7%) cardiovascular deaths, and nine (17%) major adverse cardiovascular events (MACEs). The cardiovascular events-defined as all hospitalization for MACEs plus heart failure, revascularization, and cardiovascular surgery-occurred in 21 patients (39%). The patients were divided into two groups according to each threshold of PI value for common carotid arteries (CCA), internal carotid arteries (ICA), and external carotid arteries (ECA), respectively. The thresholds were calculated based on receiver-operating characteristic curves for cardiovascular events. Log-rank test showed that the groups with CCA-PI ≥ 1.71, ICA-PI ≥ 1.20, and ECA-PI ≥ 2.46 had a higher incidence of cardiovascular events, respectively (p < 0.05). ECA-PI ≥ 2.46 was associated with an increased incidence of MACEs. Multivariate Cox regression analysis adjusting for cardiovascular risk factors showed that high PI of CCA, ICA, or ECA was a risk factor for cardiovascular events, respectively (CCA-PI ≥ 1.71, hazard ratio (HR) 3.242, p = 0.042; ICA-PI ≥ 1.20, HR 3.639, p = 0.012; ECA-PI ≥ 2.46, HR 11.322, p = 0.001). CONCLUSION The results suggested that carotid PIs were independent predictive factors for further cardiovascular events. In particular, high ECA-PI levels may reflect severe arteriosclerosis.
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Affiliation(s)
- Yasuhiro Hitomi
- Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Nobuyuki Masaki
- Department of Intensive Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan.
| | - Yuki Ishinoda
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Kazuki Kagami
- Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Risako Yasuda
- Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Takumi Toya
- Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
- Department of Intensive Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Takayuki Namba
- Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Bonpei Takase
- Department of Intensive Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Takeshi Adachi
- Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
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Zócalo Y, Bia D. Sex- and Age-Related Physiological Profiles for Brachial, Vertebral, Carotid, and Femoral Arteries Blood Flow Velocity Parameters During Growth and Aging (4-76 Years): Comparison With Clinical Cut-Off Levels. Front Physiol 2021; 12:729309. [PMID: 34512398 PMCID: PMC8427671 DOI: 10.3389/fphys.2021.729309] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/26/2021] [Indexed: 02/04/2023] Open
Abstract
Ultrasound-derived blood flow velocity (BFV) levels [e.g., peak systolic velocity (PSV)], intrabeat indexes (e.g., resistive), and intersegment ratios [e.g., internal/common carotid artery (ICA/CCA) PSV ratio] are assessed to describe cardiovascular physiology and health status (e.g., disease severity evaluation and/or risk stratification). In this respect, fixed cut-off values (disregard of age or sex) have been proposed to define “significant” vascular disease from BFV-derived data (parameters). However, the use of single fixed cut-off values has limitations. Accurate use of BFV-derived parameters requires knowing their physiological age-related profiles and the expected values for a specific subject. To our knowledge, there are no studies that have characterized BFV profiles in large populations taking into account: (i) data from different age-stages (as a continuous) and transitions (childhood–adolescence–adulthood), (ii) complementary parameters, (iii) data from different arteries, and (iv) potential sex- and hemibody-related differences. Furthermore, (v) there is little information regarding normative data [reference intervals (RIs)] for BFV indexes. Aims: The aims of this study are the following: (a) to determine the need for age-, body side-, and sex-specific profiles for BFV levels and derived parameters (intrabeat indexes and intersegment ratios), and (b) to define RIs for BFV levels and parameters, obtained from CCA, ICA, external carotid, vertebral, femoral, and brachial arteries records. Methods: A total of 3,619 subjects (3–90 years) were included; 1,152 were healthy (without cardiovascular disease and atheroma plaques) and non-exposed to cardiovascular risk factors. BFV data were acquired. The agreement between left and right data was analyzed (Concordance correlation, Bland–Altman). Mean and SD equations and age-related profiles were obtained for BFV levels and parameters (regression methods; fractional polynomials). Results: Left and right body-side derived data were not always equivalent. The need for sex-specific RIs was dependent on the parameter and/or age considered. RIs were defined for each studied artery and parameter. Percentile curves were compared with recommended fixed cut-off points. The equations for sex, body-side, and age-specific BFV physiological profiles obtained in the large population (of children, adolescents, and adults) studied were included (spreadsheet formats), enabling to determine for a particular subject, the expected values and potential data deviations.
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Affiliation(s)
- Yanina Zócalo
- Physiology Department, School of Medicine, CUiiDARTE, Republic University, Montevideo, Uruguay
| | - Daniel Bia
- Physiology Department, School of Medicine, CUiiDARTE, Republic University, Montevideo, Uruguay
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Hitsumoto T. Clinical Significance of the Cardio-Ankle Vascular Index in Postmenopausal Women With Hypercholesterolemia. J Clin Med Res 2021; 13:276-282. [PMID: 34104279 PMCID: PMC8166294 DOI: 10.14740/jocmr4509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/04/2021] [Indexed: 12/21/2022] Open
Abstract
Background The cardio-ankle vascular index (CAVI) is a physiological indicator of arterial elasticity. However, limited information regarding the clinical significance of the CAVI in patients with hypercholesterolemia is available. This cross-sectional study aimed to elucidate the clinical significance of the CAVI for the primary prevention of cardiovascular disease (CVD) among postmenopausal women with hypercholesterolemia. Methods A total of 168 untreated postmenopausal hypercholesterolemic women (low-density lipoprotein cholesterol levels ≥ 140 mg/dL, mean age ± standard deviation, 63 ± 10 years) with no history of CVD events were enrolled. The CAVI was measured using commercial devices, after which, its relationships with various clinical parameters, such as carotid artery ultrasonography findings and CVD biomarkers, were examined. Results A significant positive correlation was observed between the CAVI and maximum intima-media thickness of the common carotid artery (max-C-IMT), which was evaluated using carotid artery ultrasonography (r = 0.49, P < 0.001). Regarding CVD biomarkers, the CAVI was significantly correlated with estimated glomerular filtration rate (r = -0.18, P < 0.001), high-sensitivity C-reactive protein (r = 0.36, P < 0.001), whole blood passage time as a marker of blood rheology (r = 0.41, P < 0.001), and skin autofluorescence as a marker of advanced glycation end products in tissues (r = 0.46, P < 0.001), although no significant correlation was noted between serum lipid parameters and the CAVI. Multiple regression analysis identified max-C-IMT (β = 0.35, P < 0.001), whole blood passage time (β = 0.18, P = 0.007), skin autofluorescence (β = 0.17, P = 0.011), and age (β = 0.16, P = 0.018) as variables independently associated with CAVI. Conclusion The present study indicated that the CAVI is an essential CVD risk factor among postmenopausal women with hypercholesterolemia. Moreover, impaired blood rheology and increase of skin autofluorescence were associated with elevated CAVI in such patients.
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Affiliation(s)
- Takashi Hitsumoto
- Hitsumoto Medical Clinic, 2-7-7, Takezakicyou, Shimonoseki City, Yamaguchi 750-0025, Japan.
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Saiki A, Ohira M, Yamaguchi T, Nagayama D, Shimizu N, Shirai K, Tatsuno I. New Horizons of Arterial Stiffness Developed Using Cardio-Ankle Vascular Index (CAVI). J Atheroscler Thromb 2020; 27:732-748. [PMID: 32595186 PMCID: PMC7458785 DOI: 10.5551/jat.rv17043] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Arterial stiffness is recognized mainly as an indicator of arteriosclerosis and a predictor of cardiovascular events. Cardio-ankle vascular index (CAVI), which reflects arterial stiffness from the origin of the aorta to the ankle, was developed in 2004. An important feature of this index is the independency from blood pressure at the time of measurement. A large volume of clinical evidence obtained using CAVI has been reported. CAVI is high in patients with various atherosclerotic diseases including coronary artery disease and chronic kidney disease. Most coronary risk factors increase CAVI and their improvement reduces CAVI. Many prospective studies have investigated the association between CAVI and future cardiovascular disease (CVD), and proposed CAVI of 9 as the optimal cut-off value for predicting CVD. Research also shows that CAVI reflects afterload and left ventricular diastolic dysfunction in patients with heart failure. Furthermore, relatively acute changes in CAVI are observed under various pathophysiological conditions including mental stress, septic shock and congestive heart failure, and in pharmacological studies. CAVI seems to reflect not only structural stiffness but also functional stiffness involved in acute vascular functions. In 2016, Spronck and colleagues proposed a variant index CAVI0, and claimed that CAVI0 was truly independent of blood pressure while CAVI was not. This argument was settled, and the independence of CAVI from blood pressure was reaffirmed. In this review, we summarize the recently accumulated evidence of CAVI, focusing on the proposed cut-off values for CVD events, and suggest the development of new horizons of vascular function index using CAVI.
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Affiliation(s)
- Atsuhito Saiki
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center
| | - Masahiro Ohira
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center
| | - Takashi Yamaguchi
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center
| | | | - Naomi Shimizu
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center
| | - Kohji Shirai
- Department of Internal Medicine, Mihama Hospital
| | - Ichiro Tatsuno
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center
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