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Non-Invasive Detection of Fetal Vascular Endothelial Function in Gestational Diabetes Mellitus.
Chen, Y, Huang, D, Liu, J, Zeng, F, Tang, G, Lei, W, Wang, H, Jiang, Y, Shentu, W, Wang, H
Frontiers in endocrinology. 2021;:763683
Abstract
OBJECTIVES Endothelial dysfunction in the fetuses of women with gestational diabetes mellitus (GDM) is associated with their subsequent cardiovascular events. Prenatal assessment of endothelial function in fetuses exposed to intrauterine hyperglycemic environment remains challenging. The aim of this study was to assess the fetal vascular endothelial function in GDM patients using color M-mode derived aortic propagation velocity (APV) and evaluate the correlation of APV with endothelial function biomarkers. METHODS This observational cross-sectional study included 31 gestational diabetic mothers and 30 healthy pregnant mothers from August 2019 to January 2020. Clinical data were compared between the groups. Fetal APV was measured using color M-mode echocardiography at late gestation. Concentrations of endothelial biomarkers including von Willebrand Factor (vWF), vascular endothelial-cadherin and endothelin-1 in umbilical cord serum were assessed. Measurements between diabetic group and controls were compared. RESULTS vWF was the only endothelial functional marker that differed between the two groups. Fetuses in the GDM group had significantly lower APV levels and higher vWF levels compared with the healthy controls (P < 0.05). There was a moderate but significant correlation between APV and vWF (r =-0.58, P < 0.001). There were no associations between APV and ventricular wall thickness or umbilical artery pulsatility index. CONCLUSIONS Color M-mode propagation velocity of aorta is a non-invasive, practical method that correlates well with GDM and fetal endothelial function. This novel metric could contribute to recognizing early vascular functional alterations and hence represents a potential strategy for early risk factor surveillance and risk modification.
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Myocardial blood flow reserve is impaired in patients with aortic valve calcification and unobstructed epicardial coronary arteries.
Nel, K, Nam, MCY, Anstey, C, Boos, CJ, Carlton, E, Senior, R, Kaski, JC, Khattab, A, Shamley, D, Byrne, CD, et al
International journal of cardiology. 2017;:427-432
Abstract
BACKGROUND Although calcific aortic valve disease (CAVD) is associated with coronary atherosclerosis, it is not known whether early CAVD is associated with coronary microcirculatory dysfunction (CMD). We sought to investigate the relationship between myocardial blood flow reserve (MBFR) - a measure of CMD, and early CAVD in the absence of obstructive epicardial coronary artery disease. We also determined whether this relationship was independent of coronary artery disease (CAD) and hs-CRP, a marker of systemic inflammation. METHODS 183 patients with chest pain and unobstructed coronary arteries were studied. Aortic valve calcification score (AVCS), coronary total plaque length (TPL), and coronary calcium score were quantified from multislice CT. MBFR was assessed using vasodilator myocardial contrast echocardiography. Hs-CRP was measured from venous blood using a particle-enhanced immunoassay. RESULTS Mean (±SD) participant age was 59.8 (9.6) years. Mean AVCS was 68 (258) AU, TPL was 15.6 (22.2) mm, and median coronary calcification score was 43.5AU. Mean MBFR was 2.20 (0.52). Mean hs-CRP was 2.52 (3.86) mg/l. Multivariable linear regression modelling incorporating demographics, coronary plaque characteristics, MBFR, and inflammatory markers, demonstrated that age (β=0.05, 95% CI: 0.02, 0.08, P=0.007), hs-CRP (β=0.09, CI: 0.02, 0.16, P=0.010) and diabetes (β=1.03, CI: 0.08, 1.98, P=0.033), were positively associated with AVCS. MBFR (β=-0.87, CI: -1.44, -0.30, P=0.003), BMI (β=-0.11, CI: -0.21, -0.01, P=0.033), and LDL (β=-0.32, CI: -0.61, -0.03, P=0.029) were negatively associated with AVCS. TPL and coronary calcium score were not independently associated with AVCS when included in the regression model. CONCLUSION Coronary microvascular function as determined by measurement of myocardial blood flow reserve is independently associated with early CAVD. This effect is independent of the presence of coronary artery disease and also systemic inflammation.
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Reduced subclinical carotid vascular disease and arterial stiffness in vegetarian men: The CARVOS Study.
Acosta-Navarro, J, Antoniazzi, L, Oki, AM, Bonfim, MC, Hong, V, Acosta-Cardenas, P, Strunz, C, Brunoro, E, Miname, MH, Filho, WS, et al
International journal of cardiology. 2017;:562-566
Abstract
BACKGROUND Dietary habits play an important role in the development of atherosclerosis, the most important cause of morbidity and mortality in the world. The objective of this study was to verify if vegetarian (VEG) diet could be related a better profile of subclinical vascular disease evaluated by arterial stiffness and functional and structural properties of carotid arteries, compared to omnivorous (OMN) diet. METHODS In this cross-sectional study, 44 VEG and 44 OMN apparently healthy men ≥35years of age, in order to not have confounding risk factors of subclinical atherosclerosis, were assessed for anthropometric data, blood pressure, blood lipids, glucose, C reactive protein (CRP), and arterial stiffness determined by carotid-femoral pulse wave velocity (PWV). Also, carotid intima-media thickness (c-IMT) and distensibility were evaluated. RESULTS VEG men had lower body mass index, systolic and diastolic blood pressures, fasting serum total cholesterol, LDL and non-HDL-cholesterol, apolipoprotein B, glucose and glycated hemoglobin values in comparison with OMN individuals (all p values <0.05). Markers of vascular structure and function were different between VEG and OMN: PWV 7.1±0.8m/s vs. 7.7±0.9m/s (p<0.001); c-IMT 593±94 vs. 661±128μm (p=0.003); and relative carotid distensibility 6.39±1.7 vs. 5.72±1.8% (p=0.042), respectively. After a multivariate linear regression analysis, a VEG diet was independently and negatively associated with PWV (p value 0.005). CONCLUSIONS A VEG diet is associated with a more favorable cardiovascular diseases biomarker profile and better vascular structural and functional parameters.
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Diurnal variation of pulse waveform parameters determined by laser speckle flowgraphy on the optic nerve head in healthy subjects.
Fukami, M, Iwase, T, Yamamoto, K, Ra, E, Murotani, K, Terasaki, H
Medicine. 2017;(44):e8312
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Abstract
To investigate the diurnal variation of the pulse waveform parameters determined by laser speckle flowgraphy (LSFG) on the optic nerve head (ONH) in healthy subjects.This prospective cross sectional study was conducted at Nagoya University Hospital. We studied 13 healthy volunteers whose mean age was 33.5 ± 7.6 years. Eight pulse waveform parameters on the ONH were determined by LSFG (LSFG-NAVI) every 3 hours from 6 AM to 12 PM. The intraocular pressure (IOP), systolic (SBP) and diastolic (DBP) blood pressure, and heart rate (HR) in the brachial artery were also recorded. We evaluated the diurnal variations of the parameters and compared the pulse waveform parameters to the other parameters using a linear mixed model.Of the 8 parameters, skew (P < .001), blow out score (BOS, P < .001), blow out time (BOT, P = .028), rising rate (P < .001), falling rate (P < .001), resistivity index (P < .001) had a significant diurnal fluctuation. In addition, IOP (P < .001), SBP (P = .005), DBP (P = .001), and HR (P < .001) had significant diurnal fluctuations. The BOS and resistivity index were significantly correlated with the HR (P = .009, P = .012, respectively), and the BOT were significantly correlated with the DBP and mean ocular perfusion pressure (P = .042, P = .041, respectively).We found that there was significant diurnal variation in 6 waveform parameters on the ONH in LSFG. We believe that our results highlighting diurnal variations in these waveform parameters need to be considered when interpreting pulse waveform parameter data and in understanding the precise underlying mechanism of ocular diseases such as diabetic retinopathy, retinal vein occlusion, and glaucoma.
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Packed red blood cell transfusion (PRBC) attenuates intestinal blood flow responses to feedings in pre-term neonates with normalization at 24 hours.
Pitzele, A, Rahimi, M, Armbrecht, E, Havranek, T
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2015;(15):1770-3
Abstract
OBJECTIVE To determine whether packed red blood cell (PRBC) transfusion affects post-prandial superior mesenteric artery blood flow velocities (SMA BFVs) in very-low birth weight (VLBW) neonates and if so, at what time point after transfusion restoration of previous SMA BFV patterns occurs. DESIGN/METHODS VLBW pre-term neonates, older than 14 days and tolerating bolus enteral feedings administered every 3 h were enrolled in this prospective observational study. Pulsed Doppler ultrasound was used to measure pre- and post-prandial (at 45 min) time-averaged mean, peak and end diastolic velocities (TAMV, PSV, EDV) immediately before and after 15 ml/kg of PRBC transfusion was given over 3 h; patent ductus arteriosus (PDA) status was also evaluated. Subsequent pre- and post-prandial SMA BFVs were recorded 24 and 48 h after the transfusion. RESULTS Pre- and post-prandial measurements were obtained for 21 out of 25 enrolled infants. Post-prandial SMA BFVs were attenuated during the feedings immediately after transfusion; at 24 and 48 h after transfusion, changes in post-prandial SMA BFVs were similar to those measured prior to transfusion; the presence of the PDA did not affect results. CONCLUSIONS PRBC transfusion blunted SMA BFV responses to feedings immediately after the transfusion with normalization observed 24 h post-transfusion.
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Flow-mediated dilation is associated with cardiovascular events in non-valvular atrial fibrillation patients.
Perri, L, Pastori, D, Pignatelli, P, Violi, F, Loffredo, L
International journal of cardiology. 2015;:139-43
Abstract
BACKGROUND Atrial fibrillation is associated with multiple atherosclerotic risk factors and predisposes to cardiovascular events (CVE). Endothelial dysfunction is associated with atherosclerosis and independently predicts CVE. The aim of the study was to evaluate the association between endothelial dysfunction, as assessed by flow-mediated dilation (FMD), and CVE in AF patients. METHODS We prospectively measured FMD in 514 non-valvular AF patients on anticoagulant treatment with vitamin K antagonists. Patients were followed-up for a mean time of 23.5 months. The main composite outcome of the study was the occurrence of stroke/TIA, myocardial infarction, urgent revascularization and cardiovascular death. RESULTS Median value of FMD was 4.6% [IQR 1.46-8.00]. A CVE occurred in 44 patients (8.56%):non-fatal myocardial infarction (MI) in 7, fatal MI in 2, stent/coronary artery by-pass graft (CABG) in 10, ischemic non-fatal stroke in 10, fatal stroke in 3, transient ischemic attack (TIA) in 1, and cardiovascular death in 11 patients. Patients who experienced a CVE showed significantly reduced FMD compared to those who did not (3.06% [IQR 0.00-6.00] vs 4.67% [IQR 1.58-8.22], p=0.027). During a mean follow-up of 23.5 months, the rate of CVE was significantly higher in subjects with FMD below median (<4.6%) than in those with FMD above median (27 vs 17, log-rank test p=0.006). COX analysis demonstrated that low FMD (below median) (HR: 2.20, CI 95%:1.13-4.28, p=0.020), age (HR: 1.08, CI 95%: 1.03-1.12, p<0.001), smoking (HR: 4.15, CI 95%: 1.63-10.6, p=0.003) and history of stroke/TIA (HR: 2.38, CI 95%: 1.13-5.04, p=0.023) independently predicted CVE. CONCLUSIONS In AF patients low FMD is associated with increased risk of CVE suggesting that impaired artery dilatation predisposes to atherosclerotic complications.
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Relationship of obesity and insulin resistance with the cerebrovascular reactivity: a case control study.
Rodríguez-Flores, M, García-García, E, Cano-Nigenda, CV, Cantú-Brito, C
Cardiovascular diabetology. 2014;:2
Abstract
BACKGROUND Obesity is associated with increased risk for stroke. The breath-holding index (BHI) is a measure of vasomotor reactivity of the brain which can be measured with the transcranial Doppler (TCD). We aim to evaluate obesity as an independent factor for altered cerebrovascular reactivity. METHODS Cerebrovascular hemodynamics (mean flow velocities MFV, pulsatility index, PI, resistance index, RI, and BHI) was determined in 85 non-obese (Body Mass Index, BMI ≤27 kg/m2) and 85 obese subjects (BMI ≥35 kg/m2) without diabetes mellitus and hypertension. Anthropometric and metabolic variables, and scores to detect risk for obstructive sleep apnea (OSA) were analyzed for their association with the cerebrovascular reactivity. RESULTS The BHI was significantly lower in subjects with obesity according to BMI and in subjects with abdominal obesity, but the PI and RI were not different between groups. There was a linear association between the BMI, the HOMA-IR, the Matsuda index, the waist circumference, and the neck circumference, with the cerebrovascular reactivity. After adjusting for insulin resistance, neck circumference, and abdominal circumference, obesity according to BMI was negatively correlated with the cerebrovascular reactivity. CONCLUSIONS We found a diminished vasomotor reactivity in individuals with obesity which was not explained by the presence of insulin resistance.