Study of endothelial function in pregnant women with gestational diabetes mellitus by flow mediated dilation of brachial artery

Background: The objective of the study was to assess vascular function in normal pregnant women and women with gestational diabetes and to study its temporal relationship with gestational age at 24-28-week POG and at 36-38-week POG and changes in FMD in postpartum period.Methods: Assessment of vascular function was done at 24-28-week POG, 36-38-week POG and at 6-12-week postpartum by flow mediated dilation of brachial artery in 37 healthy pregnant women and 37 pregnant women with GDM.Results: In GDM group mean FMD at 24-28 weeks of POG, at 36-38 weeks POG was lower as compared to the control group (11.225±6.20,8.464±6.09 versus 14.49±5.21, 10.898±4.12) although the difference in mean FMD in two groups was not statistically significant. It was found that the decrease in FMD at 36-38-week POG as compared to 24-28 weeks POG was statistically significant in both the groups (p<0.001).Conclusions: This study revealed that when endothelial function as assessed by FMD was compared at different period of gestation, the mean decrease in FMD at 36-38-week POG as compared to 24-28-week POG and 6-week post-partum was statistically significant in patients with GDM and as well as the control group, however this trend of change was same in both the groups and was not statistically significant when compared between the two group (GDM versus control). A negative correlation of FMD was found with BMI, and HBA1c, that was stronger in GDM group.

Acute effects of diets rich in almonds and walnuts on endothelial function

Objective Omega-3 fatty acids, especially alpha-linolenic acid (ALA), which are present in nuts may reduce cardiovascular disease (CVD) risk, by changing vascular inflammation and improving endothelial dysfunction. The objective of the study was to evaluate the acute effects of two different diets, one containing walnuts and the other almonds on endothelial function. Methods Twenty-seven overweight volunteers underwent a randomized 2-period, crossover, controlled intervention study. The subjects were given either walnut or almond diets which varied in monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA) content. The walnut diet provided 23.1% energy from PUFA and the almond diet provided 7.6% energy from PUFA. Endothelial function was assessed physiologically by flow-mediated dilation (FMD) and biochemically by sVCAM (soluble vascular cell adhesion molecules). Results The walnut diet significantly improved FMD (p = 0.004) and decreased sVCAM (p = 0.009) whereas the almond diet tended to improve FMD (p = 0.06) and significantly decreased sVCAM (p = 0.004). Conclusion Both walnut and almond diets improved FMD and sVCAM and there was no significant difference in physiological and biochemical markers between the two diets.

Cardiac parameters and endothelial function in a strength athlete: a case report

We aimed to discuss a case of strength training athlete who competes in international competitions regarding cardiac (dimension and function), vascular (endothelium and vascular resistance), hemodynamic (blood pressure), given limited evidence supporting these cardiovascular adaptations as well as concerning endothelial function in long-term high-intensity strength training. Methods: We assessed heart structure and function (echocardiography); systolic (SBP) and diastolic blood pressure (DBP); endothelium-dependent vasodilation (flow-mediated dilation, FMD); maximum force tested in the squat, bench press, and deadlift; and maximum oxygen consumption (spirometry). Results: powerlifter's cardiac dimensions (interventricular septum 13 mm; posterior wall thickness 12 mm; LV diastolic diameter 57 mm; left ventricle mass 383 g; LV mass adjusted by body surface area 151.4 g/m2) are above the proposed cutoff values beyond which pathology may be considered. Moreover, cardiovascular function systolic (ejection fraction by Simpson's rule, 71%) is preserved and FMD measure is fairly close and above normal; however, a mild increase in systolic and diastolic blood pressure was observed (130/89 mmHg, respectively). Conclusion: Cardiac remodeling cannot be viewed as either pathological or harmful to the cardiovascular system. Furthermore, we showed an improvement in endothelial function.(AU)

Endothelial dysfunction in children with type 1 diabetes mellitus

ABSTRACT Objective The purpose of this study was to verify the presence of endothelial dysfunction and initial structural atherosclerotic changes in children with Type 1 diabetes mellitus (T1DM). Subjects and methods The study population comprised 31 diabetic children aged 6 to 12 years, divided into two subgroups according to the duration of the T1DM diagnosis: subgroup 1, with less than 5 years elapsed since diagnosis, and subgroup 2, with more than 5 years elapsed since diagnosis. The control group comprised 58 age-matched healthy children. Ultrasonographic techniques were used to measure the flow-mediated dilatation (FMD) of the brachial artery and the intima-media thickness (IMT) of the carotid arteries. Results Children with T1DM with longer disease duration showed significantly decreased mean values of FMD compared with those in the control group. No significant differences between the groups were found in relation to IMT. The FMD percentage presented a moderate negative correlation with glycated hemoglobin (HbA1c) and fasting glucose levels. Conclusion Our findings suggest that endothelial dysfunction may be already present in children with 5 years or more elapsed since diagnosis, even in the absence of atherosclerotic structural changes. The decreased vasodilation response correlated with hyperglycemia.

Early and midterm follow-up of vascular endothelial function in children with surgical repair for coarctation of aorta / 实用医学杂志

Objective To evaluate the endothelium-dependent vasodilation in children after repair for coarctation of aota (CoA). Methods A group of 20 children having undergone CoA repair between January 2010 and October 2010 in Guangzhou Women and Children′s Medical Center were include in the study , including 12 infants aged less than 6 months and 8 ones aged more than 6 months. Another 20 healthy children were enrolled during the same period as controls. All the subjects underwent monitoring of resting blood pressure and flow-mediated dilation (FMD) of the brachial artery in 4-year follow-up. Results There were no resting hypertension in all subjects , but FMD in the CoA group was higher than in the control group and so it was with the early surgery group and non early surgery group. Conclusion The surgical repair for coarctation of aorta could not cure the vascular function impairment satisfactorily , neither is the early surgery effective in alleviating the injuries in vascular endothelia.

Effects of disturbed blood flow during exercise on endothelial function: a time course analysis

This study aimed to examine the time course of endothelial function after a single handgrip exercise session combined with blood flow restriction in healthy young men. Nine participants (28±5.8 years) completed a single session of bilateral dynamic handgrip exercise (20 min with 60% of the maximum voluntary contraction). To induce blood flow restriction, a cuff was placed 2 cm below the antecubital fossa in the experimental arm. This cuff was inflated to 80 mmHg before initiation of exercise and maintained through the duration of the protocol. The experimental arm and control arm were randomly selected for all subjects. Brachial artery flow-mediated dilation (FMD) and blood flow velocity profiles were assessed using Doppler ultrasonography before initiation of the exercise, and at 15 and 60 min after its cessation. Blood flow velocity profiles were also assessed during exercise. There was a significant increase in FMD 15 min after exercise in the control arm compared with before exercise (64.09%±16.59%, P=0.001), but there was no change in the experimental arm (-12.48%±12.64%, P=0.252). FMD values at 15 min post-exercise were significantly higher for the control arm in comparison to the experimental arm (P=0.004). FMD returned to near baseline values at 60 min after exercise, with no significant difference between arms (P=0.424). A single handgrip exercise bout provoked an acute increase in FMD 15 min after exercise, returning to near baseline values at 60 min. This response was blunted by the addition of an inflated pneumatic cuff to the exercising arm.

Vascular Endothelial Dysfunction and Exercise in Metabolic Syndrome Patients

Metabolic syndrome, a constellation of cardiovascular disease risk factors, is a global pandemic. Over 30% of the adult population in both South Korea and the United States are currently classified as having metabolic syndrome. Vascular endothelial function is a precursor of future atherosclerotic cardiovascular disease. Conduit artery flow-mediated dilation using ultrasonography is considered the non-invasive, gold standard for assessing nitric oxide-mediated vascular endothelial function. Patients with metabolic syndrome commonly exhibit increased insulin resistance and hyperglycemia, which are thought to impair vascular endothelial function by increasing oxidative stress and reducing nitric oxide bioavailability in the vascular endothelium and in smooth muscle cells. Previous findings have indicated that long-term aerobic exercise has a positive effect on impaired vascular endothelial function in metabolic syndrome patients, but the underlying mechanisms have not been fully elucidated. Therefore, further studies are needed that will apply different exercise modalities and intensities with the goal of improving vascular endothelial function in patients with metabolic syndrome, as well as investigation of the associated mechanisms. Ultimately, well-designed future studies will help to establish and develop exercise prescription and/or exercise therapy programs that can reduce cardiovascular disease risk and improve cardiovascular health in metabolic syndrome patients.

Effects of Immersion in Artificial Carbon Dioxide on Endothelial Function Assessed with Flow-Mediated Dilation in Patients with Type 2 Diabetes / 日本温泉気候物理医学会雑誌

<b>Purpose:</b> The aim of present study was to investigate the endothelial function of immersion of patients with diabetes in carbon dioxide (CO₂)-enriched water<BR><b>Methods:</b> Sixteen diabetic patients with minor complications were immersed in CO₂-enriched water for 4 weeks, and 8 patients were immersed in normal spa water for the same duration. To assess endothelial function, forearm flow-mediated dilation (FMD) was measured in those patients, and %FMD at pre-immersion was compared to that at post-immersion in CO₂-enriched water. The pulse wave velocity (PWV) was also measured to determine whether vascular stiffness was affected in those patients. The percent coefficient of variation of R-R intervals was examined as CVR-R (%). All patients were medicated with antidiabetic drugs, which were not changed during the study.<BR><b>Results:</b> %FMD showed no significant difference in any patients between pre- and post-CO₂-enriched water bathing. However, %FMD was significantly increased inpatients under 8.0% of HbA1c after CO₂-enriched water bathing (p<0.05), but it was not significantly increased in patients over 8.0 of HbA1c. PWV and CVR-R (%) were significantly reduced in all patients after CO₂-enriched water bathing. <BR><b>Conclusion:</b> CO₂-enriched water immersion had a positive effect on endothelial function, and reduced arterial wall stiffness in patients with diabetes. These findings suggest that CO₂-enriched water bathing may improve microcirculation, as well as subjective symptoms, in patients with controlled diabetes.

Effects of Immersion in Artificial Carbon Dioxide on Endothelial Function Assessed with Flow-Mediated Dilation in Patients with Type 2 Diabetes / 日本温泉気候物理医学会雑誌

Purpose: The aim of present study was to investigate the endothelial function of immersion of patients with diabetes in carbon dioxide (CO2)-enriched water Methods: Sixteen diabetic patients with minor complications were immersed in CO2-enriched water for 4 weeks, and 8 patients were immersed in normal spa water for the same duration. To assess endothelial function, forearm flow-mediated dilation (FMD) was measured in those patients, and %FMD at pre-immersion was compared to that at post-immersion in CO2-enriched water. The pulse wave velocity (PWV) was also measured to determine whether vascular stiffness was affected in those patients. The percent coefficient of variation of R-R intervals was examined as CVR-R (%). All patients were medicated with antidiabetic drugs, which were not changed during the study. Results: %FMD showed no significant difference in any patients between pre- and post-CO2-enriched water bathing. However, %FMD was significantly increased in patients under 8.0% of HbA1c after CO2-enriched water bathing (p<0.05), but it was not significantly increased in patients over 8.0 of HbA1c. PWV and CVR-R (%) were significantly reduced in all patients after CO2-enriched water bathing. Conclusion: CO2-enriched water immersion had a positive effect on endothelial function, and reduced arterial wall stiffness in patients with diabetes. These findings suggest that CO2-enriched water bathing may improve microcirculation, as well as subjective symptoms, in patients with controlled diabetes.

Using ultrasound and Doppler ultrasound to assess vascular changes in pre-eclampsia and eclampsia: a systematic review / Uso de ultrassom Doppler e ultrassom na avaliação das alterações vasculares na pré-eclampsia e eclampsia: uma revisão sistemática

Objectives: This systematic review aimed to evaluate whether Doppler ultrasound of the ophthalmic artery and uterine artery, and ultrasound of flow-mediated dilation of the brachial artery, can be used to effectively assess vascular function in pregnant women without disease or other complications with pre-eclampsia and eclampsia to establish the most appropriate method for evaluating these diseases.Methods: Two databases were searched for relevant articles: the National Library of Medicine (PubMed) and the Virtual Health Library. Articles published between 1989 and 2014 about Doppler ultrasound of the ophthalmic artery were retrieved; all articles published from 2000 to 2014 about using ultrasound to assess flow-mediated dilation of the brachial artery were retrieved; and for Doppler ultrasound of the uterine artery, only articles published between January 2013 and March 2014 were retrieved because the literature in this area is extensive. Results: A total of 260 articles were retrieved; 32 were eligible for inclusion. There were 16 articles on using Doppler ultrasound to evaluate the ophthalmic artery and eight about using it to assess the uterine artery, and eight articles evaluated the use of ultrasound to assess flow-mediated dilation of the brachial artery. Conclusions: Doppler ultrasound is useful in diagnosing pre-eclampsia and eclampsia inpregnant women; the use of this technique makes early intervention feasible, and thereby improves prognosis; and it reduces the morbidity and mortality of pregnant women and their newborns.

Objetivos: Essa revisão sistemática teve como objetivo avaliar se o ultrassom Doppler das artérias oftálmica e uterina e o ultrassom de dilatação fluxo-mediada da artéria braquial podem ser utilizados para uma avaliação efetiva da função vascular em mulheres grávidas com pré-eclampsia e eclampsia e sem outras doenças ou complicações, para estabelecer o método mais apropriado para avaliação dessas doenças. Métodos: Pesquisa em dois bancos de dados National Library of Medicine (PubMed) e Virtual Health Library em busca de artigos relevantes. Foram recuperados artigos publicados entre1989 e 2014 sobre ultrassom Doppler da artéria oftálmica; todos os artigos publicados de 2000até 2014 sobre o uso do ultrassom para a avaliação da dilatação fluxo-mediada da artéria braquial; e apenas artigos publicados entre janeiro de 2013 e março de 2014 sobre ultrassom Doppler da artéria uterina, diante da grande riqueza da literatura nessa área. Resultados: No total, foram recuperados 260 artigos; 32 se qualificaram para inclusão: 16artigos sobre uso do ultrassom Doppler para avaliar a artéria oftálmica, oito artigos sobre o uso dessa técnica para avaliar a artéria uterina e, finalmente, oito artigos sobre o uso do ultrassom para avaliar a dilatação fluxo-mediada da artéria braquial. Conclusões: O ultrassom Doppler tem utilidade no diagnóstico da pré-eclâmpsia e da eclampsia em mulheres grávidas; o uso dessa técnica possibilita uma intervenção precoce e, com isso, melhora o prognóstico; e ainda diminui a morbidade e a mortalidade de grávidas e de seus neonatos.

The effect of walnut (Juglans regia L.) intake on improvement of blood lipid levels and vascular health: A meta-analysis / 한국영양학회지

PURPOSE: Walnut is known to have unique favorable fatty acids, phytochemicals, and other nutrient profiles. As a result, there has been growing interest in evaluation of its health benefit related to cardiovascular disease (CVD). Although inverse associations of nut consumption and risk factors of cardiovascular disease have been reported in many epidemiological studies and qualitative reviews, few meta-analysis studies have been reported. This meta-analysis was conducted in order to evaluate the effect of a walnut-enhanced diet on CVD risk factors. METHODS: We searched Pubmed, Cochrane, Science Direct, and KISS (Korean studies Information Service System) through July 2014. A random-effects meta-analysis was conducted on 17 trials reporting total cholesterol (TC), 14 trials reporting LDL cholesterol (LDL-C), 15 trials reporting HDL cholesterol (HDL-C), 17 trials reporting triglyceride (TG), and four trials reporting flow-mediated dilation (FMD). RESULTS: In meta-analysis, intake of a walnut-enhanced diet resulted in significantly lowered TC, LDL-C, and TG by -0.124 mmol/l (95% CI, -0.209, -0.039; p = 0.004), -0.085 mmol/lL (95% CI, -0.167, -0.004; p = l0.039), and -0.080 mmol/l (95% CI, -0.155, -0.004; p = 0.039), respectively. The overall pooled estimate of the effect on FMD was +1.313% (95% CI, 0.744, 1.882, p = 0.000). HDL-C was not affected by walnut intake. No statistical heterogeneity was observed for any analysis. Results of funnel plots and Egger's regression suggested a low likelihood of publication bias in all biomarkers (p > 0.05). CONCLUSION: Findings of this meta-analysis provide consistent evidence that walnut-enhanced diet intake reduces the CVD risk factors.

Impact of Aerobic Exercise Training on Endothelial Function in Acute Coronary Syndrome

OBJECTIVE: To confirm the improvement in arterial endothelial function by aerobic exercise training, flow-mediated dilation (FMD) was tested by ultrasonography. METHODS: Patients who received percutaneous coronary intervention due to acute coronary syndrome were included. The patients who participated in cardiac rehabilitation (CR) program were categorized as the CR group, and others who did not participate as the control. Both groups underwent initial graded exercise test (GXT) and FMD testing. Subsequently, the CR group performed aerobic exercise training sessions. Patients in control only received advice regarding the exercise methods. After six weeks, both groups received follow-up GXT and FMD testing. RESULTS: There were 16 patients in each group. There were no significant differences in the general characteristics between the groups. The VO2peak was 28.6+/-4.7 mL/kg/min in the CR group and 31.5+/-7.4 mL/kg/min in the control at first GXT, and was 31.1+/-5.1 ml/kg/min in the CR group and 31.4+/-6.0 ml/kg/min in the control at the follow-up GXT in six weeks. There was a statistically significant improvement in VO2peak only for CR group patients. FMD value was 7.59%+/-1.26% in the CR group, 7.36%+/-1.48% in the control at first and 9.46%+/-1.82% in the CR group, and 8.31%+/-2.04% in the control after six weeks. There was a statistically significant improvement in FMD value in the CR group. CONCLUSION: According to the results of GXT and FMD testing, six-week exercise-based CR program improved VO2peak and endothelial functions significantly. Thus, exercise-based CR program is necessary in patients with coronary artery disease.

Impact of Framingham Risk Score, Flow-Mediated Dilation, Pulse Wave Velocity, and Biomarkers for Cardiovascular Events in Stable Angina

Although the age-adjusted Framingham risk score (AFRS), flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV), high-sensitivity C-reactive protein (hsCRP), fibrinogen, homocysteine, and free fatty acid (FFA) can predict future cardiovascular events (CVEs), a comparison of these risk assessments for patients with stable angina has not been reported. We enrolled 203 patients with stable angina who had been scheduled for coronary angiography (CAG). After CAG, 134 patients showed significant coronary artery disease. During 4.2 yr follow-up, 36 patients (18%) showed CVEs, including myocardial infarction, de-novo coronary artery revascularization, in-stent restenosis, stroke, and cardiovascular death. ROC analysis showed that AFRS, FMD, baPWV, and hsCRP could predict CVEs (with AUC values of 0.752, 0.707, 0.659, and 0.702, respectively, all P<0.001 except baPWV P=0.003). A Cox proportional hazard analysis showed that AFRS and FMD were independent predictors of CVEs (HR, 2.945; 95% CI, 1.572-5.522; P=0.001 and HR, 0.914; 95% CI, 0.826-0.989; P=0.008, respectively). However, there was no difference in predictive power between combining AFRS plus FMD and AFRS alone (AUC 0.752 vs. 0.763; z=1.358, P=0.175). In patients with stable angina, AFRS and FMD are independent predictors of CVEs. However, there is no additive value of FMD on the AFRS in predicting CVEs.

Endothelial dysfunction in primary Sjögren syndrome / Disfunción endotelial en el síndrome de Sjögren primario

OBJECTIVE: In this study, we aimed to investigate endothelial functions in primary Sjögren syndrome. METHODS: Thirty-five patients with primary Sjögren syndrome and 20 age and sexmatched healthy volunteers were recruited to the present study. Flow mediated dilatation of brachial artery and carotid intimamedia thickness were measured in the study population. RESULTS: Carotid intimamedia thickness values were similar between groups (0.50 ± 0.10, 0.53 ± 0.08, p > 0.05). Flow mediated dilatation of the brachial artery was disrupted in the primary Sjögren syndrome group (7% vs 12%, p = 0.002). CONCLUSION: There is endothelial dysfunction in patients with primary Sjögren syndrome, although they had comparable carotid intimamedia thickness with the healthy control group.

OBJETIVO: Este estudio se encaminó a investigar las funciones endoteliales en el síndrome de Sjögren primario. MÉTODOS: Para el presente estudio, se reclutaron treinta y cinco pacientes con síndrome de Sjögren primario y 20 voluntarios sanos apareados por edad y sexo. La dilatación mediada por flujo observada en la arteria braquial, y el espesor íntimamedia carotídeo fueron medidos en la población bajo estudio. RESULTADOS: Los valores del espesor íntimamedia carotídeo fueron similares entre los grupos (0.50 ± 0.10, 0.53 ± 0.08, p > 0.05). La dilatación mediada por flujo de la arteria braquial, estaba alterada en el grupo de síndrome del Sjögren primario (7% frente a 12%, p = 0.002). CONCLUSIÓN: Hay una disfunción endotelial en los pacientes con el síndrome de Sjögren primario, aunque estos tenían un espesor íntimamedia carotídeo comparable con el grupo de control saludable.

Dopplerfluxometria de artérias oftálmicas e avaliação da função endotelial nas formas precoce e tardia da pré-eclâmpsia / Dopplerfluxometry of ophthalmic arteries and assessment of endothelial function in early and late preeclampsia

OBJETIVO: Avaliar possíveis diferenças entre a disfunção endotelial, avaliada pela dilatação fluxo-mediada, e hiperperfusão central, avaliada por dopplerfluxometria da artéria oftálmica, entre pacientes portadoras da forma precoce e tardia da pré-eclâmpsia. MATERIAIS E MÉTODOS: O teste de dilatação fluxo-mediada e a dopplerfluxometria da artéria oftálmica foram obtidos de 81 gestantes, sendo 56 portadoras de pré-eclâmpsia (26 na forma precoce e 30 na forma tardia) e 25 gestantes saudáveis (grupo controle). RESULTADOS: Portadoras de pré-eclâmpsia apresentaram valores menores de dilatação fluxo-mediada quando comparadas ao grupo controle, tanto na forma precoce (7,62 ± 5,42 por cento × 14,12 ± 6,14 por cento; p = 0,02) como na forma tardia (5,83 ± 4,12 por cento × 14,12 ± 6,14 por cento; p = 0,00). Não houve diferença quando foram comparadas as duas formas (7,62 ± 5,42 por cento × 5,83 ± 4,12 por cento; p = 0,09). A dopplerfluxometria da artéria oftálmica apresentou-se significativamente menor nas pacientes portadoras de pré-eclâmpsia quando comparadas ao grupo controle, tanto na forma precoce (0,631 ± 0,024 × 0,737 ± 0,032; p = 0,01) como na forma tardia (0,653 ± 0,019 × 0,737 ± 0,032; p = 0,03). Não houve diferença entre as duas formas de apresentação (0,631 ± 0,024 × 0,653 ± 0,019; p = 0,12). Os resultados basicamente demonstram redução nos valores de dilatação fluxo-mediada e dopplerfluxometria da artéria oftálmica nas formas tardia e precoce da pré-eclâmpsia quando comparadas ao grupo controle, sem, contudo, diferenças significativas entre as duas formas de apresentação da doença. CONCLUSÃO: Os resultados indicam a presença de disfunção endotelial e hiperperfusão central em gestantes com pré-eclâmpsia, tanto na forma precoce como na tardia.

OBJECTIVE: To identify possible differences between endothelial dysfunction evaluated by brachial artery flow-mediated dilation and central hyperperfusion evaluated by dopplerfluxometry of ophthalmic artery in women with early- and late-onset preeclampsia. MATERIALS AND METHODS: Flow-mediated dilation testing and dopplerfluxometry of ophthalmic artery were performed in 81 patients (26 with early preeclampsia, 30 with late preeclampsia, and 25 normotensive pregnant women - control group). RESULTS: As compared with the control group, patients with preeclampsia presented lower values of flow-mediated dilation, both in cases of early preeclampsia (7.62 ± 5.42 percent × 14.12 ± 6.14 percent; p = 0.02) and in cases of late preeclampsia (5.83 ± 4.12 percent × 14.12 ± 6.14 percent; p = 0.00). No statistically significant difference was observed between early- and late-onset preeclampsia (7.62 ± 5.42 percent × 5.83 ± 4.12 percent; p = 0.09). Values for dopplerfluxometry of ophthalmic artery were significant lower in patients with preeclampsia as compared with the control group, both in cases of early preeclampsia (0.631 ± 0.024 × 0.737 ± 0.032; p = 0.01) and in cases of late preeclampsia (0.653 ± 0.019 × 0.737 ± 0.032; p = 0.03). Again, no statistically significant difference was observed between early- and late-onset preeclampsia (0.631 ± 0.024 × 0.653 ± 0.019; p = 0.12). Basically, the results demonstrate a decrease in values for dopplerfluxometry of ophthalmic artery in patients with early and late presentations of preeclampsia as compared with the control group, although with no statistically significant difference between the two presentations of the disease. CONCLUSION: The present results indicate the presence of endothelial dysfunction and central hyperperfusion in patients with early- and late-onset preeclampsia.

Follow-up for vascular structure and function in children with successfully repaired coarctation of aorta / 中华胸心血管外科杂志

Objective Even after successful surgical repair,patients with coarctation of the aorta (CoA) are at high risk of long-term morbidity and mortality due to cardiovascular events,which is probably related to persistent arterial disfunction during long-terr follow-up after operation,The aim of the study was to explore the alterations of vascular structure and function in children with successfully repaired CoA in the short-and mid-term follow-up.Methods A cohort of 20 children who underwent CoA repair between January 2010 and October 2010 in Guangzhou women and children's Medical Center was studied.There were 14 males and 6 females in CoA group,which comprised 6 patients with isolated CoA,14 patients with CoA associated with intracardia anomalies,whose median age of operation was 4 months (rang from lmonth to 10.0 years).And 20 patients with isolated ventricular septal defect (VSD) were included as VSD group during the same time,with 12 males and 8 females,whose median age of operation was 5 months (rang from 1 month to 12.0 years).Resting blood pressure,flow-mediated dilation (FMD) of the brachial artery,carotid intima-media thickness (IMT) were compared in CoA group and VSD group,including preoperative media data and follow-up of 1 month,6 months and 1 year.In addition,as comparison to the operation group,20 health children with normal echocardiographic findings,whose median age was 5 months (rang from 3 month to 10.0 years),were selected as health group for the 1-year following up.None of them had obesity,hyperlipidemia,diabetes mellitus,metabolic diseases or systemic inflammatory disease.Results As a result of the datas before operation and those I month,6 months and 1 year after operation,all children were normotensive at rest.In the same period,Carotid IMT in CoA group[(0.47 ± 0.10)mm,(0.49 ±0.10) mm,(0.57 ±0.07)mm,(0.61 ± 0.07) mm]was significantly thicker than that in VSD group[(0.41 ±0.11) mm,(0.43 ±0.11)mm,(0.51 ±0.08) mm,(0.55 ±0.08) mm](P＜0.05) and health group[(0.40 ±0.09) mm,(0.42 ±0.11)mm,(0.50 ±0.08) mm,(0.57 ±0.08) mm](P ＜0.05),Brachial artery FMI in children with CoA[(5.4,6 ±1.51)％,(5.71 ±1.88)％,(5.42±1.69)％,(5.27±1.02)％]was significantly lower than that in the VSD control group[(6.69±1.45) ％,(6.66±1.21)％,(6.81 ±1.03)％,(6.43±1.34)％](P＜0.05) and health group[(6.59 ±1.84)％,(6.84±1.41)％,(6.91 ±1.31)％,(6.56±1.62)％](P＜0.05).Significant difference could not be found in neither the IMT nor the FMI between the VSI control group and health group in 4 period respectively,P ＞ 0.05.Conclusion Children after successful coarctation repair have abnomal structural and functional properties of the aorta above the place of coarctation even their blood pressure at rest is normal.These results confirm that the alterations in mechanical properties of carotid arteries as well as the generalized endothelial dysfunction in children with coarctation of the aorta are persistent,which can not be prevented or reversed by surgical repair,and which may partly explain the high incidence of cardiovascular disease observed in their adulthood and reduced life expectancy,furtherly supporting the claim that coartation of the aorta is a systemic vascular disorder which needs long-term follow-up of vascular function.

Blood Pressure Variability and Vascular Dysfunction in Essential Hypertension

There are several aspects of blood pressure. Clinically, how to best assess blood pressure average and variability is still a matter of the ongoing debate. Besides office blood pressure, we must pay more careful attention focused on hypertension with blood pressure fluctuation. Impaired endothelial function is intimately associated with the development of hypertension and atherosclerosis. In this review, we describe the relation between endothelial dysfunction and hypertension, the effect of gene polymorphism on endothelial dysfunction, the effects of antihypertensive agents and dietary supplementation on impaired endothelial function in hypertension. In order to predict the future atherosclerosis and cardiovascular events in subjects with hypertension, the adequate assessment of endothelial function is one of the most reliable markers. Furthermore, we discuss the close relationship between blood pressure variability and endothelial function. Blood pressure variability during a day or a week is an important, new risk factor for cardiovascular disease and restoring impaired endothelial function might be a target to prevent blood pressure variation and future cardiovascular events.

Correlação da resposta clínica à vardenafila em dois regimes terapêuticos com parâmetros vasculares e escore de risco cardiovascular em hipertensos com disfunção erétil vasculogênica / Correlation of clinical response of vardenafil in two therapeutic regimens with vascular parameters and cardiovascular risk score in hypertensive patients with vasculogenic erectile dysfunction

A disfunção erétil (DE) tem alta prevalência entre hipertensos e tem sido considerada marcdor precoce de risco cardiovascular. A presença e gravidade da DE bem como a resposta clínica aos inibidores da fosfodiesterase tipo 5 (PDES) parecem depender da biodisponibilidade do óxido nítrico (NO) endotelial e da extensão da doença aterosclerótica. O objetivo deste estudo foi avaliar a resposta clínica da vardenafila usada em dois regimes terapêuticos em hipertensos com DE vasculogênica e sem doença cardiovascular maior, correlacionando a gravidade da DE e a eficácia da vardenafila com dados antropométricos, laboratoriais, escore de risco cardiovascular e parâmetros vasculares funcionais e estruturais. A resposta clínica à vardenafila nos dois regimes foi avaliada conforme o percentual de respostas positivas à questão 3 do Perfil do Encontro Sexual (PES3). Os parâmetros vasculares considerados foram a espessura médio-intimal (EMI) da carótida comum, a dilatação mediada pelo fluxo (DMF) da artéria braquial e a dilatação nitrato-mediada (DNM). Foram incluídos 100 homens hipertensos com idade entre 50 e 70 anos, sendo 74 portadores de DE vasculogênica e 26 com função erétil normal que serviram de grupo controle. Nos pacientes com DE, o índice de massa corporal, relação cintura-quadril, EMI da carótida, níveis séricos de triglicerídeos, colesterol total e LDL foram significativamente maiores que no grupo controle. Após o uso de vardenafila on demand (fase 1), os pacientes com mais de 50% de respostas positivas ao PES3 ou 50% de respostas afirmativas e um incremento de 6 pontos ou mais em relação ao Índice Internacional de Função Erétil (IIEF-FE) basal e/ou resposta positiva a Questão de Avaliação Global (QAG), foram considerados respondedores. O escore do IIEF-FE basal se correlacionou negativamente com a EMI da carótida (r=-0,48, P<0,001) e com o escore de Framingham (r=-0,41, P<0,001) no grupo com DE. Houve forte correlação positiva entre a resposta clínica...

Erectile dysfunction (ED) is a high prevalent disease in hypertensive subjects and has been considered an early cardiovascular risk marker. ED's presence and severity, as well as clinical response to phosfodiesterase type 5 (PDES5) inhibitors, vary according to nitric oxide (NO) availability and atherosclerosis extension. We investigated whether vasculogenic ED severity and clinical response to vardenafil used on demand or continuously were associated with structural and functional vascular changes in patients with uncomplicated hypertension. Our main efficacy criterion was per patient percentage of positive answers on Sexual Encounter Profile question 3(SEP3). Vascular parameters considered were intima-media thickness (IMT), flow-mediated dilation (FMD) on brachial artery and nitrate-mediated dilation. A total of 100 hypertensive men aging between 50 and 70 years were included. Among these patients, 74 had vasculogenic ED and 26 presented normal erectile function according to erectile domain of International Index of Erectile Function (IIEF-EF). Among those with ED, body mass index, waist-rip ratio, carotid IMT, triglycerides, total cholesterol and LDL-cholesterol were significantly higher than controls. After vardenafil on demand usage during phase 1, patients with more than 50% of positive answers on SEP3 or 50% and more than 6 points on IIEF basal score or positive answer to global evaliation question were considered "responders". IIEF basal score correlated inversely with carotid IMT (r=-0.48, P<0.001) and with Framingham risk score (r=-0.41, P<0.001) in ED group. Clinical response to vardenafil strongly correlated with FMD (r= 0.70, P<0.001), except among diabetics. "Non responders" (n=35) on phase 1 were included on phase 2 when, after randomization, they received vardenafil 10 mg nightly or placebo during five weeks. Open vardenafil on demand were allowed on hour before sexual intercourse, and 38.8% of active group improved and became responders...

The relationship between disease-related risk factors and premature atherosclerosis in systemic lupus erythematosus / 中华风湿病学杂志

Objective To evaluate the prevalence of atherosclerosis in Chinese premenopausal women with systemic lupus erythematosus (SLE) and study possible associations between non-traditional risk factors with premature atherosclerosis. Methods One hundred and eleven premenopausal women with SLE and 40 healthy controls without clinical cardiovascular disease were evaluated. B-mode ultrasonography was used to measure carotid plaque and intima-media wall thickness( IMT). The relationship between the patients' clinical characteristics and carotid plaque was examined. At the same time, B-mode ultrasound was used to measure flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) in the brachial artery. Using this method, the difference in endothelial function between SLE patients and controls was assessed. T-test,χ2 test and logistic regression were used for statistical analysis. Results Carotid plaque was more frequently observed in patients with SLE (16 of 111 patients) than in control subjects (0 of 40 subjects) (P=0.007). The mean IMT (m-IMT) (0.62 mm vs 0.45 mm, P<0.01) and maximum IMT(M-IMT) (0.7 mm vs 0.6 mm, P<0.01) was significantly higher in patients than in controls. As compared with patients without plaque, patients with plaque were significantly older, had longer disease duration, higher body mass index (BMI), higher blood pressure, shorter prothrombin time, elevated C-reactive protein level, higher SLICC score, higher cumulative prednisone dose, less hydroxychloroquine accumulated dosage, higher m-IMT and M-IMT, lower FMD and NMD. In logistic regression analysis, older age (P=0.012, OR=1.137), higher BMI (P=0.051, OR=1.205) and higher SLICC score (P=0.000, OR=2.888) were independently related to the presence of plaque. Conclusion SLE patients have higher prevalence of carotid atherosclerosis plaque than healthy controls and the age at onset is younger than controls. In addition to traditional risk factors for cardiovascular disease, SLE itself and disease related factors play important roles in premature atherosclerosis in SLE. SLE patients have significant endothelial dysfunction. Thus, endothelial dysfunction can be regarded as one manifestation of premature atherosclerosis in SLE.

Marcadores de função endotelial no hipotireoidismo: [revisão] / Markers of endothelial function in hypothyroidism: [review]

O papel do endotélio em várias doenças vem sendo o foco da investigação científica e recentemente estão disponíveis métodos de avaliação da função endotelial de menor custo e menos invasivos. O endotélio modula o tônus vascular, participa dos processos inflamatórios, da ativação de plaquetas e da trombose. Consequentemente, a disfunção endotelial tem sido considerada evento importante na patogênese da aterosclerose. O hipotireoidismo está associado a maior risco cardiovascular, e a avaliação da função endotelial vem sendo reconhecida como ferramenta promissora na detecção de alterações cardiovasculares pré-clínicas associadas à disfunção tireoidiana. Alguns estudos recentes demonstraram relação entre o status tireoidiano e a função endotelial. Entretanto, estudos multicêntricos e controlados por placebo são necessários para abordar essa questão e o efeito da reposição da levotiroxina na função endotelial. Esse artigo propõe-se a discutir as perspectivas da relação entre endotélio e função tireoidiana.

The role of the endothelium in human disease has become the focus of scientific investigation and recently noninvasive and less expensive measures of endothelial function have become available. The endothelium modulates the vascular tonus and participates in inflammatory processes, platelet aggregation and thrombosis. Consequently, endothelial dysfunction has been implicated as an important event in the pathogenesis of atherosclerosis. Hypothyroidism is associated with an increased cardiovascular risk, and the assessment of endothelial function holds a great deal of promise as an assessment tool for the detection of preclinical cardiovascular alterations associated with thyroid dysfunction. Some recent studies have demonstrated a relationship between thyroid status and endothelial function, but large multicenter, placebo-controlled prospective trials are necessary to address this issue and the effect of levothyroxine replacement treatment in endothelial function. The objective of this work is to discuss the perspective picture in endothelium and thyroid function relationship.