Discriminative value of pulse wave velocity for arterial stiffness and cardiac injury in prediabetic patients / Valor discriminativo da velocidade da onda de pulso para rigidez arterial e lesão cardíaca em pacientes pré-diabéticos

Abstract Background Prediabetes (PD) is defined as impaired fasting glucose and/or impaired glucose tolerance (IGT) and may be associated with high risk of cardiovascular injury. It is recommended that PD patients be screened for signs of arterial stiffness and cardiovascular injury to reinforce therapeutic strategies. Objectives To identify pulse wave velocity values discriminative for arterial stiffness and cardiovascular injury in PD patients. Methods A cross-sectional study was conducted with PD (N=43) and normoglycemic (N=37) patients who underwent clinical evaluation, arterial stiffness assessment by carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor, laboratory blood analysis, investigation of morphological and functional cardiac variables by transthoracic echocardiogram, and assessment of carotid intima-media-thickness (CIMT) by carotid ultrasonography. A statistical analysis was performed using SPSS software and values of p<0.05 were considered significant. Results A cfPWV cut-off value of 6.9 m/s was identified for IGT (Sensitivity [SE]: 74% and Specificity [SP]: 51%). Comparison of general data and risk factors between subsets with values above and below this cutoff value revealed higher rates of fasting glucose (p=0.02), obesity (p=0.03), dyslipidemia (p=0.004), early signs of left ventricle (p=0.017) and right ventricle (p=0.03) impaired diastolic function, and elevated CIMT in subjects with cfPWV ≥ 6.9m/s (p=0.04). Conclusions In PD patients, a cfPWV cutoff of 6.9 m/s was considered a discriminative value for arterial stiffness. These findings highlight the value of early investigation of cardiovascular injury and aggressive therapy strategies with good control of risk factors in PD.

Resumo Contexto O pré-diabetes (PD) é definido como glicemia de jejum alterada e/ou tolerância à glicose alterada (TGA) e pode estar associado a alto risco de lesão cardiovascular. Recomenda-se discriminar quais pacientes com PD podem apresentar sinais de rigidez arterial e lesão cardiovascular para reforçar as estratégias terapêuticas. Objetivos Identificar os valores discriminativos da velocidade de onda de pulso determinantes de rigidez arterial e lesão cardiovascular em pacientes com PD. Métodos Estudo transversal em pacientes com PD (N=43) e normoglicêmicos (N=37) submetidos a avaliação clínica, avaliação da rigidez arterial pela velocidade da onda de pulso carótido-femoral (cfPWV) utilizando SphygmoCor, análise laboratorial de sangue, investigação de alterações morfológicas e variáveis cardíacas funcionais por ecocardiograma transtorácico e avaliação da espessura íntima-média carotídea (EIMC) pela ultrassonografia da carótida. A análise estatística foi realizada no software SPSS, e valores de p<0,05 foram considerados significativos. Resultados Foi identificado um valor de corte cfPWV de 6,9 m/s para TGA (sensibilidade 74% e especificidade 51%). A comparação dos dados e fatores de risco entre valores acima e abaixo do valor de corte estabelecido revelou glicemia de jejum elevada (p=0,02), obesidade (p=0,03), dislipidemia (p=0,004), sinais precoces de função diastólica prejudicada do ventrículo esquerdo (p=0,017) e ventrículo direito (p=0,03) e maior EIMC em cfPWV ≥6,9m/s (p=0,04). Conclusões Em pacientes com PD, o cfPWV de 6,9 m/s foi considerado um valor discriminativo de rigidez arterial. Esses achados reforçam que a investigação precoce da lesão cardiovascular e uma estratégia com terapia agressiva são valiosas no controle dos fatores de risco na PD.

Arterial stiffness in type 2 diabetes: determinants and indication of a discriminative value

OBJECTIVES: To identify the clinical discriminative value and determinants of arterial stiffness in individuals with type 2 diabetes mellitus (T2DM). METHODS: This prospective cohort study included 51 individuals (53.57±9.35 years) diagnosed with T2DM (stage glucose≥126 mg/dL; diagnostic time: 87.4±69.8 months). All participants underwent an initial evaluation of personal habits, medications, and history; arterial stiffness assessment by carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor; and blood laboratory analysis. A statistical analysis was performed using SPSS software, and values of p≤0.05 were considered significant. RESULTS: A cut-off cfPWV value of 7.9 m/s was identified for T2DM [Sensitivity (SE): 90% and Specificity (SP): 80%]. A subgroup analysis revealed higher glycated hemoglobin (Hb1Ac) (p=0.006), obesity (p=0.036), and dyslipidemia (p=0.013) than those with cfPWV ≥7.9 m/s. Multivariate analysis identified higher stage glucose (p=0.04), Hb1Ac (p=0.04), hypertension (p=0.001), and dyslipidemia (p=0.01) as determinant factors of cfPWV; positive and significant correlation between cfPWV and glucose (r=0.62; p=0.0003) and Hb1Ac (r=0.55; p=0.0031). CONCLUSIONS: In T2DM, an indicator of the discriminative value of arterial stiffness was cfPWV of 7.9 m/s. Clinical findings and comorbidities, such as hypertension, glucose, poor glycemic control, and dyslipidemia, were associated with and were determinants of arterial stiffness in T2DM. Reinforcement of monitoring risk factors, such as hypertension, dyslipidemia, and glycemic control, seems to be essential to the process of arterial stiffening. Confirmation of this discriminative value in larger populations is recommended.

Correlation analysis of child and adolescent Korotkoff phase Ⅳ and Ⅴ sound with subclinical cardiovascular diseases in adulthood / 中华实用儿科临床杂志

Objective To examine the value of child and adolescent Korotkoff phase Ⅳ(K4)and Korotkoff phaseⅤ(K5)diastolic blood pressures for predicting subclinical cardiovascular disease(CVD)in adulthood.Methods The data was obtained from the Beijing Children Blood Pressure Study.A total of 3 198(1 700 males,53.2%)healthy children aged 6-18 years from 6 districts in Beijing in 1987 were selected.The physical examination process included measuring height,weight,and blood pressure.From a follow-up survey in 2010-2012,1 252 subjects were analyzed by the same measurements (height,weight and blood pressure)and also by using subclinical markers for vascular damage,including carotid intima-media thickness (cIMT)and carotid-femoral pulse wave velocity (cfPWV).Childhood hypertension at baseline and adulthood hypertension were diagnosed according to the China Guideline for Hypertension Prevention and Control issued in 2010.High cfPWV and high cIMT were defined in adults as having higher than age and gender-specific 75th percentile of cfPWV and cIMT.Pearson correlation coefficients were calculated to describe the association of K4 and K5 in childhood with systolic blood pressure(SBP),diastolic blood pressure(DBP),cfPWV, and cIMT in adulthood.Logistic regression was used to analyze the values of K4 and K5 to predict subclinical CVD in adulthood.Results The baseline mean value of K4 DBP was (66.4 ± 9.1)mmHg (1 mmHg＝0.133 kPa)and K5 DBP was (54.1 ± 11.1)mmHg.The prevalence rates of high-normal blood pressure were 9.4% with DBP measured by using K4,and 6.9% with DBP measured by using K5,respectively. The prevalence rates of hypertension were 11. 3% with DBP measured by using K4,and 8.4%with DBP measured by using K5.After adjustment for age and follow-up age,Pearson correlation analyses showed K4 DBP and K5 DBP in childhood were all significantly associated with adult SBP,DBP,cIMT,cfPWV in males and in females (all P＜0.05).K4 in childhood was better correlated with SBP,DBP,cIMT and cfPWV in adulthood than K5.With multi-factor logistic regression analysis,K4 was better than K5 in predicting CVD in adulthood after controlling gender and age.Further K4 was more effective in predicting cfPWV than cIMT.Conclusions There was a significant difference between K4 and K5 in Chinese children and adolescents. K4 in childhood was better correlated with CVD in adults than K5,and K4 is superior to K5 when using auscultator technique to measure DBP.

Effects of Aging on Arterial Stiffness in Normotensives

Introduction: Recent researches have determined that decreased arterial elasticity by age is one of the Cardiovascular risk factors. The modification of arterial elasticity can be evaluated accurately by measuring PWV.\r\n', u'Objectives: To determine the age - related change in the arterial stiffness in healthy people and factors that change the arterial stiffness. \r\n', u'Subjects and methods: The study group consisted of 123 normotensive subjects, including 65 men and 58 women (mean age 51.2 \xb1 13.9 years). Aortic elasticity was assessed by measuring carotid - femoral pulse PWV using a Complior Colson device with 2 pressure transducers.\r\n', u'Results: The mean PWV in both gender groups was 10.2 \xb1 1.6 m/s. There was no significant difference in both the right and the left side of the body, as well as genders regarding PWV calculation. PWV was correlated with age (r = 0.56) and mean blood pressure index (r = 0.6). If PWV was measured on the left side, subjects with plaques in common carotid artery (proved by echo) had a higher PWV than those without carotid plaque presence. In returns, there was no significant difference in terms of PWV, if it was measured on the right side. The arterial PWV in normal subjects with CT/HDL index of more than 5 is higher than those with CT/HDL index of less than 5. There was no correlation between arterial PWV and hyper - cholesterolemia. \r\n', u'Conclusions: 1. Mean arterial PWV in the healthy subjects was. 10.2 \xb1 1.6 m/s. 2. Arterial PWV had a positive correlation with age, mean blood pressure index and CT/HDL index.\r\n', u'