O efeito da atorvastatina + aspirina na função endotelial difere com a idade em pacientes com HIV: Um estudo de caso-controle / The effect of atorvastatin + aspirin on the endothelial function differs with age in patients with HIV: A case-control study

Resumo Fundamento Pacientes com HIV têm maior probabilidade de apresentar doenças cardiovasculares quando comparados à população em geral. Objetivo Este foi um estudo de caso-controle que teve como objetivo avaliar quais fatores estavam associados a uma redução na espessura médio-intimal da carótida (IMT) da carótida e ao aumento na dilatação mediada por fluxo (DMF) da artéria braquial em pacientes com HIV que receberam atorvastatina + aspirina por um período de 6 meses. Métodos Foi realizada uma análise secundária de um ensaio clínico, que incluiu pessoas vivendo com HIV e baixo risco cardiovascular. Um total de 38 pacientes alocados para o braço de intervenção e tratados por 6 meses com uma combinação de atorvastatina + aspirina foram incluídos. Todos os participantes foram submetidos a ultrassonografia da carótida e da artéria braquial, tanto no início quanto no final do estudo. Os casos que responderam com aumento >10% da dilatação braquial (DMF) e redução da espessura médio-intimal da carótida (IMT) foram considerados casos, e aqueles que não responderam foram considerados controles. Avaliamos os fatores associados às respostas positivas obtidas através da IMT e DMF. Resultados A redução do IMT não se associou significativamente a nenhum dos fatores de risco avaliados: idade (p = 0,211), sexo (p = 0,260), tabagismo (p = 0,131) ou tempo de diagnóstico do HIV (p = 0,836). Um aumento na DMF foi significativamente associado com a idade entre aqueles na faixa etária de 40-59 anos, p = 0,015 (OR = 4,37; IC 95%: 1,07-17,79). Conclusões Os indivíduos mais velhos foram mais propensos a apresentar um aumento na DMF após 6 meses de tratamento com atorvastatina + aspirina.

Abstract Background Patients with HIV are more likely to present with cardiovascular disease when compared to the general population. Objective This was a case-control study that aimed to assess which factors were associated with a reduction in the carotid intima-media thickness (IMT) and an increase in the brachial artery flow-mediated dilation (FMD) in HIV patients who received atorvastatin + aspirin during a period of 6 months. Methods A secondary analysis of a clinical trial was conducted, which included people living with HIV infection and low cardiovascular risk. A total of 38 patients allocated to the intervention arm and treated for 6 months with a combination of atorvastatin + aspirin were included. All participants underwent a carotid and brachial artery ultrasound, both at the beginning and the end of the study. Cases that responded with an increase of >10% of the brachial dilatation (FMD) and reduction of the carotid intima-media thickness (IMT) were considered cases, and those who did not respond were considered controls. We assessed the factors associated with the positive responses obtained through IMT and FMD. Results A reduction in the IMT was not significantly associated with any of the evaluated risk factors: age (p=0.211), gender (p=0.260), smoking (p=0.131) or time since HIV diagnosis (p=0.836). An increase in the FMD was significantly associated with age amongst those in the 40-59 age group, p = 0.015 (OR = 4.37; 95% CI: 1.07-17.79). Conclusions Older individuals were more likely to present with an increased FMD after 6 months of treatment with atorvastatin + aspirin.

Uric acid as a predictor of endothelial dysfunction in patients with metabolic syndrome

ABSTRACT Objective: We conducted a study to examine the association of endothelial dysfunction and oxidative stress with uric acid levels in patients of metabolic syndrome. Subjects and methods: One hundred and two patients of Metabolic Syndrome (International Diabetes Federation definition) were included in the study. Anthropometric measurements, serum uric acid levels, fasting blood sugar levels and lipid levels, as well as malondialdehyde and reactive nitrogen intermediates were measured after an 8-hour fasting period. Flow mediated vasodilation (FMD) of the brachial artery was measured and endothelial dysfunction was defined as an increase in diameter < 10% post compression. Results: A total of 102 patients were included in the study. Mean uric acid level was 5.49 ± 1.61 mg%. A total of 59 patients in the study had endothelial dysfunction, defined by an abnormal FMD. Patients with an abnormal FMD had higher levels of serum uric acid which was statistically significant (p value = 0.010). Serum RNI and MDA levels were negatively correlated with uric acid, but did not reach statistical significance. Patients with an abnormal FMD had a lower RNI level, but this did not reach statistical significance. Serum MDA levels were significantly higher in patients with an abnormal FMD (p value = 0.038). Conclusions: Uric acid was significantly associated with endothelial dysfunction in patients with metabolic syndrome in our study. It was inversely correlated with serum RNI and MDA levels, but this did not reach statistical significance.

Vasodilation and Reduction of Systolic Blood Pressure after One Session of High-Intensity Interval Training in Patients With Heart Failure with Preserved Ejection Fraction / Vasodilatação e Redução da Pressão Arterial Sistólica após uma Sessão de Treinamento Intervalado de Alta Intensidade em Pacientes com Insuficiência Cardíaca com Fração de Ejeção Preservada

Abstract Background: Heart failure with preserved ejection fraction (HFpEF) is a multifactorial syndrome characterized by a limited exercising capacity. High-intensity interval training (HIIT) is an emerging strategy for exercise rehabilitation in different settings. In patients with HFpEF, HIIT subacute effects on endothelial function and blood pressure are still unknown. Objective: To evaluate the subacute effect of one HIIT session on endothelial function and blood pressure in patients with HFpEF. Methods: Sixteen patients with HFpEF underwent a 36-minute session of HIIT on a treadmill, alternating four minutes of high-intensity intervals with three minutes of active recovery. Brachial artery diameter, flow-mediated dilation, and blood pressure were assessed immediately before and 30 minutes after the HIIT session. In all analyses, p <0.05 was considered statistically significant. Results: There was an increase in brachial artery diameter (pre-exercise: 3.96 ± 0.57 mm; post-exercise: 4.33 ± 0.69 mm; p < 0.01) and a decrease in systolic blood pressure (pre-exercise: 138 ± 21 mmHg; post-exercise: 125 ± 20 mmHg; p < 0.01). Flow-mediated dilation (pre-exercise: 5.91 ± 5.20%; post-exercise: 3.55 ± 6.59%; p = 0.162) and diastolic blood pressure (pre-exercise: 81 ± 11 mmHg; post-exercise: 77 ± 8 mmHg; p = 1.000) did not change significantly. There were no adverse events throughout the experiment. Conclusions: One single HIIT session promoted an increase in brachial artery diameter and reduction in systolic blood pressure, but it did not change flow-mediated dilation and diastolic blood pressure.

Resumo Fundamento: Insuficiência cardíaca com fração de ejeção preservada (ICFEP) é uma síndrome multifatorial caracterizada por limitação ao exercício. O treinamento intervalado de alta intensidade (HIIT) é uma estratégia emergente para a reabilitação do exercício em diferentes contextos. Em pacientes com ICFEP, os efeitos subagudos do HIIT sobre a função endotelial e a pressão arterial ainda são desconhecidos. Objetivo: Avaliar o efeito subagudo de uma única sessão do HIIT sobre a função endotelial e a pressão arterial em pacientes com ICFEP. Métodos: Dezesseis pacientes com ICFEP foram submetidos a uma sessão de 36 minutos de HIIT em esteira rolante, alternando quatro minutos de intervalos de alta intensidade com três minutos de recuperação ativa. O diâmetro da artéria braquial, a dilatação mediada pelo fluxo e a pressão arterial foram avaliados imediatamente antes e 30 minutos após a sessão de HIIT. Em todas as análises, p <0,05 foi considerado estatisticamente significativo. Resultados: Houve aumento do diâmetro da artéria braquial (pré-exercício: 3,96 ± 0,57 mm; pós-exercício: 4,33 ± 0,69 mm; p < 0,01), e diminuição da pressão arterial sistólica (pré-exercício: 138 ± 21 mmHg; pós-exercício: 125 ± 20 mmHg; p < 0,01). A dilatação mediada por fluxo (pré-exercício: 5,91 ± 5,20%; pós-exercício: 3,55 ± 6,59%; p = 0,162) e pressão arterial diastólica (pré-exercício: 81 ± 11 mmHg; pós-exercício: 77 ± 8 mmHg; p = 1,000) não se alteraram significativamente. Não houve eventos adversos durante o experimento. Conclusões: Uma única sessão do HIIT promoveu aumento do diâmetro da artéria braquial e redução da pressão arterial sistólica, mas não alterou a dilatação mediada pelo fluxo e a pressão arterial diastólica.

Dilatação fluxo-mediana da artéria braquail: aspectos técnicos, aplicabilidade e reprodutividade em ginecologia e obstetrícia / Flow-mediated dilatation of brachial artery: technical aspects, applicability and reproducibility in gynecology and obstetrics

A avaliação da dilatação fluxo-mediada da artéria braquial (DILA) tem-se incorporada na prática clínica como método capaz de contribuir no estudo das doenças arterioescleróticas. Estudos demonstraram que os valores de DILA são reduzidos em pacientes com pré-eclâmpsia, e que a redução desses valores está diretamente ligada à morbidade da doença. Outros estudos correlacionam diabetes gestacional e disfunção endotelial com redução do DILA nestas pacientes. Ainda, a terapia de reposição hormonal tem sido demonstrada como fator de melhora nos valores do DILA em pacientes na pós-menopausa. O objetivo deste estudo foi realizar uma revisão bibliográfica sobre a utilização do DILA em Ginecologia e Obstetrícia. Foi realizado um levantamento bibliográfico nas bases da Bireme, Scielo e PubMed, de trabalhos publicados entre 2013 e 2017. Podemos concluir que métodos não invasivos e de fácil execução, como o DILA, podem ter impactos relevantes ao identificar grupos de riscos e, assim, viabilizar medidas protetivas.(AU)

The evaluation of the flow-mediated dilation of the brachial artery (FMD) has been incorporated into clinical practice as a method capable of contributing to the study of arteriosclerotic diseases. Studies have shown that FMD values are reduced in patients with preeclampsia, and that the reduction in these values is directly associated with disease morbidity. Other studies correlate gestational diabetes and endothelial dysfunction with reduction of FMD in these patients. Furthermore, hormone replacement therapy has been demonstrated as an improvement fator in FMD values in postmenopausal patients. The objective of this study was to perform a bibliographic review on the use of FMD in Gynecology and Obstetrics. A bibliographical survey was carried out on the Bireme, Scielo and PubMed databases, of works published between 2013 and 2017. We can conclude that non-invasive and easy-to-execute methods, such as FMD, can have relevant impacts when identifying gropups of risk and thus make feasible measures protective.(AU)

Low vaspin levels are related to endothelial dysfunction in patients with ankylosing spondylitis

Vaspin is a novel adipocytokine associated with glucose tolerance and chronic inflammation. Some studies reveal that vaspin may be involved in cardiovascular diseases. Our objective was to investigate the relationship between serum vaspin levels and endothelial function in patients with ankylosing spondylitis. One hundred and twenty patients with newly diagnosed ankylosing spondylitis and 100 healthy subjects were studied. Serum vaspin levels were measured with enzyme-linked immunosorbent assay. High resolution ultrasound was used to measure brachial artery diameter at rest, after reactive hyperemia (flow-mediated dilation, FMD) and after sublingual glyceryltrinitrate. Serum vaspin level in patients was 1.92±1.03 ng/mL, which was significantly lower than that in healthy subjects (2.88±0.81 ng/mL). By dividing the distribution of serum vaspin levels into quartiles, FMD levels increased gradually with the increase of serum vaspin levels in patients (P<0.01). Univariate analysis showed a correlation between vaspin and FMD (r=0.73, P=0.003), low-density lipoprotein cholesterol (r=-0.45, P=0.033), high-density lipoprotein cholesterol (r=0.63, P=0.025), fasting blood glucose (r=-0.79, P=0.006), triglycerides (TG) (r=-0.68, P=0.036), systolic blood pressure (r=-0.35, P=0.021), C-reactive protein (r=-0.67, P=0.011), homeostatic model assessment of insulin resistance (HOMA-IR) (r=-0.77, P=0.023) and erythrocyte sedimentation rate (r=-0.88, P=0.039) in patients. Multivariate analysis indicated that serum vaspin levels were independently associated with FMD, HOMA-IR and TG in patients. Our study found that serum vaspin levels were decreased in patients with ankylosing spondylitis and were associated with FMD levels. Vaspin may serve as an independent marker for detecting early stage atherosclerosis in patients with ankylosing spondylitis.

[Comparing two ovulation induction methods by brachial artery ultrasonography in infertile women with polycystic ovary syndrome]

Endothelial dysfunction can influence fertility rate in women with polycystic ovary syndrome [PCOS] as flow mediated dilatation [FMD] is impaired in patients with the disease. The aim of this study was to compare two methods of ovulation induction by letrozole or letrozole plus human menopausal gonadotropins [HMGs] in infertile women with PCOS who were resistant to clomiphene citrate based on brachial artery ultrasound findings. In this double -blind randomized clinical trial, 59 infertile women who had the inclusion criteria for PCOS were evaluated in the Infertility Clinic of Shariati Hospital in Tehran, Iran in 2010-2011. The patients were assigned to two letrozole and letrozole plus HMG groups and were evaluated for FMD in the brachial artery by transvaginal ultrasonography. Later, the values were recorded and analyzed statistically. In the letrozole group, infertility treatment was successful in 15 [57.7%] but it failed in 11 [42.3%] patients. In letrozole plus HMG group, the treatment was successful in 18 [54.5%] while it failed in 15 [45.5%] patients. The mean FMD values in the groups with successful and unsuccessful treatment results were 19.42 +/- 10% and 18.57 +/- 7.2%, respectively, but the difference was not statistically significant [P=0.712]. Moreover, the average endometrial thickness in groups with successful and unsuccessful treatment results were 8.4 +/- 1.3 mm and 9.8 +/- 3.9 mm, respectively but the difference was not significant either [P=0.06]. In infertile women with polycystic ovary syndrome that are resistant to clomiphene, letrozole or letrozole combined with gonadotropin can be equally effective for ovulation induction

Unilateral anomalous arterial pattern of human upper limb: Anatomical description and clinical implications

A unilateral case of variations in the brachial and antebrachial arterial branching pattern of a human upper limb is reported. A high bifurcation of brachial artery along with superficial course of ulnar artery was observed. Additionally, the profunda brachii and common interosseous artery originated from the radial artery instead of brachial and ulnar arteries respectively. An atypical branching pattern of arteries in an upper limb could pose a challenging problem to vascular surgeons while performing reconstructive procedures

Treatment of iatrogenic pseudoaneurysm of brachial artery with percutaneous ultrasonographically guided thrombin injection (PUGTI): a case report and a literature review.

OBJECTIVE: Report the successful treatment of iatrogenic pseudoaneurysm of the brachial artery with the percutaneous ultrasonographically guided thrombin injection (PUGTI). MATERIAL AND METHOD: The pseudoaneurysm was caused by an accidental puncture into a native brachial artery instead of the venous side of an arteriovenous fistula during hemodialysis. The aneurysmal sac had a large size with a short neck, vulnerable to intra-arterial thrombosis and distal artery embolization during the thrombin glue injection. RESULTS: This procedure was secured by using color duplex ultrasonography (CDU) for the accurate positioning of the needle and the assessment of the optimal dosage of the injected bovine thrombin. After the procedure, an elastic compression was applied at the injection site to prevent the reentry of blood flow into the aneurysmal sac. The flow in the aneurysmal sac completely disappeared in seven days after the treatment. The 4-month follow-up demonstrated the complete resolution of the aneurysmal sac. CONCLUSION: Percutaneous injection of bovine thrombin under ultrasound guidance is possible as one of the minimal invasive procedures to treat the pseudoaneurysm of the extremity artery.

Non-invasive assessment of endothelial function in offspring of patients with type-2 diabetes mellitus

Objective:- The present study aimed at evaluation of the non invasive assessment of endothelial function in offspring of patient with type 2 diabetes mellitus [type 2 DM]

Subject and methods:-The study include 36 healthy subject [mean age 25 +/- 12 year] with one or both parents were type 2 diabetes mellitus, 48 patient with type 2 DM [mean age 58 +/- 10 years] and 12 healthy control subject matched for age [23 +/- 10 years] with no history of diabetes in any of their parents The brachial artery diameter and its vascular reactivity was measured with high resolution ultrasound at rest, endothelial dependant after reactive hypereamia [Flow mediated dilatation [FMD]] and endothelial independent after administration of sublingual nitrate [NMD]

Result:- The result of our study demonstrated that The FMD was significantly low in patient with type 2 DM as compared to the control subjects 14.7 +/- 1.0, 13.9 +/- 1,8, P <0.001]. Also the NMD was significantly lower in diabetic patient compared to control subject [10.1 +/- 3.1, 21.2 +/- 22 P<0.001] The FMD and NMD were comparable among offspring of diabetic patients and their parents On the other hand the rate of blood flow was also significantly decreased in diabetic and their offspring as compared to control subjects

Conclusion:- Study of brachial artery dilatation with high resolution ultrasound is a simple non invasive index of endothelial function FMD and NMD was significantly impaired in diabetic patient FMD and NMD was significantly impaired in offspring of diabetic patient So we recommend that brachial artery reactivity study should be performed in offspring of diabetic patient in regular fashion to pick-up early impairment in endothelial function and dealt with

Non-invasive detection of endothelial dysfunction in sickle cell disease by Doppler ultrasonography.

OBJECTIVE: The purpose of the study was to assess endothelial function in sickle cell disease (SCD), to compare endothelial dysfunction between sickle cell anemia (SS) and sickle cell trait (SA) cases and to evaluate correlation of endothelial dysfunction with duration of symptoms and vaso-occlusive crises per year (voc/year) [severity of disease]. METHODS: We investigated 37 steady state SCD cases, of which 19 were SS [mean age = 23.15 + 5.27 years and M/F = 10/9] and 18 were SA cases [Mean age = 22.05 +/- 5.17 years and M/F = 9/9]. Age, sex, and hemoglobin matched 33 controls [15 (Hb < or = 11g%) for SS cases and 18 (Hb > or = 11g%) for SA cases] were studied. Endothelial function was assessed by flow-mediated dilation (FMD) in brachial artery by vascular Doppler after pneumatic tourniquet stress at forearm (by Celermajer DS, 1992). RESULTS: FMD was significantly impaired in SCD cases [6.22% + 0.91% in SS cases vs. 16.85% + 1.06% in controls, P<0.05 and 12.56% + 0.90% in SA cases vs. 16.99% + 1.05% in controls, P < 0.05]. Endothelial function was impaired more in SS as compared to SA cases (p < 0.05). Decline in endothelial function was observed with increasing duration of symptoms and voc/year in SS cases. CONCLUSION: These results suggest that endothelial function is impaired in SCD and endothelial function is impaired more in SS as compared to SA cases.

Ergotamine-Induced Upper Extremity Ischemia: A Case Report

Ergotamine-induced limb ischemia is an extremely rare case. We present a case of a 64-year-old man, who developed ischemia on the right upper extremity due to long-term use of Ergot for migraine headache. Angiography revealed diffused, smooth, and tapered narrowing of the brachial artery. The patient was successfully treated with intravenous nitroprusside.

Carotid intima-media thickness and brachial-ankle pulse wave velocity in patients with and without coronary artery disease.

BACKGROUND: Carotid intima-media thickness and pulse wave velocity are non-invasive markers of atherosclerosis and have been shown to reliably predict presence and extent of atherosclerotic vascular disease. However, studies examining their association with each other have shown inconsistent results. Hence it was sought to assess correlation between carotid intima-media thickness and pulse wave velocity in patients with and without coronary artery disease. METHODS AND RESULTS: Sixty-four patients with angiographically proven coronary artery disease and 84 age-matched individuals without coronary artery disease but having one or more conventional cardiovascular risk factors were included in the study. Individuals with established cerebrovascular disease and peripheral vascular disease were excluded from the study. Carotid intima-media thickness of far wall was measured at three predefined sites (distal common carotid, carotid bifurcation and proximal internal carotid artery) on each side. Brachial-ankle pulse wave velocity was measured non-invasively using VP 1000 (Colin Corporation) automated ABI/ PWV analyzer. There was no significant difference in gender and presence of cardiovascular risk factors in the two groups. Mean and maximum carotid intima-media thickness and brachial-ankle pulse wave velocity were all significantly higher in coronary artery disease patients as compared to patients without coronary artery disease (0.842 v. ( 0.657 mm, p <0.0001; 1.076 v. 0.795 mm, p <0.0001; 1708.63 v. 1547.26 cm/s, p <0.0004 respectively). There was a significant correlation between brachial-ankle pulse wave velocity and both mean and maximum carotid intima-media thickness in patients with coronary artery disease (r = 0.47, p <0.0001 and r=0.41, p < 0.0008 respectively) but not in individuals without coronary artery disease (r=0.01 and -0.1 respectively). CONCLUSIONS: Presence of significant correlation between carotid intima-media thickness and brachial-ankle pulse wave velocity in patients with coronary artery disease but absence of the same in individuals without major atherosclerotic vascular disease suggests that the correlation between carotid intima-media thickness and brachial-ankle pulse wave velocity becomes stronger with increasing extent of atherosclerosis.

Comparative study of ankle brachial index [abi] digitial subtraction angiography [dsa] and doppler flowmetry in evaluation of diabetic foot

It is a prospective study carried out at Lahore General Hospital from April 1993 to April 1996 in 21 Diabetic Patients with ulceration in the foot. The purpose of this study was to find out the best method for assessment of Diabetic Foot Ulceration. For this purpose Clinical Method, Ankle Brachial Index, Doppler Ultrasound and Digital Subtraction Angiography were compared as individual parameters. The results show that DSA has got the best sensitivity [93%], followed by Doppler Sonograpy [86%] and Ankle Brachial Index [84%]. We conclude that Digital Subtraction Angiography should be carried out in all doubtful cases to decide the management and the level of amputation

Irrespective to glycemic control postprandial hypertriglyceridemia induces more endothelial dysfunction in type 2 diabetes mellitus

Endothelium-dependent vasodilation was studied noninvasively in the brachial artery during fasting normolipidemic and physiological postprandial triglyceridemic states. The study was carried out on type 2 diabetics and healthy controls. The effect of both actual [FBS and 2hPPBS] and midterm [HbAlc] glycemic control was evaluated too. 14 controlled diabetics. 16 uncontrolled diabetics, and 15 healthy controls were recruited in the research. The patients had no diabetic complications. Both controlled and uncontrolled diabetic groups had matched age [43.3 +/- 11.2, 40.83 +/- 13.5 Vs 41.63 +/- 12.3] and sex [M/F 8.6, 8/8 Vs 8/7] with the control group. Beside the basic investigations, basal serum insulin and fasting lipid profile as well as 4-5 hours postprandial serum triglycerides levels, were esdtimated. Using high-resolution ultrasound, we measured the endotheliam-dependent vasodilation [FAD%] and the blood flow velocity [TAVx] at rest and postocclusive during fasting normolipidemic and 4-5 hours after a fatty meal [serum triglycerides level exceeds 350 mg/dl]. The blood flow velocity cm/sec at rest "TAVx rest"; both on fasting [9.0 +/- 0.2. 11.0 +/- 0.34 Vs 10.6 +/- 0.65] and postabsorptive hypertriglyceridemia [11.0 +/- 0.29, 12.0 +/- 0.29, 12.0 +/0.54 Vs 10.9 +/- 0.72] showed no significant difference between the controlled and uncontrolled diabetic subjects and the healthy controls, when compared to each other [P>0.1]. We found an increase in TAVx postocclustive during the fasting [28.04 +/- 1.05, 29.03 +/- 1.08 Vs 38.9 +/- 2.09 cm/sec.] as well as the significantly higher in the control subjects compared with both diabetic groups. FAD% 'fassting" [7.3 +/- 0.03, 8.02 +/- 0.09 Vs 11.4 +/- 1.07] of both diabetic groups was lower than that of the control group [P<0.01]. However, there was no significant difference between the two diabetic groups [P>0.1]. Agvain, a further reduction of FAD% "postabsorptive" [5.6 +/- 0.02, 5.1 +/- 0.01 Vs 10.4 +/- 10.04], was obtained in both diabetic groups, compared with the control group. Moreover, FAD% "postabsorptive" of each diabetic group was markedly reduced, when compared with its own fad% "fasting" value [p < 0.001], ety, there was no significant difference between the two diabetic groups regarding FAD% "fasting" as mentioned before- or FAD% "postabsorptive" [P > 0.1]. Regarding. FAD% of the healthy controls; there was no statistically significant difference between that of "fasting" and "postabsorptive"