Comparison of Cardiac and Vascular Parameters in Powerlifters and Long-Distance Runners: Comparative Cross-Sectional Study / Comparação de Parâmetros Cardíacos e Vasculares em Powerlifters e Corredores de Longa Distância: Um Estudo Transversal Comparativo

Abstract Background: Cardiac remodeling is a specific response to exercise training and time exposure. We hypothesized that athletes engaging for long periods in high-intensity strength training show heart and/or vascular damage. Objective: To compare cardiac characteristics (structure and function) and vascular function (flow-mediated dilation [FMD] and peripheral vascular resistance [PVR]) in powerlifters and long-distance runners. Methods: We evaluated 40 high-performance athletes (powerlifters [PG], n = 16; runners [RG], n = 24) and assessed heart structure and function (echocardiography), systolic and diastolic blood pressure (SBP/DBP), FMD, PVR, maximum force (squat, bench press, and deadlift), and maximal oxygen uptake (spirometry). A Student's t Test for independent samples and Pearson's linear correlation were used (p < 0.05). Results: PG showed higher SBP/DBP (p < 0.001); greater interventricular septum thickness (p < 0.001), posterior wall thickness (p < 0.001) and LV mass (p < 0.001). After adjusting LV mass by body surface area (BSA), no difference was observed. As for diastolic function, LV diastolic volume, wave E, wave e', and E/e' ratio were similar for both groups. However, LA volume (p = 0.016) and BSA-adjusted LA volume were lower in PG (p < 0.001). Systolic function (end-systolic volume and ejection fraction), and FMD were similar in both groups. However, higher PVR in PG was observed (p = 0.014). We found a correlation between the main cardiovascular changes and total weight lifted in PG. Conclusions: Cardiovascular adaptations are dependent on training modality and the borderline structural cardiac changes are not accompanied by impaired function in powerlifters. However, a mild increase in blood pressure seems to be related to PVR rather than endothelial function.

Resumo Fundamento: Remodelamento cardíaco é uma resposta específica ao tempo e modalidade de treinamento. Nós hipotetizamos que atletas de treinamento de força de alta intensidade, por longo tempo, mostram dano à estrutura cardíaca e/ou vascular. Objetivo: Comparar as características cardíacas (estrutura e funcionalidade) e função vascular (dilatação fluxo-mediada, FMD e resistência vascular periférica, PVR) em powerlifters e corredores. Métodos: Nós avaliamos 40 atletas de alto-desempenho (powerlifters [PG], n = 16; corredores [RG], n = 24). Mensuramos estrutura e funcionalidade cardíaca (ecocardiografia), pressão arterial (SBP/DBP), FMD, PVR, força máxima (agachamento, supino e levantamento terra) e consumo máximo de oxigênio (ergoespirometria). Foi utilizado teste T de Student e correlação linear de Pearson (p < 0,05). Resultados: PG mostrou maior SBP/DBP (p < 0,001), espessura de septo interventricular (p < 0,001), parede posterior (p < 0,001) e massa do VE (p < 0,001); após ajuste pela superfície corporal (BSA), não houve diferença na massa do VE. O volume do VE, onda E, onda e', e a razão E/e' foram similares entre os grupos. O volume do AE (p = 0,016), mesmo ajustado pela BSA (p < 0,001) foi menor no PG. A função sistólica (volume sistólico final e fração de ejeção) e FMD foram similares nos grupos. Contudo, foi observada maior PVR no PG (p = 0,014). Houve uma correlação direta entre as alterações cardíacas e a carga total levantada no PG. Conclusões: As adaptações cardiovasculares são dependentes da modalidade e os valores encontrados na estrutura do coração não são acompanhados por prejuízo na funcionalidade. Entretanto, um leve aumento na pressão arterial pode estar associado com maior PVR e não com a função endotelial.

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.

Exploring vascular function biomarkers: implications for rehabilitation

Abstract The endothelium plays an important role in maintaining vascular homeostasis and regulating blood vessel function. Endothelial function is considered an independent predictor for risk of future cardiovascular events in cardiovascular and non-cardiovascular patients, as well as a predictor for postoperative complications in cardiovascular surgery patients. Brachial artery flow-mediated dilation by high-resolution ultrasound is widely used to evaluate endothelium-dependent vasodilation, which is mainly mediated by nitric oxide release. Physical exercise exerts beneficial effects on endothelial function and can be used in both primary and secondary prevention of cardiac and peripheral artery diseases, even in the postoperative period of cardiovascular surgery.

Functional Vascular Study in Hypertensive Subjects with Type 2 Diabetes Using Losartan or Amlodipine / Estudo Vascular Funcional em Hipertensos com Diabetes Tipo 2 em uso de Losartana ou Anlodipina

Background: Antihypertensive drugs are used to control blood pressure (BP) and reduce macro- and microvascular complications in hypertensive patients with diabetes. Objectives: The present study aimed to compare the functional vascular changes in hypertensive patients with type 2 diabetes mellitus after 6 weeks of treatment with amlodipine or losartan. Methods: Patients with a previous diagnosis of hypertension and type 2 diabetes mellitus were randomly divided into 2 groups and evaluated after 6 weeks of treatment with amlodipine (5 mg/day) or losartan (100 mg/day). Patient evaluation included BP measurement, ambulatory BP monitoring, and assessment of vascular parameters using applanation tonometry, pulse wave velocity (PWV), and flow-mediated dilation (FMD) of the brachial artery. Results: A total of 42 patients were evaluated (21 in each group), with a predominance of women (71%) in both groups. The mean age of the patients in both groups was similar (amlodipine group: 54.9 ± 4.5 years; losartan group: 54.0 ± 6.9 years), with no significant difference in the mean BP [amlodipine group: 145 ± 14 mmHg (systolic) and 84 ± 8 mmHg (diastolic); losartan group: 153 ± 19 mmHg (systolic) and 90 ± 9 mmHg (diastolic)]. The augmentation index (30% ± 9% and 36% ± 8%, p = 0.025) and augmentation pressure (16 ± 6 mmHg and 20 ± 8 mmHg, p = 0.045) were lower in the amlodipine group when compared with the losartan group. PWV and FMD were similar in both groups. Conclusions: Hypertensive patients with type 2 diabetes mellitus treated with amlodipine exhibited an improved pattern of pulse wave reflection in comparison with those treated with losartan. However, the use of losartan may be associated with independent vascular reactivity to the pressor effect. .

Fundamento: A escolha dos fármacos anti-hipertensivos no tratamento de hipertensos diabéticos tem como objetivos o controle da pressão arterial (PA) e a redução das complicações macro/microvasculares. Objetivos: O objetivo deste estudo foi comparar as alterações vasculares funcionais em pacientes hipertensos e diabéticos tipo 2 após seis semanas de anlodipina ou losartana. Métodos: Pacientes com diagnóstico prévio de hipertensão arterial e diabetes melito tipo 2 foram randomizados e divididos em dois grupos, sendo avaliados na sexta semana de uso de losartana 100 mg/dia ou anlodipina 5 mg/dia, com medida da PA, realização de monitoração ambulatorial da pressão arterial e testes para avaliação de parâmetros vasculares, como tonometria de aplanação, velocidade de onda de pulso (VOP) e dilatação mediada por fluxo (DMF) da artéria braquial. Resultados: Foram incluídos 42 pacientes, 21 em cada grupo, com predominância do sexo feminino (71%) nos dois grupos. Os grupos anlodipina e losartana apresentaram média de idade semelhante (54,9 ± 4,5 e 54,0 ± 6,9 anos, respectivamente) e sem diferença estatística na média da PA (145 ± 14/84 ± 8 e 153 ± 19/90 ± 9 mmHg). O augmentation index (30 ± 9% × 36 ± 8%, p = 0,025), assim como a augmentation pressure (16 ± 6 mmHg × 20 ± 8 mmHg, p = 0,045) foram menores no grupo anlodipina que no grupo losartana. Os valores obtidos para VOP e DMF foram semelhantes nos dois grupos. Conclusões: Em hipertensos e diabéticos tipo 2, o uso de anlodipina demonstrou um padrão de reflexão da onda de pulso mais favorável nesse grupo, mas o uso de losartana pode estar associado com ações vasculares independentes do efeito pressórico. .

Bifurcación alta de la arteria braquial (humeral) / Bifurcation of the brachial artery (humeral)

El presente trabajo se trata de la observación, por disección, de la bifurcación alta de la arteria braquial o humeral en cadáveres. En 34 años, de trabajo de docencia en anatomía en anfiteatros de Universidades de La Paz, Bolivia y realizando disecciones en más de 200 cadáveres, se observaron, en cuatro de ellos, la bifurcación alta de la arteria braquial o humeral. Hoy presentamos el último hallazgo de esta serie.

Determinants of Brachial-Ankle Pulse Wave Velocity and Carotid-Femoral Pulse Wave Velocity in Healthy Koreans

The aim of this study was to determine the normal value of brachial-ankle pulse wave velocity (baPWV) and carotid-femoral pulse wave velocity (cfPWV) according to age group, gender, and the presence of cardiovascular risk factors in healthy Koreans, and to investigate the association between PWV and risk factors such as prehypertension, dyslipidemia, smoking, and obesity. We measured an arterial stiffness in 110 normal subjects who were 20 to 69 yr-old with no evidence of cardiovascular disease, cerebrovascular accident or diabetes mellitus. The mean values of baPWV and cfPWV were 12.6 (+/-2.27) m/sec (13.1+/-1.85 in men, 12.1+/-2.51 in women; P=0.019) and 8.70 (+/-1.99) m/sec (9.34+/-2.13 in men, 8.15+/-1.69 in women; P=0.001), respectively. The distribution of baPWV (P<0.001) and cfPWV (P=0.006) by age group and gender showed an increase in the mean value with age. Men had higher baPWV and cfPWV than women (P<0.001). There was a difference in baPWV and cfPWV by age group on prehypertension, dyslipidemia, current smoking, or obesity (P<0.001). In multiple linear regression, age and prehypertension were highly associated with baPWV and cfPWV after adjustment for confounding factors (P<0.001). The present study showed that baPWV and cfPWV are associated with age, gender, and prehypertension in healthy Koreans.

Relação entre biomarcadores inflamatórios, de adesão celular, de estresse oxidativo, de lesão endotelial, remodelamento tecidual e vascular e os diferentes estágios da doença venosa crônica primária (classes clínicas CEAP C0a, C2, C3, C4) / Relationship between biomarkers of inflammation, cell adhesion, oxidative stress, endothelial cell damage, vascular and tissue remodeling and the different stages of primary chronic venous disease (CEAP clinical classes C0a, C2, C3, C4)

A doença venosa crônica (DVC) é uma desordem complexa que compreende sinais e sintomas que variam das telangiectasias às úlceras ativas. A DVC é classificada de acordo com aspectos clínicos, etiológicos, anatômicos e fisiopatológicos (CEAP) em sete classes variando de C0 à C6. A principal causa da DVC é a hipertensão venosa que altera o fluxo venoso e, consequentemente, a força de cisalhamento que induz alterações fenotípicas nas células endoteliais que passam a expressar mediadores pró-inflamatórios e pró-trombóticos, que levam à adesão de leucócitos, ao aumento do estresse oxidativo, da permeabilidade vascular e do dano endotelial e ao remodelamento tecidual e vascular.Em virtude dos inúmeros mecanismos e da diversidade de moléculas envolvidas na patogênese e progressão da DVC, é essencial conhecer a interação entre elas e também saber quais são as moléculas (biomarcadores) que se correlacionam positivamente ou negativamente com a gravidade da doença. Foram avaliados os níveis de Interleucina-6 (IL-6), sL-selectina, sE-selectina, sP-selectina, molécula de adesão intercelular-1solúvel (sICAM-1), molécula de adesão das células vasculares-1 solúvel (sVCAM-1), ativador tecidual do plasminogênio (tPA), atividade do inibidor do ativador do plasminogênio-1 (PAI-1), trombomodulina solúvel (sTM), fator de von Willebrand (vWF), metaloproteinase de matriz (MMP)-2, MMP-3, MMP-9, inibidor tecidual das MMPs -1 (TIMP-1), angiopoietina-1 e -2, sTie-2 e s-Endoglina e fator de crescimento do endotélio vascular (VEGF) no sangue coletado da veia braquial de 173 mulheres com DVC primária divididas em grupos C2, C3, C4 e C4 menopausadas (C4m) e de 18 voluntárias saudáveis (grupo C0a). Foram também analisados os níveis urinários de ent-prostaglandina F2α nesses grupos. Não foram encontradas diferenças estatisticamente significativas com relação às concentrações sanguíneas e urinárias de sE-selectina, sP-selectina, sICAM-1, atividade de PAI-1, MMP-3, razão TIMP-1/MMP-3 ...

Chronic Venous Disease (CVD) is a complex disorder, which encompasses signs and symptoms that vary from telangiectasias to active ulcers. The CVD is classified according Clinical, Etiologic, Anatomical and Pathophysiological (CEAP) aspects into seven classes varying from C0 to C6. The main cause of CVD is venous hypertension, which alters venous flow and consequently, shear stress. Abnormal shear stress induces phenotypic changes in endothelial cells that start to express pro-inflammatory and pro-thrombotic mediators that lead to leukocyte adhesion, oxidative stress, increased vascular permeability and endothelial cell damage and tissue and vascular remodeling. Due to several mechanisms and the diversity of molecules involved in the pathogenesis and progression of CVD, is essential to know the interplay between them and which are the molecules (biomarkers) that correlate positively and negatively with the severity of the disease. We investigated the levels of interleukin-6 (IL-6), sL-selectin, sE-selectin, sP-selectin, soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1) activity, soluble thrombomodulin (sTM), von Willebrand factor (vWf), matrix metalloproteinase (MMP)-2, MMP-3, MMP-9, tissue inhibitor of metaloproteinases-1 (TIMP-1), angiopoietin-1 and -2, sTie-2, s-Endoglin, vascular endothelial growth factor (VEGF) in the blood taken from the brachial vein of 173 patients with primary CVD divided into C2, C3, C4 and menopaused C4 (C4m) groups and 18 healthy volunteers (C0a group).We also investigated the urinary levels of ent-prostaglandin F2α in these groups. There was no statistically significant difference between groups with respect to blood or urinary levels of sE-selectin, sP-selectin, sICAM-1, PAI-1 activity, MMP-3, TIMP-1/MMP-3 ratio, angiopoietin-2, angiopoietin-1/angiopoietin-2 ratio, s-Endoglin ...

Valor prognóstico da função endotelial em portadores de aterosclerose: revisão sistemática / Prognostic value of endothelial function in patients with atherosclerosis: systematic review

A Vasodilatação Mediada por Fluxo (VMF) da artéria braquial, por meio da ultrassonografia, é um método de avaliação da função endotelial que pode oferecer informações fisiopatológicas, diagnósticas e prognósticas. A realização dessa revisão sistemática objetivou avaliar o nível de evidência na literatura a respeito da capacidade preditora da função endotelial, medida pela VMF da artéria braquial, por meio da ultrassonografia, quanto a eventos cardiovasculares, em indivíduos portadores de aterosclerose. Foram realizadas buscas nas bases de dados MEDLINE, SCIELO e LILACS e selecionados estudos de coorte prospectivos, em seres humanos, que analisaram o valor prognóstico da função endotelial medida pela VMF da artéria braquial, em populações portadoras de doença aterosclerótica, periférica ou coronariana. Trabalhos com evidentes vieses metodológicos foram excluídos. A seleção final constituiu-se de 15 estudos. Dos 13 estudos que, na análise univariada, mostraram significância estatística do método da VMF na predição de eventos cardiovasculares, 12 deles demonstraram sua capacidade preditora independente, em análise multivariada. Em nenhum dos trabalhos foi descrito valor prognóstico incremental em relação a modelos preditores tradicionais, como escore de Framingham. Resultados de três trabalhos sugerem que o método agrega valor prognóstico a marcadores isolados como: Índice Tornozelo-Braquial (ITB), diabetes e Proteína C Reativa (PCR) de alta sensibilidade. Em conclusão, a VMF da artéria braquial prediz risco cardiovascular, porém não é estabelecido seu valor preditor incremental a modelos prognósticos clínicos, não havendo, até o momento, evidências sólidas que amparem seu uso na rotina clínica para predição de risco cardiovascular.

Analysis of flow-mediated vasodilation (FMV) of the brachial artery by use of ultrasound allows assessing endothelial function, and provides pathophysiological, diagnostic and prognostic information. This systematic review was aimed at assessing the literature level of evidence of the predictive capacity of endothelial function, measured through brachial artery FMV by use of ultrasound, regarding cardiovascular events in individuals with atherosclerosis. The MEDLINE, SCIELO and LILACS databases were searched, and prospective cohort studies on human beings about the prognostic value of endothelial function, measured by use of brachial artery FMV in individuals with peripheral or coronary atherosclerosis, were selected. Studies with clear methodological biases were excluded. The final selection consisted of 15 studies. Of the 13 studies that on univariate analysis showed statistical significance of the FMV method to predict cardiovascular events, 12 showed independent predictive capacity on multivariate analysis. None of the studies reviewed described the incremental predictive value of FMV to the traditional predictive models, such as the Framingham score. Results of three studies have suggested that the method adds prognostic value to isolated markers such as ankle-brachial index (ABI), diabetes, and high-sensitivity C-reactive protein (hsCRP). In conclusion, brachial artery FMV predicts cardiovascular risk, but its incremental predictive value to clinical prognostic models has not been established. In addition, solid evidence supporting its use in routine clinical practice to predict cardiovascular risk still lacks.

Effects of a Smoking Cessation Education on Smoking Cessation, Endothelial Function, and Serum Carboxyhemoglobin in Male Patients with Variant Angina

PURPOSE: The aim of this study was to evaluate the effects of a smoking cessation education on endothelial function and carboxyhemoglobin levels in smokers with variant angina. METHODS: A nonequivalent control group pretest-posttest design was used. Participants were 60 male smokers with variant angina admitted to one hospital: the control group (30) between September and December, 2009, and the experimental group (30) between February and May, 2010. Endothelial function, as defined by flow-mediated vasodilation (FMD) of the brachial artery, and serum carboxyhemoglobin (COHb) were determined at baseline and at 3 months after the initiation of education in both groups. RESULTS: Three months after the program, smoking cessation was successful in 22 of the 30 smokers in the experimental group, but only in 4 of 30 smokers in the control group (p<.001). After the education, the experimental group showed a significant increase in FMD, and a significant decreased in serum COHb compared with the control group. CONCLUSION: The findings indicate that this smoking cessation education program is effective for hospitalized smokers with variant angina.

Determinants of Brachial-Ankle Pulse Wave Velocity in Normotensive Young Adults with Type 2 Diabetes Mellitus

Brachial-ankle pulse wave velocity (baPWV) is simple, noninvasive method which correlates well with arterial stiffness. Herein, we assessed the determinants of baPWV in normotensive young adults with type 2 diabetes. We retrospectively enrolled 103 consecutive type 2 diabetic patients aged between 30 and 39 yr who measured baPWV with noninvasive pulse wave analyzer. The anthropometric parameters, blood pressure, pulse rate, fasting plasma glucose, fasting insulin, fasting C-peptide, HbA1c, lipid profile, hs-CRP, albuminuria status, AST/ALT, gamma-GTP were checked concurrently. Also, we investigated history of smoking, alcohol drinking and medications by questionnaire. We found that maximal baPWV was positively correlated with mean blood pressure (r = 0.404, P < 0.001), heart rate (r = 0.285, P = 0.004), AST (r = 0.409, P < 0.001), ALT (r = 0.329, P = 0.001), gamma-GTP (r = 0.273, P = 0.006), Urine albumin/creatinine ratio (r = 0.321, P = 0.003). By multiple linear regression, mean blood pressure and heart rate were significantly associated with maximal baPWV in male and total group. In female group, mean blood pressure was the only variable associated with maximal baPWV. These factors can be surrogate markers of arterial stiffness in this population.

Determinants of Brachial-Ankle Pulse Wave Velocity in Normotensive Young Adults with Type 2 Diabetes Mellitus

Brachial-ankle pulse wave velocity (baPWV) is simple, noninvasive method which correlates well with arterial stiffness. Herein, we assessed the determinants of baPWV in normotensive young adults with type 2 diabetes. We retrospectively enrolled 103 consecutive type 2 diabetic patients aged between 30 and 39 yr who measured baPWV with noninvasive pulse wave analyzer. The anthropometric parameters, blood pressure, pulse rate, fasting plasma glucose, fasting insulin, fasting C-peptide, HbA1c, lipid profile, hs-CRP, albuminuria status, AST/ALT, gamma-GTP were checked concurrently. Also, we investigated history of smoking, alcohol drinking and medications by questionnaire. We found that maximal baPWV was positively correlated with mean blood pressure (r = 0.404, P < 0.001), heart rate (r = 0.285, P = 0.004), AST (r = 0.409, P < 0.001), ALT (r = 0.329, P = 0.001), gamma-GTP (r = 0.273, P = 0.006), Urine albumin/creatinine ratio (r = 0.321, P = 0.003). By multiple linear regression, mean blood pressure and heart rate were significantly associated with maximal baPWV in male and total group. In female group, mean blood pressure was the only variable associated with maximal baPWV. These factors can be surrogate markers of arterial stiffness in this population.

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 Brachial Ankle Pulse Wave Velocity and Complement 1 Inhibitor

Complement 1 (C1) inhibitor is an acute phase protein with anti-inflammatory properties. The aim of the present study was to elucidate the relationship between brachial ankle pulse wave velocity (baPWV), the parameter of arterial stiffness, and C1 inhibitor. One hundred subjects were randomly enrolled in this study. Data about baPWV, age, gender, hypertension, smoking, and body mass index (BMI) were measured. Blood tests for total cholesterol, low density lipoprotein, high density lipoprotein, triglycerides, hemoglobin A1c, erythrocyte sedimentation rate, C-reactive protein, complement 3, and C1 inhibitor were performed. Based on the Pearson correlation, the C1 inhibitor showed a positive relation to the baPWV (P<0.001). Multiple regression analysis revealed the significant predictors of baPWV were not only the conventional risk factors of arteriosclerosis and/or atherosclerosis, such as age (P<0.001), gender (P<0.001), hypertension (P<0.001), and BMI (P=0.006), but also the acute phase protein, C1 inhibitor (P=0.025). In conclusion, C1 inhibitor is associated with arterial stiffness through its association with increased inflammation.

The Effects of Short-duration Exercise on Arterial Stiffness in Patients with Stable Coronary Artery Disease

Arterial stiffness is an important contributor to the development of cardiovascular disease. We investigated the effect of short duration exercise using the treadmill test on arterial stiffness in the presence of coronary artery disease. We enrolled patients with and without coronary artery diseases (CAD and control group, 50 patients each) referred for treadmill testing. Brachial-ankle pulse wave velocity (baPWV) were measured before and after treadmill testing. Values of baPWV were significantly reduced at 10 min after exercise in both groups, more in the CAD group than in the control group (baseline baPWV and post-exercise change [cm/sec]: 1,527+/-245 and -132+/-155 in the CAD group, 1,439+/-202 and -77+/-93 in the control group, respectively, P for change in each group <0.001, P for difference in changes between the two groups <0.001). These findings persisted after adjusting for age, body mass index, systolic blood pressure, mean arterial pressure (MAP), MAP decreases, and baseline baPWV. Significant post-exercise baPWV reductions were observed in both groups, and more prominently in the CAD group. This finding suggests that short-duration exercise may effectively improve arterial stiffness even in patients with stable coronary artery disease.

Diurnal variation of vascular diameter and reactivity in healthy young men

The higher incidence of cardiovascular events in the morning is accompanied by an increased vascular tone. However, there are few published studies designed to evaluate the diurnal variation of vascular and endothelial parameters in healthy subjects. In the present investigation, we evaluated the diurnal variation in brachial artery diameter (BAD), flow-mediated dilation (FMD) and endothelium-independent dilation (NFMD) in a homogeneous sample of healthy non-smoker young men. Fifty subjects aged 20.8 ± 0.3 years (range: 18 to 25 years) were investigated by brachial artery ultrasound. Exclusion criteria were female gender and evidence of clinically significant health problems, including obesity. Volunteers were asked to rest and avoid fat meals as well as alcoholic beverages 48 h before and until completion of the evaluations. BAD, FMD and NFMD were measured at 7 am, 5 pm, and 10 pm and tested by repeated measures ANOVA. BAD was smaller at 7 am (mean ± SEM, 3.8 ± 0.1 mm) in comparison with 5 pm (3.9 ± 0.1) and 10 pm (4.0 ± 0.1 mm; P < 0.001). FMD values did not change significantly during the day, while NFMD increased more at 7 am (18.5 ± 1.1 percent), when compared to 15.5 ± 0.9 percent at 10 pm and 15.5 ± 0.9 percent at 5 pm (P = 0.04). The physiological state of vasoconstriction after awakening, with preserved capability to dilate in the morning, should be considered to be part of the healthy cardiovascular adaptation before considering later life risk factors and endothelial dysfunction.

Índice Tornozelo-Braquial (ITB) determinado por esfigmomanômetros oscilométricos automáticos / Assessing Ankle-Brachial Index (ABI) by using automated oscillometric devices

FUNDAMENTO: Índice Tornozelo-Braquial (ITB) é essencial na prática clínica, mas dificuldades técnicas na sua execução pelo padrão de referência Doppler vascular (DV) tornam-no ainda pouco utilizado. OBJETIVO: Avaliar aplicabilidade da determinação do ITB com uso de esfigmomanômetros oscilométricos automáticos (EOA) e sugerir a utilização dos índices delta-Bráquio-Braquial (delta-BB) e delta-ITB como marcadores de risco cardiovascular. MÉTODOS: Estudo descritivo e observacional de 247 pacientes ambulatoriais (56,2 por cento feminino, média 62,0 anos) submetidos à determinação do ITB com aferição simultânea da pressão arterial (PA) em membros superiores (MMSS) e inferiores (MMII) utilizando-se dois EOA (OMRON-HEM705CP). Nos casos em que não foi possível aferir PA em pelo menos um dos MMII utilizou-se DV. Os pacientes divididos em Grupo N (ITB normal: 0,91 a 1,30) e Grupo A (ITB alterado: <0,90 ou >1,30) tiveram comparados entre si os valores de delta-ITB (diferença absoluta ITB/MMII) e delta-BB (diferença absoluta PAS/MMSS). RESULTADOS: Utilizando-se EOA foi possível determinar ITB em 90,7 por cento. Com dados do Grupo N determinaram-se valores de referência (VR) no percentil 95 de delta-ITB (0-0,13) e delta-BB (0-8 mmHg). Quando comparado com o Grupo N, o Grupo A apresentou prevalência mais elevada tanto de delta-ITB (30/52 contra 10/195; Razão de Chances: 25,23; p<0,0001) como de delta-BB (13/52 contra 7/195; Razão de Chances: 8,95; p<0,0001) acima dos VR. CONCLUSÃO: O ITB pode ser determinado na maioria das vezes com EOA. Delta-ITB e delta-BB acima dos VR estiveram significativamente mais prevalentes nos portadores de ITB alterado e podem ser sugeridos como marcadores de risco cardiovascular em futuros estudos epidemiológicos.

BACKGROUND: Assessing Ankle-Brachial Index is an essential procedure in clinical settings, but since its measurement by the gold standard Doppler Ultrasonic (DU) technique is impaired by technical difficulties, it is underperformed. OBJECTIVE: The aim of this study was to assess the efficacy of an automated oscillometric device (AOD) by performing Ankle-Brachial Index (ABI) assessments and to suggest delta brachial-brachial (delta-BB) and delta-ABI as markers of cardiovascular risk. METHODS: In this observational and descriptive study, 247 patients (56.2 percent females, mean age 62.0 years) had their arterial blood pressure (ABP) measured for ABI calculation. Two AOD (OMRON-HEM705CP) devices were used for simultaneous measurements of the ABP, first of the two arms and then of the arm with higher systolic ABP and a leg, first the left and then the right one. When leg ABP measurements were not possible, ABI determination was performed by using the standard Doppler Ultrasonic (DU) technique. Patients were designated to Group N (normal ABI: 0.91 to 1.30) or Group A (abnormal ABI: <0.90 or >1.30). Other indexes were also calculated: delta-BB (absolute difference in mmHg of systolic ABP between arms) and delta-ABI (absolute difference of ABI between legs) and the results were compared. RESULTS: In most patients (90.7 percent), it was possible to determine the ABI. Group N data allowed calculation of the 95th percentile reference values (RV) of delta-BB (0 to 8 mmHg) and delta-ABI (0 to 0.13). When compared to Group N, Group A had a significantly higher prevalence of high values greater than the RVs of delta-ABI (30 of 52 and 10 of 195, respectively; Odds Ratio = 25.23; p<0.0001) and delta-BB (13 of 52 and 7 of 195, respectively; Odds Ratio = 8.95; p<0.0001). CONCLUSION: In most patients, the ABI could be measured by AOD. Both indexes, delta-BB and delta-ABI greater than the RVs, were significantly more prevalent in patients with abnormal ABI ...

Confiabilidade da medida da dilatação fluxo-mediada da artéria braquial pela ultra-sonografia / Reliability of brachial artery flow-mediated dilatation measurement using ultrasound

OBJETIVO: Determinar a confiabilidade das medidas dos diâmetros basal (DBAB) e pós-oclusão (DPOAB) da artéria braquial e da dilatação fluxo-mediada da artéria braquial (DILA), assim como quantificar o erro típico dessas medidas (ETM). MÉTODOS: A consistência interna (2 medidas intradias) foi determinada em 10 voluntários, enquanto a estabilidade (2 medidas interdias) foi determinada em 13 voluntários aparentemente saudáveis e não-fumantes. As imagens da artéria braquial foram obtidas pelo aparelho de ultra-sonografia bidimensional com Doppler, utilizando transdutor de 14 MHz. As distâncias entre as interfaces íntima-luz foram medidas antes e após interrupção do fluxo sangüíneo durante 5 minutos por manguito posicionado no braço. O DILA foi considerado o porcentual de aumento do DPOAB em relação ao DBAB. RESULTADOS: A ANOVA não identificou diferenças significativas entre as medidas intradias e interdias. Para o DILA, os coeficientes de correlação intraclasse entre as medidas intradias e interdias foram R = 0,7001 e R = 0,8420, respectivamente (p < 0,05). Os coeficientes de variação foram 5,8 por cento e 12,4 por cento e os ETM relativos 13,8 por cento e 14,9 por cento, respectivamente para medidas intra e interdias. A análise dos gráficos de Bland-Altman apontou que as variáveis não apresentaram erro heterocedástico. CONCLUSÃO: A medida do DBAB, DPOAB e do DILA por meio de técnica manual pela ultra-sonografia apresenta alta confiabilidade tanto para os valores intradias quanto interdias, possibilitando seu uso para diagnóstico e monitoramento da função endotelial.

OBJECTIVE: To determine the reliability of the baseline (BBAB) and post occlusion (POBAD) brachial artery diameters, brachial artery flow-mediated dilatations (BAFMD) measurements, and to quantify the typical error of the measurements (TEM). METHODS: Internal consistency (2 measurements on the same day) was determined in 10 volunteers, whereas stability (2 measurements on separate days) was determined in 13 volunteers. All the volunteers looked healthy and were nonsmokers. The brachial artery images were obtained using a two dimensional Doppler ultrasound instrument: a 14 MHz transducer was used. The distances between the intima-lumen interfaces were measured before and after the blood flow had been stopped by means of a cuff on the arm for five minutes. BAFMD was considered as the percentile increase of POBAD in relation to BBAD. RESULTS: ANOVA did not identify any significant differences between the measurements taken on the same and separate days. For BAFMD, the intraclass correlation coefficients between the measurements taken on the same and separate days were: R = 0.7001 and R = 0.8420, respectively (p < 0.05). The variation coefficients were 5.8 percent and 12.4 percent and the relative SMEs were 13.8 percent and 14.9 percent, respectively, for the measurements taken on the same and separate days. Analysis of the Bland-Altman graphs indicated that the variables did not present heteroscedastic errors. CONCLUSION: The BBAD, POBAD and BAFMD measurements using the manual ultrasound technique were highly reliable for both the same and separate day measurements and therefore can be used to diagnose and monitor endothelial function.

Dilatação fluxo-mediada da artéria braquial em mulheres com artrite reumatóide / Brachial artery flow-mediated dilatation in women with rheumatoid arthritis

OBJETIVO: Avaliar a função endotelial em pacientes com artrite reumatóide, pela dilatação fluxo-mediada da artéria braquial. MATERIAIS E MÉTODOS: Sessenta e oito pacientes, sendo 32 com artrite reumatóide e 36 do grupo controle, foram avaliadas pela dilatação fluxo-mediada da artéria braquial (método ultra-sonográfico, no modo B, de avaliação de risco cardiovascular). Em um segundo tempo, foi avaliada a correlação entre a dilatação fluxo-mediada da artéria braquial, a proteína C reativa e o tempo de doença em pacientes com artrite reumatóide. RESULTADOS: A dilatação fluxo-mediada da artéria braquial na artrite reumatóide foi igual a 5,6 ± 9,69 por cento e no grupo controle foi igual a 23,24 ± 5,65 por cento, diferença estatisticamente significante (p < 0,00001). A proteína C-reativa teve resultado de 4,8 ± 9,1 mg/l. A correlação entre a idade, a dilatação fluxo-mediada da artéria braquial e a proteína C reativa nas pacientes com artrite reumatóide não mostrou resultado estatisticamente significante. CONCLUSÃO: Mulheres com artrite reumatóide apresentam importante disfunção endotelial quando comparadas com mulheres normais.

OBJECTIVE: To evaluate the endothelial function in patients with rheumatoid arthritis by means of brachial artery flow-mediated vasodilation. MATERIALS AND METHODS: Sixty-eight patients, 32 with rheumatoid arthritis and 36 in the control group, underwent brachial artery flow-mediated dilatation (B-mode ultrasound for evaluating cardiovascular risk). Afterwards, the correlation among brachial artery flow-mediated vasodilation, C-reactive protein, and disease duration in patients with rheumatoid arthritis was evaluated. RESULTS: The brachial artery flow-mediated dilatation of the brachial artery in rheumatoid arthritis corresponded to 5.6 ± 9.69 percent, and in the control group, to 23.24 ± 5.65 percent, with a statistically significant difference (p < 0.00001). C-reactive protein result was 4.8 ± 9.1 mg/l. The correlation among age, brachial artery flow-mediated dilatation, and C-reactive protein in patients with rheumatoid arthritis has not shown a statistically significant result. CONCLUSION: Women with rheumatoid arthritis present a significant endothelial dysfunction when compared with normal women.

Avaliação da função endotelial pela reatividade braquial em pacientes com cardiopatia isquêmica documentada, antes e após a utilização de suplementos vitamínicos / Evaluation of endothelial function by braquial reactivity in patients with documented ischemic heart disease, before and after using vitamin supplements

Introdução: Várias drogas e substâncias vêm sendo testadas visando melhorar a função endotelial, porém a utilização de suplementos vitamínicos em pacientes portadores de doença ateromatosa ainda é controversa, Método: Para avaliar a resposta da função endotelial antes e após a utilização de suplementos vitamínicos (vitaminas C,E e C mais E)foi utilizada a técnica de reatividade braquial em 21 pacientes com doença ateromatosa coronariana documentada pela cinecoronariografia. Foram comparados os percentuais de dilatação da artéria braquial antes e após a a utilização dos suplementos vitamínicos. Resultados: Após a utilização da E, o percentual de dilatação da artéria elevou-se de 8,24 por cento para 9,48 por cento (variação de 1,23 por cento), após a utilização da vitamina C, o percentual de dilatação elevou-se de 8,24 por cento para 10,29 por cento(variação de 2,05 por cento) e após a utilização de vitamina E associada a vitamina C, o percentual de dilatação elevou-se de 8,24 por cento para 10,81 por cento (variação de 2,57 por cento). Conclusão A vitamina C administrada na forma isolada ou em associação com a vitamina E, promoveu a melhora da função endotelial avaliada pela técnica da reatividade braquial pelo ultra-som