Diabetes Mellitus, Arterial Wall, and Cardiovascular Risk Assessment

Diabetes mellitus is an independent risk factor for atherothrombotic cardiovascular disease. Adults with diabetes are two to four times more likely to develop heart disease or stroke than adults without diabetes. The two major features of diabetes, i.e., hyperglycemia and insulin-resistance, trigger arterial stiffening and increase the susceptibility of the arterial wall to atherosclerosis at any given age. These pathological changes in the arterial wall may provide a functional and structural background for cardiovascular events. The present paper provides a critical overview of the clinical evidence linking diabetes-related metabolic abnormalities to cardiovascular risk, debates the pathophysiologic mechanisms through which insulin resistance and hyperglycemia may affect the arterial wall, and discusses the associations between vascular biomarkers, metabolic abnormalities and cardiovascular events

Vascular ultrasound and cardiovascular risk assessment

Vascular ultrasound is able to detect endothelial dysfunction, arterial structural remodeling and increased arterial stiffness. These alterations have been shown to be associated with established and emerging cardiovascular risk factors and with incident cardiovascular events. Therefore, vascular ultrasound has been proposed to evaluate the role of different risk factors in the initiation and progression of atherosclerotic process, to study vascular aging and the relationship between arterial stiffness and atherosclerosis, to assess the efficacy of life-style and therapeutic interventions, and to improve the estimation of individual cardiovascular risk. The present paper provides a critical overview of the clinical evidence appraising the association of flow-mediated dilation, carotid and femoral intima-media thickness and plaque presence as well as local arterial stiffness with cardiovascular risk factors and cardiovascular events

Increased carotid IMT in patients with type 2 diabetes free of cardiovascular complications appears to be an adaptive mechanism to an increased wall stress more than atheromasic degeneration

Type 2 diabetes (DM2) and poor glycemic control adversely affect common carotid intima media thickness (IMT), considered marker of preclinical atherosclerosis. However, studies evaluating the effect of DM2 and glucose levels on IMT did not consider carotid diameter, known to affect IMT. A certain IMT increase could reflect a mutual adjustment between diameter and wall thickness aimed to maintain constant wall tensile stress (WTS). Aim: To compare carotid IMT, luminal diameter, WTS and local wave speed (WS) between patients with uncomplicated DM2 and healthy controls. Methods: Eighty-four patients with well controlled DM2 (HbA1c <7.8%) and 84 controls matched for sex, age and BMI. were studied by radiofrequencybased carotid ultrasound (QIMT and QAS, Esaote). Results: DM2 against controls had higher (p<0.0001) IMT (720131 vs. 62076 mm), luminal diameter (6.60.6 vs. 6.00.7 mm), WS (8.3.61.7 vs. 6.51.2 m/s) and pulse pressure (5813 vs. 478 mmHg), but comparable WTS (498 vs. 5014 kPa; pZ0.82). In the entire population, fasting glucose was not independently related to IMT, but was related to carotid diameter (together with male sex and waist), pulse pressure and local WS (together with age and antihypertensive treatment). In DM2, HbA1c was independently related to carotid diameter, pulse pressure and WS. Conclusions: Chronically increased plasma glucose levels may induce intrinsic stiffening of large artery and widening of pulse pressure. Increased pulsatile load in stiff arteries causes luminal dilatation and increases WTS, triggering an increase in arterial wall thickness. Hyperglycaemia affects arterial wall, but through a “sclerotic” more than “atherogenic” mechanism

Impact of glycemic control on aortic stiffness, left ventricular mass and diastolic longitudinal function in type 2 diabetes mellitus

Poor glycemic control is associated with impaired left ventricular (LV) diastolic function in patients with type 2 diabetes mellitus (T2DM). Inappropriate LV mass increase and accelerated aortic stiffening were suggested to participate on deterioration of diastolic function. The present study investigated the inter-relationships between glycemic control, early diastolic and systolic longitudinal velocity of mitral annulus, LV mass and aortic stiffness in T2DM patients free of cardiovascular disease and with preserved LV ejection fraction, and compared them with those observed in healthy volunteers of similar age and sex distribution

Spigelian Hernia in a 14-Year-Old Girl: A Case Report and Review of the Literature

Spigelian hernia (SH) is a surgical rarity in children, which occurs through slit-like defects in the anterior abdominal wall adjacent to the semilunar line, the convexity lateral line which joins the nine ribs to the pubic tubercle and signs the limit between the muscular and aponeurotic portion of transversus abdominis muscle. As there are no specific symptoms and signs, the diagnosis is difficult, especially in children. We report a case of SH that comes to our observation: a 14-year-old girl presented recurrent abdominal pain associated to intermittent palpable mass in the paraumbilical region. Starting from our case report, we review the literature of pediatric SH from 2000 to 2013 and we describe the anatomy, etiology, clinical presentation, instrumental diagnosis, and surgical technique of pediatric SH

Left ventricular ejection time, not heart rate, is an independent correlate of aortic pulse wave velocity.

Salvi P, Palombo C, Salvi GM, Labat C, Parati G, Benetos A. Left ventricular ejection time, not heart rate, is an independent correlate of aortic pulse wave velocity. J Appl Physiol 115: 1610–1617, 2013. First published September 19, 2013; doi:10.1152/japplphysiol.00475.2013.— Several studies showed a positive association between heart rate and pulse wave velocity, a sensitive marker of arterial stiffness. However, no study involving a large population has specifically addressed the dependence of pulse wave velocity on different components of the cardiac cycle. The aim of this study was to explore in subjects of different age the link between pulse wave velocity with heart period (the reciprocal of heart rate) and the temporal components of the cardiac cycle such as left ventricular ejection time and diastolic time. Carotid-femoral pulse wave velocity was assessed in 3,020 untreated subjects (1,107 men). Heart period, left ventricular ejection time, diastolic time, and early-systolic dP/dt were determined by carotid pulse wave analysis with high-fidelity applanation tonometry. An inverse association was found between pulse wave velocity and left ventricular ejection time at all ages (25 years, r2 0.043; 25–44 years, r2 0.103; 45–64 years, r2 0.079; 65–84 years, r2 0.044; 85 years, r2 0.022; P 0.0001 for all). A significant (P 0.0001) negative but always weaker correlation between pulse wave velocity and heart period was also found, with the exception of the youngest subjects (P0.20). A significant positive correlation was also found between pulse wave velocity and dP/dt (P 0.0001). With multiple stepwise regression analysis, left ventricular ejection time and dP/dt remained the only determinant of pulse wave velocity at all ages, whereas the contribution of heart period no longer became significant. Our data demonstrate that pulse wave velocity is more closely related to left ventricular systolic function than to heart period. This may have methodological and pathophysiological implications

P24 Restored Physiological Local Carotid Pulse Wave Velocity After Bariatric Surgery in Obese Subjects

AbstractObesity is a risk factor for cardiovascular events and is associated with increased arterial stiffness [1,2]. However, the effect of drastic changes in Body Mass Index (BMI) on arterial mechanics has not been fully investigated. Our study aimed at evaluating changes in local carotid PWV (cPWV) in obese patients before and 6 months after bariatric surgery. N = 20 obese subjects free of cardiovascular events and diabetes (44 ± 9 years, 5 men, BMI = 48.8 ± 7.5 kg/m2) undergoing bariatric surgery were recruited in the Pisa University Hospital (Italy). Flow and diameter waveforms were acquired by ultrasound scanner (Aloka Alpha10, Hitachi Group, Japan) (1 kHz) at the right common carotid artery at baseline, after a 32.4 ± 7.6 days diet period, and 6.5 ± 2.7 months post-intervention. The lnDU-loop method was used for the estimation of cPWV [3]. Basal cPWV was 6.05 ± 1.21 m/s. The 1-month diet period produced a 2 kg/m2 reduction in BMI, while cPWV decreased by approx. 0.6 m/s. 6–7 months after bariatric surgery, BMI dropped to 35.3 ± 6.5 kg/m2 and cPWV furtherly decreased of approx. 0.9 m/s reaching a mean value of 4.57 ± 1.02 m/s (76% of the basal value) (Figure 1). Bariatric surgery and the consequent intensive weight loss produced a significant decrease of arterial stiffness and restored cPWV to physiological values of age-matched healthy subjects [4]. The fast reversal of increased arterial stiffness suggests a functional mechanism possibly related to a reduced haemodynamic load. Moreover, while having a small effect on the BMI, 1-month diet regulation effectively decreased cPWV by 10%, possibly indicating the short-term positive effects of a healthy lifestyle on haemodynamics

Hypnotizability-related complexity of heart rate variability during long lasting relaxation

Aim of the experiment was to compare heart rate and HRV of healthy subjects with high (Highs) and low (Lows) susceptibility to hypnosis during long-lasting relaxation. HRV indexes extracted in the frequency and time domain as well as related to the complexity of the tachogram (entropy) were analyzed through repeated measures ANOVA. The results indicated a parasympathetic prevalence in Highs all over the session and a sympathetic modulation across the session in both groups reflected in the sd2 dimension of the Poincar? plot and in entropy. The possible role of the Very Low Frequency spectral component in these changes, supported by the different correlations between entropy and frequency/time related indexes of HRV, is suggeste