ABSTRACT
ABSTRACT Background The ambulatory arterial stiffness index (AASI), derived from 24 h ambulatory blood pressure monitoring (ABPM) can be a good indicator of arterial stiffness. Aim To assess the correlation between AASI and brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) and cardio-ankle vascular index (CAVI) in patients with type 2 diabetes mellitus without hypertension. Material and Methods Cross sectional study in 28 diabetic patients aged 49 ± 7 years (40% women). AASI was calculated as 1 minus the regression slope of diastolic on systolic blood pressure, using ABPM data. ABPM was measured in the arm using an oscillometric device. ABI was calculated as the ratio between ankle and brachial systolic blood pressure. CAVI was derived from pulse wave velocity using the Vasera VS-1000 device. Correlations were calculated using a bivariate Spearman correlation. Results The mean values for AASI, ABI, baPWV and CAVI were 0.39 ± 0.14, 1.14 ± 0.09, 15.15 ± 2.71 m/s and 7.60 ± 1.90, respectively. There was a significant negative correlation between AASI and ABI (r = -0.491, p < 0.01). Conclusions In these diabetic patients, there was an association between AASI, an arterial stiffness marker and ABI, an indicator for the presence of atherosclerosis.
Antecedentes El índice de rigidez arterial ambulatorio (AASI), derivado del monitoreo ambulatorio de presión arterial de 24 h (MAPA), puede ser un buen indicador de rigidez arterial. Objetivo Evaluar la correlación entre el AASI y la velocidad de onda de pulso braquial (VOP), el índice tobillo-brazo (ITB) y el índice vascular cardio-tobillo (CAVI) en pacientes con diabetes mellitus tipo 2 sin hipertensión arterial. Material y Métodos Estudio transversal en 28 pacientes con diabetes de 49 ± 7 años (40% mujeres). El AASI se calculó como 1 menos la pendiente de regresión de la presión arterial diastólica sobre la sistólica, usando datos del MAPA de 24 h, el cual se midió en el brazo, usando un dispositivo oscilométrico. El ITB se calculó como la razón entre la presión arterial sistólica del tobillo sobre la del brazo. El CAVI se derivó de la velocidad de onda de pulso medida con el dispositivo Vasera VS-1000. Para el análisis estadístico se utilizó el coeficiente de correlación bivariada de Spearman. Resultados Los valores de AASI, VOP, ITB y CAVI fueron 0.39 ± 0.14, 1.14 ± 0.09, 15.15 ± 2.71 m/s y 7.60 ± 1.90, respectivamente. Hubo una correlación negativa significativa entre AASI e ITB (r = -0.491, p < 0.01). Conclusiones Hay una asociación entre AASI, un marcador de rigidez arterial e ITB, un indicador de aterosclerosis, en estos pacientes con diabetes mellitus tipo 2.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Arteries/physiopathology , Blood Pressure/physiology , Brachial Artery/physiopathology , Diabetes Mellitus, Type 2/complications , Vascular Stiffness/physiology , Ankle/blood supply , Carotid Arteries/diagnostic imaging , Cross-Sectional Studies , Predictive Value of Tests , Blood Pressure Monitoring, Ambulatory , Diabetes Mellitus, Type 2/blood , Ankle Brachial Index , Pulse Wave AnalysisABSTRACT
Abstract Background: Psoriasis correlates with metabolic disorders, early atheromatosis and increased cardiovascular risk. Objectives: To assess markers of cardiovascular disease in psoriatic patients. Methods: Cross-sectional, observational study involving 11 psoriatic participants and 33 controls. Anthropometric, biochemical, hemodynamic and imaging parameters were evaluated. Arterial stiffness was assessed by oscillometric measurement of the brachial artery. Intima-media thickness (IMT) and left ventricular diastolic function were assessed by Doppler echography and echocardiography. Between-group comparisons of numerical variables were performed by the Student's t-test or Wilcoxon Mann-Whitney test for independent samples. Significance level was set at 5%. Results: Psoriatic patients showed increased pulse wave velocity (PWV) (9.1 ± 1.8 vs 8.0 ± 2 m/s, p = 0.033), IMT of the left common carotid artery (p = 0.018) and a higher percentage of patients above the 75th percentile according to the ELSA table when compared with controls (54.5 vs 18.2%, p = 0.045). Psoriatic patients also showed an increase in peripheral/central systolic blood pressure (137.1 ± 13.2 vs 122.3 ± 11.6 mmHg, p = 0.004)/(127 ± 13 vs 112.5 ± 10.4 mmHg, p = 0.005), peripheral/central diastolic blood pressure (89.9 ± 8.9 vs 82.2 ± 8, p = 0.022)/(91 ± 9.3 vs 82.2 ± 8.3, p = 0.014), total cholesterol (252 ± 43.5 vs 198 ± 39.8 mg/dL, p < 0.001), LDL cholesterol (167 ± 24 vs 118 ± 40.8 mg/dL, p < 0.001) and C-reactive protein (7.6 ± 35.4 vs 1 ± 1.2 mg/L p < 0.001) compared with controls. Conclusion: Psoriasis patients show increased PWV, IMT, peripheral and central blood pressures, and serum cholesterol and C-reactive protein levels, denoting a higher cardiovascular risk.
Resumo Fundamento: A psoríase correlaciona-se a distúrbios metabólicos, ateromatose precoce e aumento do risco cardiovascular. Objetivos: Avaliar marcadores de doença cardiovascular na população psoriásica. Métodos: Estudo observacional transversal, envolvendo 11 participantes psoriásicos e 33 controles. Foram avaliados parâmetros antropométricos, laboratoriais, hemodinâmicos e de imagem. A rigidez arterial foi avaliada por oscilometria da artéria braquial. A espessura médio-intimal (EMI) e a função diastólica do ventrículo esquerdo foram avaliadas por meio da ecografia e ecocardiografia Doppler. As comparações de variáveis numéricas entre grupos foram realizadas por teste t-Student e Wilcoxon Mann-Whitney para amostras independentes, adotando-se o nível de significância de 5%. Resultados: Os pacientes psoriásicos apresentaram aumento de VOP (9,1 ± 1,8 e 8 ± 2 m/s, p = 0,033), EMI da artéria carótida comum esquerda (p = 0,018) e maior proporção de percentil > 75 pela tabela ELSA (54,5 e 18,2%, p = 0,045) e) quando comparados aos controles. Pacientes psoriásicos também mostraram aumento nos seguintes parâmetros em relação ao grupo controle, respectivamente: pressão arterial sistólica periférica/central (137,1 ± 13,2 e 122,3 ± 11,6 mmHg, p = 0,004)/(127 ± 13 e 112,5 ± 10,4 mmHg, p = 0,005), pressão arterial diastólica periférica/central (89,9 ± 8,9 e 82,2 ± 8 mmHg, p = 0,022) / (91 ± 9,3 e 82,2 ± 8,3 mmHg, p = 0,014), colesterol total (252 ± 43,5 e 198 ± 39,8 mg/dL, p < 0,001), colesterol LDL (167 ± 24 e 118 ± 40,8 mg/dL, p < 0,001) e proteína C reativa (7,6 ± 35,4 e 1 ± 1,2 mg/L, p<0,001). Conclusão: Pacientes psoriásicos apresentam elevações de VOP e EMI, além de maiores pressões arteriais periféricas e centrais, níveis séricos de colesterol e de proteína C reativa, denotando maior risco cardiovascular.
Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Psoriasis/complications , Psoriasis/physiopathology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/physiopathology , Oscillometry/methods , Reference Values , Severity of Illness Index , Blood Pressure/physiology , Brachial Artery/physiopathology , C-Reactive Protein/analysis , Echocardiography, Doppler , Case-Control Studies , Cholesterol/blood , Cross-Sectional Studies , Risk Factors , Statistics, Nonparametric , Risk Assessment , Carotid Intima-Media Thickness , Vascular Stiffness , Pulse Wave AnalysisABSTRACT
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)
Subject(s)
Humans , Female , Brachial Artery/physiopathology , Brachial Artery/diagnostic imaging , Dilatation, Pathologic/diagnostic imaging , Pre-Eclampsia , Coronary Artery Disease , Risk Factors , Databases, Bibliographic , Diabetes, Gestational , Postmenopause/drug effects , Ultrasonography, Doppler , Hormone Replacement Therapy , Hormone Replacement Therapy/adverse effectsABSTRACT
Abstract Background: Excessive weight is a cardiovascular risk factor since it generates a chronic inflammatory process that aggravates the endothelial function. Objective: To evaluate the endothelial function in individuals with excess weight and mild dyslipidemia using brachial artery flow-mediated dilation (BAFMD), and the association of endothelial function with anthropometric and biochemical variables. Methods: Cross-sectional study that included 74 individuals and evaluated anthropometric variables (body mass index [BMI], waist-hip ratio [WHR], waist circumference [AC], and percentage of body fat [PBF]), biochemical (blood glucose, insulinemia, ultrasensitive C-reactive protein, fibrinogen, total cholesterol, HDL-cholesterol, triglycerides, and LDL-cholesterol) and endothelial function (BAFMD, evaluated by ultrasound). The statistical analysis was performed with SPSS, version 16.0. To study the association between the variables, we used chi-square, Student's t and Mann-Whitney tests, and Pearson's correlation. Logistic regression analyzed the independent influence of the factors. Values of p < 0.05 were considered significant. Results: The participants had a mean age of 50.8 years, and 57% were female. BMI, WC, WHR, and PBF showed no significant association with BAFMD. The male gender (p = 0.02) and higher serum levels of fibrinogen (p = 0.02) were significantly and independently associated with a BAFMD below 8%. Conclusions: In individuals with excess weight and mild untreated dyslipidemia, male gender and higher levels of fibrinogen were independently associated with worse BAFMD.
Resumo Fundamento: O excesso de peso é um fator de risco cardiovascular, pois gera um processo inflamatório crônico que agrava a função endotelial. Objetivo: Avaliar a função endotelial de indivíduos com excesso de peso e dislipidemia leve através da dilatação da artéria braquial mediada pelo fluxo (DABMF) e sua associação com variáveis antropométricas e bioquímicas. Métodos: Estudo transversal com inclusão de 74 indivíduos e avaliação de variáveis antropométricas (índice de massa corporal [IMC], razão cintura-quadril [RCQ], circunferência abdominal [CA] e percentual de gordura corporal [PGC]), bioquímicas (glicemia, insulinemia, proteína C reativa ultrassensível, fibrinogênio, colesterol total, HDL-colesterol, triglicerídeos e LDL-colesterol) e função endotelial (DABMF, avaliada por ultrassonografia). A análise estatística foi realizada pelo programa SPSS, versão 16.0. Para estudar a associação entre as variáveis, foram utilizados os testes do qui-quadrado, t de Student, Mann-Whitney e correlação de Pearson. Regressão logística analisou a influência independente dos fatores. Valores de p < 0,05 foram considerados significativos. Resultados: Os participantes tinham uma média de idade de 50,8 anos e 57% eram do gênero feminino. O IMC, a CA, a RCQ e o PGC não mostraram associação significativa com a DABMF. O gênero masculino (p = 0,02) e níveis séricos mais elevados de fibrinogênio (p = 0,02) estiveram significativamente e independentemente associados a uma DABMF inferior a 8%. Conclusões: Em indivíduos com excesso de peso e dislipidemia leve não tratada, o gênero masculino e níveis mais elevados de fibrinogênio foram associados de forma independente com uma pior DABMF.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Fibrinogen/analysis , Endothelium, Vascular/physiopathology , Atherosclerosis/blood , Dyslipidemias/physiopathology , Overweight/physiopathology , Regional Blood Flow/physiology , Body Weight , Brachial Artery/physiopathology , Biomarkers/blood , Sex Factors , Anthropometry , Adipose Tissue/physiopathology , Cholesterol/blood , Cross-Sectional Studies , Risk Factors , Atherosclerosis/etiology , Dyslipidemias/complications , Overweight/complicationsABSTRACT
Abstract Background: The effect of statins on the endothelial function in humans remains under discussion. Particularly, it is still unclear if the improvement in endothelial function is due to a reduction in LDL-cholesterol or to an arterial pleiotropic effect. Objective: To test the hypothesis that modulation of the endothelial function promoted by statins is primarily mediated by the degree of reduction in LDL-cholesterol, independent of the dose of statin administered. Methods: Randomized clinical trial with two groups of lipid-lowering treatment (16 patients/each) and one placebo group (14 patients). The two active groups were designed to promote a similar degree of reduction in LDL-cholesterol: the first used statin at a high dose (80 mg, simvastatin 80 group) and the second used statin at a low dose (10 mg) associated with ezetimibe (10 mg, simvastatin 10/ezetimibe group) to optimize the hypolipidemic effect. The endothelial function was assessed by flow-mediated vasodilation (FMV) before and 8 weeks after treatment. Results: The decrease in LDL-cholesterol was similar between the groups simvastatin 80 and simvastatin 10/ezetimibe (27% ± 31% and 30% ± 29%, respectively, p = 0.75). The simvastatin 80 group presented an increase in FMV from 8.4% ± 4.3% at baseline to 11% ± 4.2% after 8 weeks (p = 0.02). Similarly, the group simvastatin 10/ezetimibe showed improvement in FMV from 7.3% ± 3.9% to 12% ± 4.4% (p = 0.001). The placebo group showed no variation in LDL-cholesterol level or endothelial function. Conclusion: The improvement in endothelial function with statin seems to depend more on a reduction in LDL-cholesterol levels, independent of the dose of statin administered, than on pleiotropic mechanisms.
Resumo Fundamento: O efeito das estatinas na função endotelial em seres humanos permanece em discussão. Particularmente, ainda carece resposta se a melhora na função endotelial deve-se à redução do LDL-colesterol ou a um efeito pleiotrópico arterial. Objetivo: Testar a hipótese de que a modulação da função endotelial promovida por estatinas é prioritariamente mediada pelo grau de redução do LDL-colesterol, independente da dose de estatina utilizada. Métodos: Ensaio clínico randomizado com dois grupos de tratamento hipolipemiante (16 pacientes/cada) e um grupo placebo (14 pacientes). Os dois grupos ativos foram desenhados para promover graus semelhantes de redução de LDL-colesterol: o primeiro utilizou estatina em alta dose (80 mg, grupo sinvastatina 80) e o segundo em baixa dose (10 mg) associada a ezetimiba (10 mg, grupo sinvastatina 10/ezetimiba) para otimizar o efeito hipolipemiante. A função endotelial foi analisada pela vasodilatação mediada por fluxo (VMF) antes e após 8 semanas de tratamento. Resultados: A redução no LDL-colesterol foi semelhante entre os grupos sinvastatina 80 e sinvastatina 10/ezetimiba (27% ± 31% e 30% ± 29%, respectivamente, p = 0,75). O grupo sinvastatina 80 apresentou incremento da VMF de 8,4% ± 4,3% no basal para 11% ± 4,2% após 8 semanas (p = 0,02). Da mesma forma, o grupo sinvastatina 10/ezetimiba apresentou melhora da VMF de 7,3% ± 3,9% para 12% ± 4,4% (p = 0,001). O grupo placebo não apresentou variação no nível de LDL-colesterol ou da função endotelial. Conclusão: A melhora da função endotelial com uso de estatina parece depender mais da redução do LDL-colesterol, independente da dose de estatina utilizada, do que de mecanismos pleiotrópicos.
Subject(s)
Humans , Female , Adult , Middle Aged , Endothelium, Vascular/drug effects , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Simvastatin/administration & dosage , Ezetimibe/administration & dosage , Hyperlipidemias/drug therapy , Anticholesteremic Agents/administration & dosage , Reference Values , Time Factors , Vasodilation/drug effects , Brachial Artery/drug effects , Brachial Artery/physiopathology , Endothelium, Vascular/physiopathology , Placebo Effect , Double-Blind Method , Analysis of Variance , Treatment Outcome , Statistics, Nonparametric , Hyperlipidemias/blood , Cholesterol, LDL/drug effects , Cholesterol, LDL/bloodABSTRACT
Objectives: To evaluate the occurrence of maternal brain centralization in pregnant women with specific gestational hypertension; to establish normal values of the ratio of the uterine artery with (mean and standard deviation) ophthalmic artery; to compare the ratio of uterine to the ophthalmic artery with normal and abnormal groups; and to establish the Receiver Operator Curve (ROC) for diagnosis of patients with specific hypertensive disease of pregnancy. Methods: To achieve the proposed objectives a casecontrol study was carried out where the sample consisted of 178 pregnant patients divided into two groups. The control group included pregnant 83 pregnant normotensive women; a case group included 95 patients with clinical and laboratory diagnoses of specific gestational hypertension. Results: Patients with preeclampsia had lower values than the patients who had eclampsia. The Doppler parameters that were statistically significant were those of the ratio of uterine artery with the ophthalmic artery (AU/AO) and vice versa. A comparison between the normal curve systolediastole and the respective cut-off point was performed. A ROC is shown in the cut-off considering the systolic velocity, the diastolic velocity, the systole/diastole relation, and the index of resistance of the ophthalmic artery. Conclusion: The maternal centralization in high risk pregnancies was observed when specific gestational hypertension is real. The normal curve has a mean and standard deviation of the relative Doppler of the uterine artery to the ophthalmic artery systolic/diastolic ratio was 0.43 ± 0.16 for normal pregnant patients. Comparing the group of patients with normal pathological group of patients there was a statistically significant difference between them considering the relation of Doppler uterine artery with ophthalmic artery.(...)
Objetivos: Avaliar a ocorrência de centralização no cérebro materno em grávidas com hipertensão gestacional específica; estabelecer os valores normais (média e desvio padrão)da razão artéria uterina/artéria oftálmica; comparar a razão artéria uterina/artéria oftálmica entre grupos normal e enfermo; estabelecer a curva ROC para o diagnóstico de pacientes com doença hipertensiva específica da gravidez. Métodos: Estudo de caso-controle em uma amostra de 178 pacientes gestantes, divididas em dois grupos. O grupo controle consistiu em 83 grávidas normotensas; o grupo de casos consistiu em 95 pacientes com diagnóstico clínico e laboratorial de hipertensão gestacional específica. Resultados: Pacientes com pré-eclâmpsia apresentaram valores mais baixos versus pacientes que sofreram eclampsia. Os parâmetros da sonografia Doppler estatisticamente significativos foram os referentes à relação artéria uterina/artéria oftálmica (AU/AO) e vice versa. Foi traçada uma curva de normalidade para sístole-diástole de comparação com os respectivos pontos de corte. A curva ROC exibe os pontos de corte, respectivamente, para velocidade sistólica, velocidade diastólica, razão sístole/diástole e índice de resistência da artéria oftálmica.Conclusão: Foi observada centralização materna em gestações de alto risco em casos de hipertensão gestacional específica. Na curva normal, a média±desvio-padrão da relação sistólica/diastólica entre artéria uterina e artéria oftálmica foi de 0,43±0,16 (Doppler) para pacientes grávidas normais. Comparando-se o grupo de pacientes normais com o grupo de pacientes enfermas, houve diferença estatisticamente significativa entre grupos, considerando o estudo Doppler para a razão artéria uterina/artéria oftálmica.(...)
Subject(s)
Humans , Female , Pregnancy , Brachial Artery/physiopathology , Brachial Artery , Ophthalmic Artery/physiopathology , Ophthalmic Artery , Uterine Artery/physiopathology , Uterine Artery , Eclampsia , Pre-EclampsiaABSTRACT
Microalbuminuria is a marker of generalized endothelial dysfunction resulting from arterial stiffness or insulin resistance, and brachial-ankle pulse wave velocity (baPWV) is a good measure of arterial stiffness. We aimed to investigate whether elevated baPWV is independently associated with microalbuminuria. This study included 1,648 individuals aged over 40 who participated in the baseline Multi-Rural Cohort Study conducted in Korean rural communities between 2005 and 2006. Participants were classified into less than 30 mg/g as normoalbuminuria or 30-300 mg/g as microalbuminuriausing urinary albumin creatinine ratio (UACR). The median and Q1-Q3 baPWV values were significantly higher in the microalbuminuric group both in men (1,538, 1,370-1,777 cm/s vs. 1,776, 1,552-2,027 cm/s, P < 0.001) and women (1,461, 1,271-1,687 cm/s vs. 1,645, 1,473-1,915 cm/s, P < 0.001). BaPWV was independently associated with microalbuminuria in both genders after adjusting for pulse rate; fasting blood glucose; triglyceride; homeostatic model assessment insulin resistance (HOMA(IR)) and, history of hypertension and diabetes. Fasting blood sugar and HOMA(IR) were judged as having nothing to do with multicolinearity (r = 0.532, P < 0.001). Elevated baPWV was independently associated with microalbuminuria regardless of insulin resistance among rural subjects over 40 yr.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Albuminuria/diagnosis , Ankle Brachial Index , Ankle Joint/physiopathology , Blood Chemical Analysis , Blood Glucose/analysis , Brachial Artery/physiopathology , Cohort Studies , Diabetes Mellitus, Type 2/complications , Hypertension/complications , Pulse Wave Analysis , Risk Factors , Rural Population , Serum Albumin/analysis , Triglycerides/blood , Vascular StiffnessABSTRACT
FUNDAMENTO: Em condição homeostática, o Sistema Nervoso Autônomo (SNA), pela liberação de neurotransmissores vasoconstritores, e o endotélio, pela liberação de substâncias vasodilatadoras, atuam em sintonia para manter o tônus vascular. Todavia, a associação entre esses dois sistemas em portadores da doença de Chagas na forma indeterminada (DChI) ainda não foi estudada. OBJETIVO: Verificar a associação entre parâmetros referentes à modulação autonômica e à função endotelial em portadores da DChI. MÉTODOS: Treze pacientes com DChI (59,2 ± 11,23 anos) sem fatores de risco para doença cardiovascular foram avaliados para modulação autonômica pelo método oscilométrico da pressão arterial (Finapress) e a análise dos registros mediante a técnica da Variabilidade da Frequência Cardíaca (VFC) no domínio da frequência. A função endotelial foi avaliada pelo método de dilatação mediada pelo fluxo da artéria braquial (DMF), usando imagens de ultrassom de alta resolução. RESULTADOS: Na posição em decúbito dorsal foi observada correlação entre os componentes espectrais de alta (HF) (r = 0,78 p = 0,007) e baixa (LF) frequências normalizadas (r = 0,68 p = 0,01), bem como com o balanço simpatovagal (LF/HF) (r= -0,78 p = 0,004) com a DMF. CONCLUSÃO: Nosso estudo aponta a existência de uma relação entre as alterações na modulação autonômica e na função endotelial em pacientes com Doença de Chagas na forma indeterminada.
BACKGROUND: Under homeostatic condition, the autonomic nervous system (ANS), through the release of vasoconstrictor neurotransmitters, and the endothelium, through the release of vasodilating substances, interact to maintain blood vessel tone. However, the association between those two systems in patients with Chagas disease in its indeterminate phase (IChD) has not been studied. OBJECTIVE: To assess the association between autonomic modulation parameters and endothelial function in patients with IChD. METHODS: Thirteen patients with IChD (59.2 ± 11.23 years) and no risk factors for cardiovascular disease were assessed for autonomic modulation by using the blood pressure oscillometric method (Finapress) and the heart rate variability technique (HRV) in the frequency domain. Endothelial function was assessed by use of the brachial artery flow-mediated dilation (FMD) method with high-resolution ultrasound images. RESULTS: In the dorsal decubitus position, correlation of FMD was observed with normalized high-frequency (r = 0.78; p = 0.007) and low-frequency spectral components (r = 0.68; p = 0.01), as well as with sympathovagal balance (r = -0.78; p = 0.004). CONCLUSIONS: Our study indicates the existence of a relationship between the changes in autonomic modulation and endothelial function in patients with IChD.
Subject(s)
Female , Humans , Male , Middle Aged , Autonomic Nervous System/physiopathology , Blood Pressure/physiology , Chagas Disease/physiopathology , Endothelium, Vascular/physiopathology , Heart Rate/physiology , Blood Pressure Determination , Brachial Artery/physiopathology , Brachial Artery , Cross-Sectional Studies , Chagas Disease , Endothelium, Vascular , Oscillometry , Regional Blood Flow/physiology , Statistics, Nonparametric , Ultrasonography, Doppler, ColorABSTRACT
OBJECTIVE: In this study, we aimed to investigate endothelial functions in primary Sjögren syndrome. METHODS: Thirty-five patients with primary Sjögren syndrome and 20 age and sexmatched healthy volunteers were recruited to the present study. Flow mediated dilatation of brachial artery and carotid intimamedia thickness were measured in the study population. RESULTS: Carotid intimamedia thickness values were similar between groups (0.50 ± 0.10, 0.53 ± 0.08, p > 0.05). Flow mediated dilatation of the brachial artery was disrupted in the primary Sjögren syndrome group (7% vs 12%, p = 0.002). CONCLUSION: There is endothelial dysfunction in patients with primary Sjögren syndrome, although they had comparable carotid intimamedia thickness with the healthy control group.
OBJETIVO: Este estudio se encaminó a investigar las funciones endoteliales en el síndrome de Sjögren primario. MÉTODOS: Para el presente estudio, se reclutaron treinta y cinco pacientes con síndrome de Sjögren primario y 20 voluntarios sanos apareados por edad y sexo. La dilatación mediada por flujo observada en la arteria braquial, y el espesor íntimamedia carotídeo fueron medidos en la población bajo estudio. RESULTADOS: Los valores del espesor íntimamedia carotídeo fueron similares entre los grupos (0.50 ± 0.10, 0.53 ± 0.08, p > 0.05). La dilatación mediada por flujo de la arteria braquial, estaba alterada en el grupo de síndrome del Sjögren primario (7% frente a 12%, p = 0.002). CONCLUSIÓN: Hay una disfunción endotelial en los pacientes con el síndrome de Sjögren primario, aunque estos tenían un espesor íntimamedia carotídeo comparable con el grupo de control saludable.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Brachial Artery/physiopathology , Carotid Intima-Media Thickness , Endothelium, Vascular/physiopathology , Sjogren's Syndrome/diagnosis , Sjogren's Syndrome/physiopathology , Vasodilation/physiology , Hyperemia/physiopathology , Reference ValuesABSTRACT
FUNDAMENTO: A cistatina C sérica (s-CC), um marcador endógeno da função renal, tem sido proposta também como um marcador de risco cardiovascular. No entanto, ainda não está estabelecido se se trata de um marcador direto de aterosclerose, independentemente da função renal. OBJETIVO: O objetivo deste estudo foi correlacionar a s-CC com dois marcadores substitutos de aterosclerose subclínica. MÉTODOS: Trata-se de um estudo transversal envolvendo 103 pacientes hipertensos ambulatoriais, de meia idade (57,49 ± 11,7 anos), sendo 60 do sexo feminino (58,25%) e a maioria com função renal preservada. A s-CC foi correlacionada com a espessura mediointimal carotídea (EMIc) e a dilatação mediada por fluxo de artéria braquial (DMF), ambas avaliadas por ultrassonografia, bem como com o clearance de creatinina medido e fatores de risco cardiovascular estabelecidos. RESULTADOS: A s-CC não se correlacionou significativamente nem com a EMIc (r = -0,024, p = 0,84) nem com a DMF (r = -0,050 e p = 0,687), e não foi observada também associação significativa com fatores de risco convencionais nem marcadores inflamatórios. Na análise univariada, a s-CC se correlacionou com o clearance de creatinina medido (r = - 0,498, p < 0,001), idade (r = 0,408, p < 0,001), microalbuminúria (r = 0,291, p = 0,014), ácido úrico (r = 0,391, p < 0,001), relação E/e' (r = 0,242, p = 0,049) e escore de Framingham (r = 0,359, p = 0,001). No entanto, após análise de regressão múltipla, apenas a associação com o clearance de creatinina medido permaneceu significativa (r = -0,491, p <0,001). CONCLUSÃO: Em pacientes hipertensos ambulatoriais de meia idade, a s-CC se correlacionou com o clearance de creatinina medido,como esperado, mas não foi observada associação com marcadores de aterosclerose nem com fatores de risco cardiovascular estabelecidos.
BACKGROUND: Serum cystatin C (s-CC), an endogenous marker of kidney function, has also been proposed as a cardiovascular risk marker. However, it is unknown whether it is a direct marker of atherosclerosis, independently of kidney function. OBJECTIVE: The aim of this study was to correlate s-CC with two surrogate markers of subclinical atherosclerosis. METHODS: This is a cross-sectional study involving 103 middle-aged (57.49 ± 11.7 years) hypertensive outpatients, being 60 female (58.25%), most with preserved kidney function. S-CC was correlated with carotid intima media thickness (IMT) and flow-mediated dilation of brachial artery (FMD), both assessed by ultrasound, as well as with measured creatinine clearance and established cardiovascular risk factors. RESULTS: S-CC was neither significantly correlated with IMT (r = -0.024; p = 0.84) nor with FMD (r = -0.050 and p = 0.687) and no significant association was observed with conventional risk factors and inflammatory markers. In univariate analysis, s-CC was correlated with measured creatinine clearance (r = -0,498; p < 0,001), age (r = 0,408; p < 0,001), microalbuminuria (r = 0,291; p = 0,014), uric acid (r = 0,391; p < 0,001), ratio E/e' (r = 0,242; p = 0,049) and Framingham score (r = 0,359; p = 0,001). However, after multiple regression analysis, only the association with measured creatinine clearance remained significant (r = -0,491; p < 0,001). CONCLUSION: In middle-aged hypertensive outpatients, s-CC correlated with measured creatinine clearance, as expected, but no association was observed with markers of atherosclerosis neither with established cardiovascular risk factors.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Atherosclerosis/blood , Cystatin C/blood , Hypertension/blood , Age Factors , Atherosclerosis/diagnosis , Biomarkers/blood , Brachial Artery/physiopathology , Carotid Intima-Media Thickness , Cross-Sectional Studies , Creatinine/blood , Hypertension/physiopathology , Kidney/physiopathology , Risk FactorsABSTRACT
FUNDAMENTO: A fisiopatologia da Pré-Eclampsia (PE) é caracterizada por deficiência no processo de placentação, disfunção endotelial sistêmica e hiperfluxo do Sistema Nervoso Central (SNC). Do ponto de vista clínico, seria interessante determinar a ocorrência desses fenômenos antes do aparecimento das manifestações clínicas da doença, levantando a possibilidade de novos métodos de predição da PE. OBJETIVO: Comparar o processo de placentação, a função endotelial e o hiperfluxo do SNC em gestantes de alto risco para desenvolvimento de PE que posteriormente desenvolveram ou não a síndrome. MÉTODOS: Um total de 74 gestantes foi submetido ao exame de Dilatação Fluxo-Mediada (DFM) da artéria braquial, dopplerfluxometria de artérias uterinas e oftálmica para avaliação da função endotelial, processo de placentação e hiperfluxo central, respectivamente. Os exames foram realizados entre 24 e 28 semanas de gestação e as pacientes foram acompanhadas até o puerpério para coleta de dados. RESULTADOS: Quinze pacientes tiveram a gestação complicada pela PE e 59 se mantiveram normotensas até o puerpério. Pacientes que subsequentemente desenvolveram PE apresentaram entre 24 e 28 semanas de gestação, maiores valores no índice de pulsatilidade das artérias uterinas e menores valores de DFM (p < 0,001 e p = 0,001, respectivamente). Entretanto, não houve diferença nos valores obtidos no índice de resistência da artéria oftálmica (p = 0,08). CONCLUSÃO: Os dados obtidos sugerem que a deficiência no processo de placentação e a disfunção endotelial precedem cronologicamente as manifestações clínicas da PE, o que não ocorre com o hiperfluxo do SNC.
BACKGROUND: The physiopathology of Preeclampsia (PE) is characterized by a deficiency in the process of placentation, systemic endothelial dysfunction and Central Nervous System (CNS) hyperflow. From a clinical point of view, it would be interesting to determine the occurrence of these phenomena before the onset of clinical manifestations of the disease, raising the possibility of new methods for predicting PE. OBJECTIVE:Compare the process of placentation, endothelial function and CNS hyperflow in pregnant women at high risk for the development of PE who subsequently developed or not the syndrome. METHODS: A total of 74 pregnant women underwent the Flow-Mediated Dilation (FMD) of the brachial artery, Doppler study of uterine and ophthalmic arteries for the assessment of endothelial function, process of placentation and central hyperflow, respectively. The examinations were performed between 24 and 28 weeks of gestation and were followed until the postpartum period for data collection. RESULTS: Fifteen patients had PE and 59 remained normotensive until the puerperium. Patients who subsequently developed PE had between 24 and 28 weeks of gestation, higher pulsatility index of uterine arteries and lower values of FMD (p < 0.001 and p = 0.001, respectively). However, there was no difference in the values obtained in the resistive index in the ophthalmic artery (p = 0.08). CONCLUSION: The data obtained suggest that the deficiency in the process of placentation and endothelial dysfunction chronologically precede the clinical manifestations of PE, which does not occur with CNS hyperflow.
Subject(s)
Adult , Female , Humans , Pregnancy , Endothelium, Vascular/physiopathology , Pre-Eclampsia/physiopathology , Uterus/physiopathology , Blood Flow Velocity/physiology , Blood Pressure/physiology , Brachial Artery/physiopathology , Central Nervous System/blood supply , Central Nervous System/physiopathology , Gestational Age , Placenta/blood supply , Placenta/physiopathology , Placentation/physiology , Risk Factors , Statistics, Nonparametric , Uterine Artery/physiopathology , Uterus/blood supplyABSTRACT
INTRODUÇÃO: Durante o envelhecimento, a pressão arterial sistólica (PS) e a pressão de pulso (PP) se elevam gradativamente, consequente à redução da elasticidade arterial. A medida da pressão arterial sistêmica (PAS) aferida na raiz da aorta tem sido considerada como um determinante independente da mortalidade cardiovascular superior aos valores PAS braquial. OBJETIVO: Comparar os valores da PAS central e PAS braquial em portadores de hipertensão arterial nas diversas faixas etárias. MÉTODO: Avaliamos a PAS central na raiz da aorta e a PAS braquial no braço esquerdo pelo método oscilométrico em 244 pacientes com hipertensão submetidos à cineangiocoronariografia. Foram constituídos cinco grupos de pacientes: Grupo I, 39-49 anos, n = 36; Grupo II, 50-59 anos, n = 67; Grupo III, 60-69 anos, n = 69; Grupo IV, 70-79 anos, n = 46; e o Grupo V, > 80 anos, n = 26. RESULTADOS: Ao comparar a PS central versus PS braquial, foi possível encontrar significância a partir dos 50 anos de vida. Não encontramos diferença estatística entre a pressão diastólica central versus diastólica braquial, exceto nos pacientes com idade entre 60-69 anos. Na comparação entre a PP central e PP braquial, observamos que a PP central foi significativamente maior (entre 11 a 15 mmHg) em todos os pacientes com idade superior a 50 anos. CONCLUSÃO: Com o envelhecimento, os valores das PS e de PP, aferidas diretamente na raiz da aorta, são superiores àqueles obtidos por método indireto na artéria braquial. Essas diferenças são significantes a partir dos 50 anos de idade.
INTRODUCTION: Systolic blood pressure (SP) and pulse pressure (PP) rise gradually during the aging process as a consequence of a reduction in arterial elasticity. The measure of systemic arterial pressure (SAP) taken at the root of the aorta has been considered an independent determinant of cardiovascular mortality superior to the values of brachial SAP. AIM: To compare the values of SAP central to those of braquial SAP in patients of different age brackets who have systemic hypertension. METHOD: We evaluated the central SAP at the root of the aorta and the brachial SAP in the left arm using the ocillometric method 244 hypertensive patients who had been submitted to cineangiocoronarography. Five groups of patients were constituted: Group I, 39-49 years-old (y.o.), n = 36; Group II, 50-59 y.o., n = 67; Group III, 60-69 y.o., n = 69; Group IV, 70-79 y.o., n = 46; Group V, > 80 y.o., n = 26. RESULTS: When central SP was compared to brachial SP, it was possible to find significance in patients who were 50 y.o and upwards. It was not possible to find a statistical difference between central diastolic pressure and brachial except in patients between the ages of 60-69 y.o. When comparing central to brachial PP, we observed that central PP was significantly greater (between 11 and 15 mmHg) in all patient above the age of 50 y.o. CONCLUSION: In older people, the values of SP and PP, taken directly at the root of the aorta, are superior to those obtained by indirect means from the brachial artery. These differences are significant from the age of 50 y.o. onwards.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Aorta/physiopathology , Brachial Artery/physiopathology , Cineangiography , Coronary Angiography , Hypertension/physiopathology , Blood Pressure , Cross-Sectional Studies , SystoleABSTRACT
OBJETIVO: O objetivo deste estudo foi comparar a resposta dilatadora dependente e independente do endotélio em pacientes portadores de esclerose sistêmica limitada (ESL) com aquela de indivíduos sadios de mesmo gênero, idade e cor. MÉTODOS: Vinte mulheres adultas, não obesas, não tabagistas, não diabéticas, não dislipidêmicas, não hipertensas, que preencheram os critérios para esclerose sistêmica (ES) segundo o American College of Rheumatology, foram submetidas ao exame de Doppler de artéria braquial do membro superior direito. Foi analisada a resposta dilatadora, dependente do endotélio, após isquemia induzida com esfigmomanômetro por cinco minutos no braço direito, e a resposta dilatadora, independente do endotélio, após administração de 300 mcg de nitroglicerina (NTG) sublingual. Esses resultados foram comparados com a resposta obtida em indivíduos sadios. RESULTADOS: O diâmetro longitudinal da artéria braquial (DAB) foi significativamente menor na fase basal 1 nos pacientes com ESL (3,57 ± 0,52 mm e 3,93 ± 0,39 mm, respectivamente no grupo paciente (P) e grupo-controle (C), P = 0,005). Não foi encontrada diferença estatisticamente significativa entre a velocidade das hemácias (VH) após isquemia/hiperemia reativa (HR) e após NTG (110,2 ± 43,86 cm/s vs. 102,0 ± 25,89 cm/s e 63,80 ± 17,69 cm/s vs. 65,4 ± 12,90 cm/s nos grupos P e C, após HR e NTG, respectivamente). Também não foi encontrada diferença significativa entre o DAB após HR e após NTG (3,77 ± 0,59 mm vs. 4,14 ± 0,49 mm e 4,44 ± 0,64 mm vs. 4,70 ± 0,58 mm nos grupos P e C, após HR e NTG, respectivamente). CONCLUSÃO: Embora o grupo de pacientes com ESL tenha apresentado menor DAB basal, a resposta dilatadora dependente e independente do endotélio se manteve preservada em ambos os grupos.
OBJECTIVES: The aim of this study was to compare the brachial artery endothelium-dependent and endothelium-independent dilating responses in patients with limited systemic sclerosis (LSSc) with those of healthy subjects of the same gender, age and color. METHODS: Twenty adult, non-obese, non-smoker, non-diabetic, non-dyslipidemic, and non-hypertensive women, who fulfilled the American College of Rheumatology criteria for the diagnosis of SSc, were submitted to right brachial artery Doppler ultrasound. The vasodilating responses were analyzed as follows: the endothelium-dependent dilating response, after a 5-minute ischemia in the right arm; and the endothelium-independent dilating response, after administering 300 mcg of nitroglycerin (NTG) sublingually. The results were compared with the response obtained in healthy subjects. RESULTS: Brachial artery longitudinal diameter was significantly low at baseline 1: 3.57 ± 0.52 mm and 3.93 ± 0.39 mm for the LSSc group and the control group, respectively, P = 0.005. The vascular reactivity after the ischemia/reactive hyperemia and the NTG showed no significant difference between the groups (8.60 ± 5.45 mm vs. 9.26 ± 5.91 mm and 25.01 ± 12.55 mm vs. 19.59 ± 7.94 mm for the LSSc and control groups, respectively). Also, no statistically significant difference was found between red blood cell velocity (RBCV) after reactive hyperemia and NTG (110.2 ± 43.86 cm/s vs. 102.0 ± 25.89 cm/s and 63.80 ± 17.69 cm/s vs. 65.4 ± 12.90 cm/s in the LSSc and control groups, respectively). CONCLUSION: Although the LSSc group showed lower brachial artery diameter, the endotheliumdependent and the endothelium-independent dilating responses were preserved in both groups.
Subject(s)
Adult , Female , Humans , Middle Aged , Brachial Artery/physiopathology , Brachial Artery , Endothelium, Vascular/physiopathology , Endothelium, Vascular , Scleroderma, Systemic/physiopathology , Scleroderma, Systemic , Ultrasonography, Doppler , Prospective StudiesABSTRACT
Flow mediated brachial dilatation (FMD) and carotid intima-media thickness (IMT) have been a surrogate for early atherosclerosis. Slow coronary flow in a normal coronary angiogram is not a rare condition, but its pathogenesis remains unclear. A total of 85 patients with angina were evaluated of their brachial artery FMD, carotid IMT and conventional coronary angiography. Coronary flow was quantified using the corrected thrombosis in myocardial infarction (TIMI) frame count method. Group I was a control with normal coronary angiography (n = 41, 56.1 +/- 8.0 yr) and group II was no significant coronary stenosis with slow flow (n = 44, 56.3 +/- 10.0 yr). Diabetes was rare but dyslipidemia and family history were frequent in group II. Heart rate was higher in group II than in group I. White blood cells, especially monocytes and homocysteine were higher in group II. The FMD was significantly lower in group II than in group I. Elevated heart rate, dyslipidemia and low FMD were independently related with slow coronary flow in regression analysis. Therefore, endothelial dysfunction may be an earlier vascular phenomenon than increased carotid IMT in the patients with slow coronary flow.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Angina, Unstable/complications , Brachial Artery/physiopathology , Carotid Intima-Media Thickness , Coronary Angiography , Coronary Circulation/physiology , Dyslipidemias/complications , Endothelium, Vascular/physiopathology , Heart Rate , Homocysteine/metabolism , Leukocyte Count , Monocytes/cytology , ROC Curve , Regression Analysis , Risk FactorsABSTRACT
FUNDAMENTO: A função endotelial braquial tem sido associada ao fluxo lento coronário (FLC). O aumento do fluxo sanguíneo para a artéria braquial faz com que o endotélio libere óxido nítrico (ON), com subsequente vasodilatação. Além de sua atividade com betabloqueador, o nebivolol provoca vasodilatação, aumentando a liberação endotelial de ON. OBJETIVO: Avaliar os efeitos do nebivolol na função endotelial vascular em pacientes com FLC. MÉTODOS: 46 pacientes com FLC e 23 indivíduos com artérias coronárias epicárdicas normais foram examinados com ecocardiografia transtorácica e ultrassonografia da artéria braquial. Os pacientes foram reavaliados dois meses após o tratamento com aspirina ou aspirina e nebivolol. RESULTADOS: Os pacientes com FLC apresentaram maior índice de massa corporal (26,5 ± 3,3 vs. 23,8 ± 2,8, p < 0,001), tempo de relaxamento isovolumétrico (TRIV) de influxo mitral (114,9 ± 18,0 vs. 95,0 ± 22,0 mseg, p < 0,001), menor fração de ejeção do ventrículo esquerdo (FEVE) (63,5 ± 3,1 por cento vs. 65,4 ± 2,2, p = 0,009), colesterol HDL (39,4 ± 8,5 vs. 45,8 ± 7,7 mg/dL, p = 0,003) e dilatação fluxo-mediada da artéria braquial (DFM) (6,1 ± 3,9 por cento vs. 17,6 ± 4,5 por cento, p <0,001). Houve correlações significativas entre a DFM e a presença de FLC (r = 0,800, p < 0,001) e o colesterol HDL (r = 0,349, p = 0,003). Dos pacientes com FLC, apesar de os valores médios de DFM em pré-tratamento terem sido semelhantes (6,1 ± 4,3 por cento vs. 6,0 ± ,6 por cento, p = 0,917), em comparação com a DFM do grupo em pós-tratamento apenas com aspirina, a DFM apresentou valores significativamente maiores do que os pacientes tratados com aspirina e nebivolol (6,0 ± 3,5 por cento vs. 8,0 ± 2,9 por cento, p = 0,047). Constatou-se que o tratamento com nebivolol está associado a um significativo aumento na DFM (6,0 ± 3,6 a 8,0 ± 2,9 por cento, p = 0,030), ao passo que o tratamento apenas com aspirina não apresentou a mesma associação. CONCLUSÃO: A função endotelial pode ser comprometida nas artérias coronárias e braquiais em pacientes com FLC, e o nebivolol pode ser eficaz na melhora da função endotelial em pacientes com FLC.
BACKGROUND: Brachial endothelial function has been associated with coronary slow flow (CSF). Increasing blood flow to brachial artery provokes endothelium to release nitric oxide (NO) with subsequent vasodilatation. Besides its β1-blocker activity, nebivolol causes vasodilatation by increasing endothelial NO release. OBJECTIVE: To assess the effects of nebivolol on vascular endothelial function in patients with CSF. METHODS: Forty-six patients with CSF and 23 individuals with normal epicardial coronary arteries were examined with transthoracic echocardiography and brachial artery ultrasonography. The patients were reevaluated two months after treatment with aspirin or aspirin plus nebivolol. RESULTS: Patients with CSF had higher body mass index (26.5 ± 3.3 vs. 23.8 ± 2.8, p < 0.001), mitral inflow isovolumetric relaxation time (IVRT) (114.9 ± 18.0 vs. 95.0 ± 22.0 msec, p < 0.001) and lower left ventricular ejection fraction (LVEF) (63.5 ± 3.1 percent vs. 65.4 ± 2.2, p = 0.009), HDL-cholesterol (39.4 ± 8.5 vs. 45.8 ± 7.7 mg/dL, p = 0.003) and brachial flow-mediated dilatation (FMD) (6.1 ± 3.9 percent vs. 17.6 ± 4.5 percent, p < 0.001). There were significant correlations between FMD and the presence of CSF (r = 0.800, p < 0.001) and HDL-cholesterol (r = 0.349, p = 0.003). Among Patients with CSF, although pretreatment mean FMD values were similar (6.1 ± 4.3 percent vs. 6.0 ± ,6 percent, p = 0.917) compared to aspirin alone group, posttreatment FMD was significantly higher in patients treated with aspirin plus nebivolol (6.0 ± 3.5 percent vs. 8.0 ± 2.9 percent, p = 0.047). Treatment with nebivolol was associated with a significant increase in FMD (6.0 ± 3.6 to 8.0 ± 2.9 percent, p = 0.030) whereas treatment with aspirin alone was not. CONCLUSION: Endothelial function may be impaired in both coronary and brachial arteries in patients with CSF and nebivolol may be effective in the improvement of endothelial function in patients with CSF.
Subject(s)
Humans , Middle Aged , Aspirin/pharmacology , Benzopyrans/pharmacology , Brachial Artery/drug effects , Coronary Circulation/drug effects , Endothelium, Vascular/drug effects , Ethanolamines/pharmacology , Vasodilator Agents/pharmacology , Blood Flow Velocity/drug effects , Blood Flow Velocity/physiology , Brachial Artery/physiopathology , Brachial Artery , Case-Control Studies , Coronary Circulation/physiology , Drug Therapy, Combination/adverse effects , Endothelium, Vascular/physiopathology , Endothelium, Vascular , Statistics, Nonparametric , Treatment OutcomeABSTRACT
Devido à facilidade de aplicação da dilatação fluxo-mediada da artéria braquial (FMD) como método de avaliação da função endotelial, seu uso foi difundido naturalmente. Contudo, a técnica correta, as limitações e sua reprodutibilidade devem ser determinados até que seu uso seja liberado com segurança para a prática clínica. Estudos demonstram que gestantes portadoras de pré-eclâmpsia apresentam menor valor de FMD em relação às pacientes normotensas, podendo essa medida ser usada inclusive como preditor da doença. Da mesma forma, as que possuem Diabetes Gestacional (DG) apresentam valores de FMD menores que gestantes normoglicêmicas; porém, um rígido controle glicêmico por insulinoterapia ou dieta melhora significativamente esses valores. Além disso, a terapia de reposição hormonal está relacionada à melhora nos níveis de FMD. O objetivo deste estudo é realizar uma revisão bibliográfica sobre utilização FMD em Ginecologia e Obstetrícia. Este trabalho foi baseado em levantamento bibliográfico no Medline, de trabalhos publicados entre 2002 e 2009, além de estudos e textos clássicos que abordam o tema. Podemos concluir que a dilatação fluxo-mediada da artéria braquial é um exame de grande valor para a propedêutica e acompanhamento da função endotelial. Apesar das dificuldades técnicas e da falta de padronização ainda existentes, não há motivo para que esse método não seja bem aceito na prática clínica.
Due to the facility of application the flow-mediated dilatation of the brachial artery (FMD) as assessment method of the endothelial function, its use has been naturally widespread. However, the correct technique, limitations and its reproducibility must be determined until its use be liberated with security for the clinical practice. Studies showed that pregnant women with pre-eclampsia present lower values of FMD in comparison to normotensive patients and this measure can also be used as predictor of the illness. Similarly, women with gestational diabetes (GD) present values of FMD lower than normoglicemic pregnant women. However, a strict glycemic control by insulin therapy or diet, improve significantly these values. Moreover, the hormone replacement therapy is related to improvements in the levels of FMD. The objective of this study was to perform a literature review on the applications of flow-mediated dilatation of Brachial Artery in Gynecology and Obstetrics. The paper was based on a search on Medline/PubMed databases of papers published between 2002 and 2009, as well as studies and classical texts on this subject. We can conclude that the flow-mediated dilatation of the brachial artery is a valuable exam for the assessment and management of endothelial function. Despite the existing technical difficulties and absence of standardization, there is no reason that hinders this method of being well accepted in the clinical practice.
Subject(s)
Humans , Female , Brachial Artery/physiopathology , Brachial Artery , Blood Flow Velocity , Diabetes, Gestational/drug therapy , Dilatation/methods , Endothelium, Vascular/physiopathology , Hypoglycemic Agents/therapeutic use , Pre-Eclampsia , Hormone Replacement TherapyABSTRACT
FUNDAMENTO: Considerando o alto número de pacientes infectados por HIV em uso de antirretrovirais, evoluindo com alteração da função endotelial e aterotrombose, levando ao alto custo médico social, é importante identificar mecanismos fisiopatológicos envolvidos com a função endotelial em portadores de HIV, para que, precocemente, possamos intervir e evitar a progressão da doença. OBJETIVO: Avaliar a função endotelial pela vasodilatação endotélio dependente e independente em pacientes HIV positivo e em grupo controle. MÉTODOS: O estudo avaliou 27 pacientes HIV positivo e 16 do grupo controle. A avaliação da função endotelial foi realizada por meio da vasodilatação da artéria braquial endotélio dependente (hiperemia reativa) e independente (nitroglicerina SL). RESULTADOS: Pacientes HIV positivo em uso de inibidor de protease (IP) apresentaram vasodilatação endotélio independente significativamente menor que os subgrupos HIV negativo (p = 0,020) e HIV positivo sem uso de IP (p = 0,034). A variação do diâmetro da artéria braquial durante hiperemia reativa não apresentou significância estatística em qualquer subgrupo. A análise de regressão linear múltipla mostrou que apenas o IP estava associado ao delta relativo da reatividade braquial pelo vasodilatador, nos pacientes HIV positivo, aos 60 e 90 segundos. CONCLUSÃO: Os pacientes HIV positivo em uso de IP apresentam disfunção endotélio independente quando comparados a pacientes HIV positivo que não fazem uso de IP e a um grupo controle.
BACKGROUND: A great number of HIV-infected patients using antiretroviral drugs develop endothelial dysfunction and atherothrombosis, which lead to a high medical and social burden. Thus, it is important to identify pathophysiological mechanisms involved with the endothelial function in these patients, so that early intervention can be made to avoid disease progression. OBJECTIVE: To evaluate endothelial function using endothelium-dependent and independent vasodilation in HIV-positive patients and in a control group. METHODS: A total of 27 HIV-positive patients and 16 controls were evaluated. Endothelium-dependent (reactive hyperemia) and independent (SL nitroglycerine) vasodilation of the brachial artery was used to evaluate the endothelial function. RESULTS: HIV-positive patients receiving protease inhibitors (PI) showed significantly lower endothelium-independent vasodilation than the HIV-negative (p=0.020) and HIV-positive without PI (p=0.034) subgroups. The change in brachial artery diameter during active hyperemia was not statistically significant in any subgroup. Multiple linear regression analysis showed that only PI was associated with the relative delta of brachial reactivity to vasodilator in HIV-positive patients at 60s and 90s. CONCLUSION: HIV-positive patients receiving PI presented endothelium-independent dysfunction when compared to HIV-positive patients not receiving PI and to the control group.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Brachial Artery/physiopathology , Endothelium, Vascular/drug effects , HIV Infections/drug therapy , HIV Infections/physiopathology , HIV Protease Inhibitors/therapeutic use , Brachial Artery/drug effects , Brachial Artery , Case-Control Studies , Endothelium, Vascular/physiopathology , Hyperemia/physiopathology , Nitroglycerin , Vasodilator Agents , Young AdultABSTRACT
Subclinical hypothyroidism (SHT) is a disease for which exact therapeutic approaches have not yet been established. Previous studies have suggested an association between SHT and coronary heart disease. Whether this association is related to SHT-induced changes in serum lipid levels or to endothelial dysfunction is unclear. The aim of this study was to determine endothelial function measured by the flow-mediated vasodilatation of the brachial artery and the carotid artery intima-media thickness (IMT) in a group of women with SHT compared with euthyroid subjects. Triglycerides, total cholesterol, HDL-C, LDL-C, apoprotein A (apo A), apo B, and lipoprotein(a) were also determined. Twenty-one patients with SHT (mean age: 42.4 ± 10.8 years and mean thyroid-stimulating hormone (TSH) levels: 8.2 ± 2.7 µIU/mL) and 21 euthyroid controls matched for body mass index, age and atherosclerotic risk factors (mean age: 44.2 ± 8.5 years and mean TSH levels: 1.4 ± 0.6 µIU/mL) participated in the study. Lipid parameters (except HDL-C and apo A, which were lower) and IMT values were higher in the common carotid and carotid bifurcation of SHT patients with positive serum thyroid peroxidase antibodies (TPO-Ab) (0.62 ± 0.2 and 0.62 ± 0.16 mm for the common carotid and carotid bifurcation, respectively) when compared with the negative TPO-Ab group (0.55 ± 0.24 and 0.58 ± 0.13 mm, for common carotid and carotid bifurcation, respectively). The difference was not statistically significant. We conclude that minimal thyroid dysfunction had no adverse effects on endothelial function in the population studied. Further investigation is warranted to assess whether subclinical hypothyroidism, with and without TPO-Ab-positive serology, has any effect on endothelial function.
Subject(s)
Adult , Female , Humans , Brachial Artery/physiopathology , Carotid Arteries/physiopathology , Hypothyroidism/physiopathology , Tunica Intima/physiopathology , Tunica Media/physiopathology , Vasodilation/physiology , Brachial Artery/pathology , Brachial Artery , Case-Control Studies , Carotid Arteries/pathology , Carotid Arteries , Hypothyroidism/blood , Lipids/blood , Tunica Intima/pathology , Tunica Intima , Tunica Media/pathology , Tunica MediaABSTRACT
Entre as mulheres brasileiras a principal causa de mortalidade são as doenças cardiovasculares, seguida em freqüência pelo câncer, sendo o de mama o mais comum. É bastante conhecida a associação de câncer com eventos tromboembólicos, mas pouco estabelecida sua relação com os demais eventos cardiovasculares. Para estudar estes eventos desde suas alterações primordiais, como a lesão e disfunção endotelial e a formação da placa aterosclerótica, vários métodos têm sido utilizados. Dentre eles, a dosagem sérica de P e E-selectina e do fator de von Willebrand são relevantes devido à associação tanto com o risco cardiovascular quanto com o processo de progressão e formação de metástase do câncer de mama. Outro método de avaliação da função endotelial é a medida da dilatação da artéria braquial mediada por fluxo, que cada vez mais ganha popularidade devido à sua natureza não-invasiva e a comprovação de sua associação com a disfunção endotelial e risco de eventos cardiovasculares. Buscamos, através desta revisão, condensar o que houve de mais relevante nestes últimos anos sobre a associação de câncer, em especial o de mama, com lesão endotelial e risco cardiovascular.
The main cause of death among Brazilian women is cardiovascular disease followed by cancer with breast cancer as the most incident. The relationship between cancer and thrombosis is well known, although its association with other cardiovascular events is poorly understood. In order to study these events from the earliest findings such as endothelial injury and dysfunction and the evolving atherosclerotic plaque, many methods are currently being used. Among these methods, E- and P-selectin and the von Willebrand factor have been associated, either with cardiovascular risk or with breast cancer growth and metastasis. Brachial artery flow-mediated dilatation is a tool available that emerged in the last decade due to its noninvasive nature and its clear association with endothelial dysfunction and cardiovascular risk. The aim of this revision is to bring the newest and most relevant updates about the association of breast cancer, endothelial injury and cardiovascular risk.