Ventilatory Muscle Training for Early Cardiac Rehabilitation Improved Functional Capacity and Modulated Vascular Function of Individuals Undergoing Coronary Artery Bypass Grafting: Pilot Randomized Clinical Trial.

Background: Cardiac rehabilitation with aerobic exercises is the first strategy for nonpharmacological treatment in the postoperative period of individuals undergoing coronary artery bypass grafting (CABG) to improve functional capacity and vascular health. However, other exercise modalities remain uncertain regarding the same benefits. Objectives: Evaluation of the effect of different modalities of exercise, such as early cardiac rehabilitation on subjects submitted to CABG in the six-minute walk test (6-MWT) and on the percentage of flow-mediated dilatation (FMD) of the brachial artery. Methods: A randomized clinical trial in which 15 patients (62.7 ± 6.7 years) who underwent CABG were randomly assigned to the following groups: isometric (IG, Handgrip Jamar®), ventilatory muscle training (VG, PowerBreathe®) and control (CG, conventional respiratory and motor physiotherapy). All patients were attended to physically twice a day (20 min/session) for a consecutive week after the CABG (hospital admission). Functional capacity was assessed by 6-MWT and endothelial function was assessed through the technique of FMD, before and after (~7 days) admission to CABG. The doppler ultrasound videos were analyzed by Cardiovascular Suite® software (Quipu, Pisa, Italy) to measure %FMD. Statistics: Generalized estimation equation, followed by Bonferroni post hoc (p < 0.05). Results: Systolic, diastolic and mean arterial pressure (SBP/DBP/MAP, respectively) were 133, 76 and 95 mmHg. The groups presented walking meters (m) distance before and after intervention of: IGbasal 357.80 ± 47.15 m vs. IGpost 306.20 ± 61.63 m, p = 0.401 (+51 m); VGbasal 261.50 ± 19.91 m vs. VGpost 300.75 ± 26.29 m, p = 0.052 (+39 m); CG basal 487.83 ± 83.23 m vs. CGpost 318.00 ± 31.08, p = 0.006 (−169 m). %FMD before and after intervention was IGbasal 10.4 ± 4.8% vs. IGpost 2.8 ± 2.5%, p = 0.152; VGbasal 9.8 ± 5.1% vs. VGpost 11.0 ± 6.1%, p = 0.825; CGbasal 9.2 ± 15.8% vs. CGpost 2.7 ± 2.6%, p = 0.710 and resting mean basal blood flow was IGbasal 162.0 ± 55.0 mL/min vs. IGpost 129.9 ± 63.7 mL/min, p = 0.662; VGbasal 83.74 ± 12.4 mL/min vs. VGpost 58.7 ± 17.1 mL/min, p = 0.041; CGbasal 375.6 ± 183.7 mL/min vs. CGpost 192.8 ± 115.0 mL/min, p = 0.459. Conclusions: Ventilatory muscle training for early cardiac rehabilitation improved acute functional capacity and modulated mean flow of individuals undergoing CABG.

Patterns of vascular response immediately after passive mobilization in patients with sepsis: an observational transversal study.

Sepsis is a serious organ dysfunction leading to endothelial damage in critical patients. Physiologically, there is an augment of vascular diameter in response to increased vascular blood flow and shear stress stimulus. However, the pattern of vascular response in face of passive mobilization (PM), an early mobilization physical strategy, has not yet been explored in patients with sepsis. To explore patterns of vascular response to PM and associations with clinical and cardiovascular profile in patients with sepsis. Cross-sectional, single-arm study. Thirty-two patients diagnosed with sepsis were enrolled. Vascular response was assessed by flow-mediated dilation (FMD) using brachial artery ultrasound, before and after PM. The PM (to assess the response pattern) and SR (shear rate) were also calculated. PM protocol consisted of knees, hips, wrists, elbows, shoulders, dorsiflexion/plantar flexion movements 3 × 10 repetitions each (15 min). Arterial stiffness was assessed by Sphygmocor®, by analyzing the morphology and pulse wave velocity. Cardiac autonomic modulation (CAM) was assessed by analyzing heart rate variability indexes (mean HR, RMSSD, LF, HF, ApEn, SampEn, DFA). Different vascular responses were observed after PM: (1) increased vascular diameter (responders) (n = 13, %FMD = 11.89 ± 5.64) and (2) reduced vascular diameter (non-responders) (n = 19, %FMD= -7.42 ± 6.44). Responders presented a higher non-linear DFA2 index (p = 0.02). There was a positive association between FMD and DFA (r = 0.529; p = 0.03); FMD and SampEn (r = 0.633; p < 0.01). A negative association was identified between FMD and LF (Hz) (r= -0.680; p < 0.01) and IL-6 (r= -0.469; p = 0.037) and SR and CRP (r= -0.427; p = 0.03).

Sex Differences in Post-exercise Hypotension, Ambulatory Blood Pressure Variability, and Endothelial Function After a Power Training Session in Older Adults.

Background: The efficacy of power training (PT) to acutely reduce blood pressure (BP) in participants with hypertension is controversial, and no studies have assessed the influence of sex on post-exercise hypotension and its mechanisms in older adults. Purpose: The aims of this secondary, exploratory analysis were to compare the effects of a single bout of PT on post-exercise hypotension, BP variability, and endothelial function between older men and women with hypertension. Methods: Twenty-four participants with hypertension (12 men and 12 women aged to >60 years old) took part in this crossover study and randomly performed two experimental sessions: power exercise training (PT) and non-exercising control session (Con). The PT protocol was composed of 3 sets of 8-10 repetitions of five exercises performed in the following order: leg press, bench press, knee extension, upright row, and knee flexion, using an intensity corresponding to 50% of one repetition maximal test (1RM) and 2-min intervals between sets and exercises. The concentric phase of exercises during each repetition was performed "as fast as possible," while the eccentric phase lasted 1 to 2 s. During Con, the participants remained at seated rest on the same exercise machines, but without any exercise. Each protocol lasted 40 min. Office BP, flow-mediated dilatation (FMD), 24-h ambulatory BP, and the average real variability (ARV) of systolic and diastolic BP were assessed before and after experimental sessions. Results: Comparing PT with Con, a reduced office BP after exercise was found in men (systolic BP-average post 1 h: -14 mmHg, p < 0.001; diastolic BP-average post 1 h: -8 mmHg, p < 0.001) and only a reduced systolic BP in women (average post 1 h: -7 mmHg, p = 0.04). Comparing men and women, a reduced systolic BP (post 60': -15 mmHg, p = 0.048; average post 1 h: -7 mmHg, p = 0.046) and diastolic BP (post 60': -9 mmHg, p = 0.049) after the first hour were found in men. In relation to 24-h ambulatory BP, ARV, and FMD, no statistically significant differences were found between men and women. Conclusion: In older adults with hypertension, the office BP response after the experimental sessions was different in men and women, showing that the PT protocol is more effective to acutely reduce BP in men. Additionally, the mechanisms behind this reduction remain unclear. This finding suggests that sex cannot be combined to analyze post-exercise hypotension. Clinical Trial Registration: ClinicalTrials.gov, Identifier: NCT03615625.

Effect of fructooligosaccharide on endothelial function in CKD patients: a randomized controlled trial.

BACKGROUND: Microbiota-derived uremic toxins have been associated with inflammation that could corroborate with endothelial dysfunction (ED) and increase cardiovascular risk in patients with chronic kidney disease (CKD). This trial aimed to evaluate the effect of the prebiotic fructooligosaccharide (FOS) on endothelial function and arterial stiffness in nondialysis CKD patients. METHODS: In a double-blind controlled trial, 46 nondiabetic CKD patients were randomized to receive 12 g/day of FOS or placebo (maltodextrin) for 3 months. Total p-cresyl sulfate (PCS) and indoxyl sulfate by high-performance liquid chromatography, urinary trimethylamine N-oxide by mass spectrometry, C-reactive protein, interleukin-6 (IL-6), serum nitric oxide and stroma-derived factor-1 alfa were measured at baseline and at the end of follow-up; endothelial function was assessed through flow-mediated dilatation (FMD) and arterial stiffness by pulse wave velocity (PWV). RESULTS: The mean (± standard deviation) age of the study participants was 57.6 ± 14.4 years, with an estimated glomerular filtration rate of 21.3 ± 7.3 mL/min/1.73 m2. During the follow-up, regarding the inflammatory markers and uremic toxins, there was a significant decrease in IL-6 levels (3.4 ± 2.1 pg/mL versus 2.6 ± 1.4 pg/mL; P = 0.04) and a trend toward PCS reduction (55.4 ± 38.1 mg/L versus 43.1 ± 32.4 mg/L, P = 0.07) only in the prebiotic group. Comparing both groups, there was no difference in FMD and PWV. In an exploratory analysis, including a less severe ED group of patients (FMD ≥2.2% at baseline), FMD remained stable in the prebiotic group, while it decreased in the placebo group (group effect P = 0.135; time effect P = 0.012; interaction P = 0.002). CONCLUSIONS: The prebiotic FOS lowered circulating levels of IL-6 in CKD patients and preserved endothelial function only in those with less damaged endothelium. No effect of FOS in arterial stiffness was observed.

Endothelial dysfunction in children with chronic kidney disease.

BACKGROUND AND OBJECTIVE: Cardiovascular disease (CVD) is the main cause of death in children with chronic kidney disease (CKD). Inflammation and endothelial dysfunction (ED) are found in the majority of these patients and are factors associated to CVD. Flow mediated dilatation (FMD) is a surrogate marker validated for evaluating ED. Our objective was to identify risk factors associated to ED in children with CKD. MATERIALS AND METHODS: Children 2-16 years of age were studied. Clinical information and biochemical variables were gathered, including intact parathyroid hormone (iPTH), interleukins 6 and 1b, high sensitivity C reactive protein (hsCRP), reduced glutathione, nitric oxide, malondialdehyde and homocysteine. FMD was measured, and considered altered if <7%. RESULTS: Included were 129 patients aged 13.1 ±â€¯2.6 years. FMD < 7% was found in 69 (52.7%). Patients with altered FMD had higher levels of triglycerides and hsCRP than those with normal FMD (145.5 mg/dl vs. 120.0 mg/dl, P = .042, y 1.24 U/L vs. 0.55 U/L, P = .007, respectively), as well as higher frequency of low iPTH (19.1% vs. 4.9%, P = .036). Levels of hsCRP correlated significantly with FMD (Rho = -0.28, P = .003). Patients with low iPTH (OR = 4.41, 95%CI 1.13-17.27, P = .033) and increased hsCRP (OR = 2.89, 95%CI 1.16-7.17, P = .022) had higher adjusted risk of having FMD < 7%. CONCLUSIONS: Hypertriglyceridemia, inflammation and low iPTH associated significantly with altered FMD. They are frequent, treatable risk factors for CVD.

Effects of fish protein hydrolysate ingestion on endothelial function compared to whey protein hydrolysate in humans.

Fish protein-derived bioactive peptides may improve endothelial dysfunction through an antihypertensive and antioxidant effect. However, few studies have evaluated the bioactive peptides effect on vascular function. Therefore, this study investigates the effect of a single dose of fish protein hydrolysate (FPH) or whey protein hydrolysates (WPH) on endothelium-dependent dilation in nine healthy adults. The subjects ingested a single dose (20 g) of FPH, WHP or placebo (PLA). The endothelium-dependent dilation was evaluated by flow-mediated dilatation before and at 30, 60 and 120 min after supplementation. Total antioxidant capacity (TAC) of the FPH and WPH supplements was evaluated by using the Trolox equivalent antioxidant capacity assay. There was a significant increase of endothelium-dependent dilation at 30 min after WPH but not after FPH as compared to PLA. There was a significant great TAC in FPH than WPH supplement. A single dose of FPH was not able to improve endothelium-dependent dilation compared to WPH.

Effect of radiation on endothelial functions in workers exposed to radiation

SUMMARY OBJECTIVE Our aim is to determine whether radiation affects the endothelial function of hospital staff working in the radiation unit for diagnostic and therapeutic purposes. We have evaluated endothelial function with vascular imaging parameters such as flow-mediated dilatation (FMD) and aortic stiffness index (ASI). METHODS A total of 75 employees, 35 of whom are exposed to radiation due to their profession and 40 as the control group, were included in our single-centered study. Demographic data, FMD, aortic stiffness, and echocardiographic findings of the two groups were compared. RESULTS There were no significant differences in demographic data. Median FMD values tended to be lower in the radiation exposure group [7.89 (2.17-21.88) vs. 11.69 (5.13-27.27) p=0.09]. The FMD value was significantly lower in the catheter laboratory group than in the radiation-exposed (p=0.034) and control (p=0.012) groups. However, there was no statistically significant difference between the non-catheter lab radiation exposed group and the control group (p=0.804). In addition, there was no statistically significant difference in the ASI value between the groups (p=0.201). CONCLUSION We have found that FMD is decreased among hospital staff working in radiation-associated areas. This may be an early marker for radiation-induced endothelial dysfunction.

RESUMO OBJETIVO O nosso objetivo é determinar se a radiação afeta a função endotelial de funcionários do hospital que trabalham em unidades com exposição à radiação para fins diagnósticos e terapêuticos. Avaliamos a função endotelial com parâmetros de imagens vasculares, tais como dilatação fluxo-mediada (FMD) e o índice de rigidez aórtica (ASI). METODOLOGIA Um total de 75 funcionários, 35 expostos à radiação devido à sua ocupação e 40 como grupo de controle, foram incluídos em nosso estudo monocêntrico. Os dados demográficos, de FMD, rigidez aórtica e ecocardiográficos dos dois grupos foram comparados. RESULTADOS Não houve diferenças significativas nos dados demográficos. Os valores médios de FMD, em geral, foram mais baixos no grupo de exposição à radiação [7,89 (2,17-21,88) e 11,69 (5,13-27,27) p=0,09]. O valor de FMD foi significativamente menor no grupo laboratorial com cateter do que no exposto à radiação (p=0,034) e no de controle (p=0,012). No entanto, não houve diferença estatisticamente significativa entre o grupo laboratorial sem cateter e exposto à radiação e o grupo de controle (p=0,804). Além disso, não houve diferença estatisticamente significativa quanto ao valor de ASI entre os grupos (p=0,201). CONCLUSÃO Observamos que a FMD é menor entre funcionários que trabalham em setores hospitalares associados à radiação. Isso pode ser um marcador inicial de disfunção endotelial induzida por radiação.

Effects of exercise training on endothelial function in individuals with hypertension: a systematic review with meta-analysis.

A slight increase (1%) in endothelial function is associated with reduction of cardiovascular risks by 13% in individuals with cardiovascular disease risk, including those with hypertension. Thus, we conducted a systematic review and meta-analysis to assess the efficacy of exercise training on endothelial function in individuals with hypertension.We included randomized clinical trials (RCTs) with adult participants diagnosed with hypertension undergoing exercise training (≥4 weeks), and the primary outcome was endothelial function, measured by flow-mediated dilatation (FMD). Five studies comprising a total of 362 participants (252 exercise and 110 controls; 59.3 years old, ranged from 52.0 to 67.2 years) were included in the meta-analysis. The pooled mean estimate indicated increased FMD after exercise training of 1.45 (P = .001), and 95% confidence interval -0.11 to 3.00 compared with control comparators. The studies were characterized by significant heterogeneity (χ2 = 23.34, P < .001, I2 = 70%). The present results are consistent with the notion that aerobic exercise training elicits favorable adaptations in endothelial function in individuals with hypertension. However, more studies are needed to make more definitive conclusions.

A single dose of beetroot juice improves endothelial function but not tissue oxygenation in pregnant women: a randomised clinical trial.

Beetroot juice (BJ) consumption has been associated with improved cardiovascular health owing to an increase in NO bioconversion. This study evaluates the effect of BJ consumption on macrovascular endothelial function (flow-mediated dilation (FMD)) and muscle oxygen saturation (StO2) parameters in pregnant women within a randomised, crossover, double-blind design in which twelve pregnant women consumed a single dose (140 ml) of BJ or placebo (PLA). Urinary nitrate was assessed before (T0) and 150 min after BJ/PLA consumption. FMD was used to evaluate macrovascular endothelial function, and near-IR spectroscopy was used to evaluate muscle StO2 parameters during the occlusion and reperfusion phases, which were taken at baseline (PRE) and 120 and 140 min after BJ/PLA consumption, respectively. A significant increase in urinary nitrate was observed at 150 min after BJ consumption when compared with T0 (BJ: 0·20 (sd 0·13) v. T0: 0·02 (sd 0·00), P=0·000) and PLA intervention (PLA: 0·02 (sd 0·00), P=0·001). FMD improved after BJ consumption when compared with PRE (BJ: 11·00 (sd 1·67) v. PRE: 5·53 (sd 1·17), P=0·000) and PLA (5·34 (sd 1·31), P=0·000). No significant difference between PLA and PRE in FMD (P=1·000) was observed. In StO2 parameters, a difference was not observed after BJ consumption compared with PRE and PLA intervention. The data demonstrate that a single dose of 140 ml of BJ consumption improves macrovascular endothelial function, but not StO2 parameters.

Effect of exercise intensity on postprandial lipemia, markers of oxidative stress, and endothelial function after a high-fat meal.

The aim of this study was to compare the effects of 2 different exercise intensities on postprandial lipemia, oxidative stress markers, and endothelial function after a high-fat meal (HFM). Eleven young men completed 2-day trials in 3 conditions: rest, moderate-intensity exercise (MI-Exercise) and heavy-intensity exercise (HI-Exercise). Subjects performed an exercise bout or no exercise (Rest) on the evening of day 1. On the morning of day 2, an HFM was provided. Blood was sampled at fasting (0 h) and every hour from 1 to 5 h during the postprandial period for triacylglycerol (TAG), thiobarbituric acid reactive substance (TBARS), and nitrite/nitrate (NOx) concentrations. Flow-mediated dilatation (FMD) was also analyzed. TAG concentrations were reduced in exercise conditions compared with Rest during the postprandial period (P < 0.004). TAG incremental area under the curve (iAUC) was smaller after HI-Exercise compared with Rest (P = 0.012). TBARS concentrations were reduced in MI-Exercise compared with Rest (P < 0.041). FMD was higher in exercise conditions than Rest at 0 h (P < 0.02) and NOx concentrations were enhanced in MI-Exercise compared with Rest at 0 h (P < 0.01). These results suggest that acute exercise can reduce lipemia after an HFM. However, HI-Exercise showed to be more effective in reducing iAUC TAG, which might suggest higher protection against postprandial TAG enhancement. Conversely, MI-Exercise can be beneficial to attenuate the susceptibility of oxidative damage induced by an HFM and to increase endothelial function in the fasted state compared with Rest.

Brachial artery flow mediated dilation and pulsatility index change as independent predictors for hypertensive disorders in the second trimester of pregnancy.

OBJECTIVE: To assess brachial artery flow mediated dilatation (FMD) and pulsatility index change (PIC) as independent parameters for prediction hypertensive disorders (preeclampsia - PE and gestational hypertension - GH) in the second trimester of pregnancy. STUDY DESIGN: We performed a prospective cohort study with 372 singleton pregnant women who underwent routine second trimester morphology scan. FMD and PIC were measured immediately after the ultrasound scan using the following formulas: FMD (%)=[(post occlusion arterial diameter-baseline arterial diameter)/baseline arterial diameter]×100 and PIC (%)=[(pulsatility index pre-pulsatility index post)/pulsatility index pre]. The control and hypertensive disorder groups were compared using the Kruskal-Wallis to continue variables and Chi-square and Fisher exact tests to categorical variables. We assessed the predictive accuracy of FMD and PIC by the area under the receiver operating characteristics (ROC) curve with its respective 95% confidence interval (CI). RESULTS: We did not observe statistical difference between control and hypertensive disorder groups regarding the FMD and PIC (p=0.17 and p=0.38, respectively). Areas under ROC curve for prediction of GH using FMD and PIC were 0.59 (CI95% 0.48-0.71) and 0.60 (CI95% 0.47-0.73), respectively. Areas under ROC curve for prediction of PE using FMD and PIC were 0.55 (CI95% 0.46-0.64) and 0.52 (CI95% 0.61-0.69), respectively. CONCLUSION: Brachial artery FMD and PIC as independent parameters did not show good prediction for hypertensive disorders in the second trimester of pregnancy.

Endothelial dysfunction in children within 5 years after onset of Kawasaki disease.

OBJECTIVE: To evaluate endothelial function in children within 5 years after the onset of Kawasaki disease (KD). STUDY DESIGN: A total of 46 children were enrolled prospectively as follows: 9 patients with KD and coronary artery lesions composed group 1, 15 patients with KD but without coronary artery lesions composed group 2, and 22 healthy age- and sex-matched children composed group 3. Flow-mediated dilatation (FMD) of the brachial artery, intima-media thickness of the common carotid artery, and biologic characteristics were compared among the 3 groups. Differences in the factors associated with endothelial function after KD were examined as well. RESULTS: The mean age of the study group was 6.5 ± 1.7 years. The patients with KD were studied at a median interval of 3.3 years (IQR, 2.0-4.4 years) from the onset of disease. The percent FMD (%FMD) was significantly lower in group 1 patients (median, 4.4%; IQR, 2.6%-5.7%) compared with both group 2 (median, 9.1%; IQR 6.6%-10.7%; P < .01) and group 3 (median, 11.1%; IQR, 10.1%-13.9%, P < .01). The %FMD was statistically significantly lower in group 2 compared with group 3 (P < .05). There were no significant differences in the intima-media thickness among the 3 groups. There was a significant negative correlation between %FMD and the total duration of fever (r = -0.50; P = .013). CONCLUSION: The children with KD already had arterial endothelial dysfunction within 5 years after the onset of illness. The longer the duration of fever, the greater the risk of inflammation-induced endothelial dysfunction.

Dilatação Fluxo-Mediada da artéria braquial como método de avaliação da função endotelial na pré-eclâmpsia e em gestantes normotensas / Flow-mediated dilation of the brachial artery as a method of evaluating endothelial function in preeclampsia and in normotensive pregnant women

Introdução: durante as últimas duas décadas, a ativação de células endoteliais tornou-se o evento mais estudado na compreensão da fisiopatologia da pré-eclâmpsia (PE).Acredita-se que fatores desconhecidos, provavelmente de origem placentária, são secretados na circulação materna, provocando ativação e lesão endotelial. A dilatação fluxo mediada (DILA) da artéria braquial é técnica não invasiva, capaz de avaliar a integridade endotelial. Objetivos: este estudo avalia o índice de dilatação da artéria braquial medido pelo DILA em portadoras de PE, comparativamente a gestantes normotensas.Materiais e métodos: foram estudadas 78 gestantes atendidas na Maternidade do Hospital das Clínicas da UFMG, sendo 51 delas com diagnóstico de PE e 27 normotensas. Adilatação fluxo-mediada da artéria braquial foi obtida de acordo com a técnica descrita por Anderson e Mark, em 1989, modificada. Resultados: a dilatação fluxo-mediada da artéria braquial mostrou-se significativamente reduzida nas gestantes portadoras de pré-eclâmpsia em relação às normotensas (6,098±5,633; 15,48±8,56; p menor que 0,01). Conclusões: pacientes em pré-eclâmpsia possuem DILA significativamente alterado quando comparadas às gestantes normais, sugerindo que tenham lesão endotelial.

Introduction: activation of endothelial cells became the most studied event in understanding the pathophysiology of preeclampsia (PE) during the past two decades. Unknown factors, probably of placental origin, are secreted into the maternal blood flow, causing activation and endothelial damage. Flow-mediated dilation (FMD) of the brachial artery is a noninvasive technique able to evaluate endothelial integrity. Objectives: this study evaluates the rate of the brachial artery dilatation measured by FMD in women with PE compared to normotensive pregnant women. Materials and methods: a total of 78pregnant women seen at the University Hospital from Minas Gerais were studied. From the total, 51 were diagnosed with PE diagnostic and 27 were normotensive. The flow-mediated dilation of the brachial artery was obtained according to the technique described by Anderson and Mark in 1989, adapted. Results: Flow-mediated dilation of the brachial artery was significantly reduced in pregnant women with preeclampsia when compared to the normotensive patients (6.098 ± 5.633, 15.48 ± 8.56, p less than 0.01). Conclusion: patients in preeclampsia have significantly altered FMD when compared to the normal pregnancies, suggesting endothelial lesion.

Dilatação fluxo-mediada da artéria braquial e complexo médio-intimal das artérias carótida e braquial: avaliação de indivíduos com e sem fatores de risco para aterosclerose / Brachial artery flow-mediated dilatation and intima-media thickness of carotid and brachial arteries: evaluation of individuals with and without risk factors for atherosclerosis

OBJETIVO: Avaliar a função endotelial em pacientes com fatores de risco para aterosclerose pela dilatação fluxo-mediada da artéria braquial (DILA) e complexo médio-intimal (CMI) das artérias carótida e braquial. MATERIAIS E MÉTODOS: Estudo transversal, caso controle, no qual foi avaliada a função endotelial pelo DILA e CMI das artérias carótida e braquial e presença ou não de fatores de risco para aterosclerose, em 112 pacientes assim distribuídos: mulheres com fatores de risco (n = 49), mulheres grupo controle (n = 24), homens com fatores de risco (n = 21) e homens grupo controle (n = 18). RESULTADOS: O DILA esteve comprometido significativamente no grupo fator de risco, quando comparado ao controle, independente do sexo: em mulheres, 15,2 × 25,3 (p < 0,01); em homens, 11,8 × 16,8 (p < 0,02). Já o CMI, tanto na braquial quanto na carótida, não foi significativo, independente do sexo: braquial em mulheres, 0,3 × 0,3 (p < 0,06); braquial em homens, 0,36 × 0,23 (p < 0,07); carótida em mulheres, 0,6 × 0,4 (p < 0,07); carótida em homens, 0,85 × 0,38 (p < 0,08). Utilizou-se como índice de significância p < 0,05. CONCLUSÃO: O DILA foi eficiente para atestar comprometimento endotelial em população de risco para aterosclerose.

OBJECTIVE: To evaluate endothelial function in patients with risk factors for atherosclerosis by measuring brachial artery flow-mediated dilatation (BAFMD) and intima-media thickness (IMT) of carotid and brachial arteries. MATERIALS AND METHODS: A cross-sectional, case-control study in which endothelial function was evaluated by measurement of BAFMD and IMT of carotid and brachial arteries and presence or absence of risk factors in 112 patients distributed as follows: women with risk factors (n = 49), women control group (n = 24), men with risk factors (n = 21), men control group (n = 18). RESULTS: BAFMD was significantly compromised in the group with risk factors as compared with the control group, regardless of sex: in women, 15.2 × 25.3 (p < 0.01); in men, 11.8 × 16.8 (p < 0.02). On the other hand, IMT was not significant both for the carotid and brachial arteries, regardless of sex: brachial artery in women, 0.3 × 0.3 (p < 0.06); brachial artery in men, 0.36 × 0.23 (p < 0.07); carotid artery in women, 0.6 × 0.4 (p < 0.07); carotid artery in men, 0.85 × 0.38 (p < 0.08). The significance level was set at 5 percent (p < 0.05). CONCLUSION: Measurement of BAFMD was effective for detecting endothelial impairment in a population with risk factors for atherosclerosis.

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.