Name: Video: Evaluating Endothelial Dysfunction Using Flow-Mediated Dilation and Subclinical Atherogenesis Using Carotid Intima-Media Thickness for Cardiovascular Risk Assessment
Uploaded: 2024-09-27T12:30:00
Description: 46 Views. Evaluating Endothelial Dysfunction Using Flow-Mediated Dilation and Subclinical Atherogenesis Using Carotid Intima-Media Thickness for Cardiovascular Risk Assessment

evaluating endothelial dysfunction using flow-mediated dilation and subclinical atherogenesis using carotid intima-media thickness for cardiovascular risk assessment

Using Arterial Stiffness and Endothelial Function for Cardiovascular Assessment

Obesity is a major health problem worldwide due to its associated complications, such as hypertension, dyslipidemia, liver disease, atherosclerosis, insulin resistance, and type 2 diabetes mellitus (T2DM), as well as an increased risk of cardiovascular diseases (CVD)1.
The constellation of these conditions, known as Metabolic Syndrome (MS), has been reported to be a major cause of CVD pathogenesis, which is one of the leading causes of death, accounting for up to 30% of all deaths worldwide2. Obese individuals have a higher requirement for oxygen and nutrients throughout the body due to an increased blood supply demand, leading to significant hemodynamic changes. These changes can result in decreased nitric oxide (NO) availability, increased oxidative stress, and vascular endothelial dysfunction3,4,5.
Atherosclerotic diseases are major cardiovascular conditions and represent the leading cause of death worldwide. This is a clinical manifestation of multiple possible factors, including genetic and environmental factors6. People with metabolic abnormalities, such as insulin resistance or prediabetes, have been shown to have a significantly higher prevalence and incidence of coronary atherosclerosis than healthy people. Furthermore, congested blood vessels with highly lipidic plaque have been found even before the appearance of clinical manifestations of metabolic dysfunction7,8,9,10.
Arterial stiffness, endothelial dysfunction, and atherogenesis have been described as important factors in the development of cardiovascular diseases. These processes are related to vascular aging and atherogenic plaque formation in critical vessels like coronary, carotid, or limb arteries. Translational research has evidenced that arterial stiffness, endothelial dysfunction, and atherogenesis are related to common vascular damage induced by chronic inflammation, lower NO production, and oxidative stress11,12.
Measurement of Carotid-femoral pulse-wave velocity (cfPWV) represents the gold standard method to measure arterial stiffness. cfPWV can be measured using a carotid tonometer simultaneously with a leg cuff to capture blood pressure waveforms at the carotid and femoral sites. Then, a software can perform velocity calculation by computing D/&#916;t, where D is the transit distance between carotid and femoral pulse sites, and &#916;t is the time delay from the peak ECG R-wave to the foot of the corresponding pressure waveform between the carotid and femoral waveforms. Increased stiffness of central arteries, like the aorta, causes a higher speed of the ejected pulse from the left ventricle through the arteries, as well as a faster return of the reflected pressure, with a consequent elevation of pressure during left ventricular ejection, which potentially decreases coronary artery perfusion. Therefore, cfPWV may be useful as a marker of coronary artery disease, stroke, and cardiovascular diseases13,14.
Likewise, Pulse Wave Analysis (PWA) is a non-invasive vascular parameter that assesses central pressure wave characteristics, where aortic systolic and diastolic blood pressures are the main variables. By measuring arterial stiffness and elastic compliance, PWA reflects arterial distensibility, which is closely related to cardiovascular risk. This method allows for measuring parameters like the Augmentation Index, which has the ability to predict the severity of cardiovascular and coronary artery diseases. The Augmentation Index may be described as follows: an early incident arterial wave is produced after left ventricular ejection, with a subsequent reflected wave originating from the periphery. The velocity of these waves increases according to arterial stiffness, and if the reflected wave arrives at the central aorta early, aortic systolic pressure will increase. This is known as Augmented Pressure (AP), whereas its percentage relative to Pulse Pressure is known as the Augmentation Index. PWA can be measured through the applanation tonometry method, involving a slight compression of the brachial artery so that its transmural pressure is zero. At this point, Mean Arterial Pressure can be measured. After scaling the arterial pressure waveform, the systolic part of the AP waveform is analyzed, also considering biometric and demographic data15,16,17. Particularly, the applanation tonometry method (SphygmoCor) has shown acceptable repeatability and significant correlation with invasive aortic catheterization in determining aortic PWV, as well as good agreement with the Artery Society Guidelines18,19,20.
Other vascular tests like flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) represent non-invasive techniques performed by ultrasonography with linear transducers. These assessment procedures are useful for evaluating vascular health, specifically endothelial dysfunction and subclinical atherogenesis, respectively. Both have shown prognostic ability for cardiovascular events. FMD is commonly considered a reflection of endothelium-dependent arterial function, primarily mediated by nitric oxide. It serves as a surrogate marker for vascular health and has been utilized non-invasively to compare subject groups and assess the effects of interventions on individuals21.
The aim of the present study is to describe the use of methods that yield the determination of markers reflecting early subclinical vascular aging, endothelial dysfunction, and atherogenic disease. Such information allows risk stratification among populations with obesity and different metabolic profiles. These methods might be useful to determine cardiovascular damage and prognosis, as well as to evaluate vascular and atherogenic responses to pharmacologic and non-pharmacologic interventions, particularly among populations with metabolic risk factors.

Author Spotlight: Assessing the Cardiovascular Profile of Patients with Metabolic Syndrome

Pulse-Wave Velocity, Flow-Mediated Dilation, and Carotid Intima-Media Thickness to Assess Cardiovascular Risk in Population with Metabolic Syndrome

Vascular aging and atherogenesis are key mechanisms promoting cardiovascular diseases, particularly in the presence of risk factors like diabetes, hypertension, and other metabolic dysfunctions, pulse wave velocity, flow-mediated dilation, and carotid intima-media thickness, evolving to arterial stiffness, endothelial dysfunction, and subclinical atherogenesis, providing highly valuable information about patients'cardiovascular profile. Using combined metals to assess vascular health, we found that patient with metabolically unhealthy obesity has lower values of flow-mediated dilation or FMD and than patient with metabolically healthy obesity. This finding provide information leading to prevention, early intervention, and reduction of cardiovascular diseases in population at risk.Determination of vascular elasticity and compliance, as well as mediators of vasodilation and atherosclerosis provide a more comprehensive evaluation of vascular health and disease leading to improve re-stratification and early intervention in the metabolic syndrome population. Our hemodynamic parameters, FMD, and CIMT represent useful diagnostic tools for evaluating cardiovascular risk. Future challenges for these methods include a combined prognostic interpretation where research is still evolving.

Evaluating Endothelial Dysfunction Using Flow-Mediated Dilation and Subclinical Atherogenesis Using Carotid Intima-Media Thickness for Cardiovascular Risk Assessment

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Research

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46 Views. Evaluating Endothelial Dysfunction Using Flow-Mediated Dilation and Subclinical Atherogenesis Using Carotid Intima-Media Thickness for Cardiovascular Risk Assessment

Video: Evaluating Endothelial Dysfunction Using Flow-Mediated Dilation and Subclinical Atherogenesis Using Carotid Intima-Media Thickness for Cardiovascular Risk Assessment