Insulin Stimulation Reduces Aortic Waveform in Adults with Metabolic Syndrome

2021 ◽  
Author(s):  
Brielle L. Dotson ◽  
Emily M. Heiston ◽  
Stephanie L. Miller ◽  
Steven K. Malin
Keyword(s):  
Metabolic Syndrome ◽  
Augmentation Index ◽  
Applanation Tonometry ◽  
Insulin Stimulation ◽  
Cvd Risk ◽  
Euglycemic Hyperinsulinemic Clamp ◽  
Deconvolution Analysis ◽  
Augmentation Pressure ◽  
Before And After ◽  
Blood Potassium

Adults with metabolic syndrome (MetS) have increased fasting arterial stiffness and altered central hemodynamics that contribute, partly, to increased cardiovascular disease (CVD) risk. Although insulin affects aortic wave reflections in healthy adults, the effects in individuals with MetS are unclear. We hypothesized that insulin stimulation would reduce measures of pressure waveforms and hemodynamics in people with MetS. Thirty-five adults with obesity (27F; 54.2 ± 6.0 yr; 37.1 ± 4.8 kg/m2) were selected for MetS (ATP III criteria) following an overnight fast. Pulse wave analysis was assessed using applanation tonometry before and after a 2hr euglycemic-hyperinsulinemic clamp (90 mg/dl, 40 mU/m2/min). Deconvolution analysis was used to decompose the aortic waveform (augmentation index corrected to heart rate of 75 bpm (AIx@75); augmentation pressure (AP)) into backward and forward pressure components. Aerobic fitness (VO2max), body composition (DXA), and blood biochemistries were also assessed. Insulin significantly reduced augmentation index (AIx@75, 28.0 ± 9.6 vs. 23.0 ± 9.9 %, P<0.01), augmentation pressure (14.8 ± 6.4 vs. 12.0 ± 5.7 mmHg, P<0.01), pulse pressure amplification (1.26 ± 0.01 vs. 0.03 ± 0.01, P=0.01), and inflammation (hsCRP: P=0.02; MMP-7: P=0.03) compared to fasting. In subgroup analyses to understand HTN influence, there were no insulin stimulation differences on any outcome. VO2max, visceral fat, and blood potassium correlated with fasting AIx@75 (r=-0.39, P=0.02; r=0.41, P=0.03; r=-0.53, P=0.002). Potassium levels were also associated with insulin-mediated reductions in AP (r=0.52, P=0.002). Our results suggest insulin stimulation improves indices of aortic reflection in adults with MetS.

Acute Central Hemodynamic Effects of a Volume Exchange in Peritoneal Dialysis

2008 ◽  
Vol 28 (2) ◽  
pp. 142-148 ◽  
Author(s):  
Francis Verbeke ◽  
Wim Van Biesen ◽  
Anneleen Pletinck ◽  
Luc M. Van Bortel ◽  
Raymond Vanholder
Keyword(s):  
Peritoneal Dialysis ◽  
Augmentation Index ◽  
Applanation Tonometry ◽  
Hemodynamic Effects ◽  
Intraperitoneal Pressure ◽  
Venous Compression ◽  
Augmentation Pressure ◽  
Before And After ◽  
Central Hemodynamic ◽  
Acute Increase

Background Although peritoneal dialysis is considered to offer more hemodynamic stability than hemodialysis, the acute hemodynamic effects of peritoneal dialysis have only been investigated scarcely. The present study assesses the central hemodynamic impact of volume infusion using pH-adjusted icodextrin, thus avoiding interference of glucose, pH, and osmolarity. Methods Patients were randomized to 3 different starting volumes (A: 1000 mL, B: 1500 mL, and C: 2500 mL) of icodextrin, followed by addition (A and B) or drainage (C) of 200 mL every 10 minutes for 50 minutes. Local carotid systolic blood pressure (BP; as a surrogate for central BP), augmentation index, and augmentation pressure were measured by applanation tonometry before and after infusion of the starting volumes and after each volume change. Results We included 13 patients (median age 57 years). Baseline brachial BP was 126/77 mmHg. After infusion of the starting volume, carotid systolic BP and augmentation pressure increased by 4.7 mmHg ( p = 0.006) and 3.1 mmHg ( p = 0.015). Augmentation index increased by 5.7% ( p = 0.04) and heart rate decreased by 2.6/minute ( p = 0.006). Intraperitoneal pressure increased by 2.3 cm H2O ( p = 0.03). No additional hemodynamic changes except for a rise in diastolic BP with increasing volume ( p = 0.004) were observed after subsequent addition or removal of volumes. Conclusions Infusion of peritoneal dialysis fluids causes an acute increase in carotid systolic B P, followed by a progressive rise in diastolic BP. These effects persist until complete drainage of the abdomen and may be due to an enhanced preload, resulting from intraperitoneal venous compression, and/or increased wave reflection.

scholarly journals The Effect of Hypertriglyceridemia on Arterial Structure and Function Parameters in Patients with Metabolic Syndrome

2020 ◽  
Author(s):  
Egidija Rinkūnienė ◽  
Vilma Dženkevičiūtė ◽  
Žaneta Petrulionienė ◽  
Egle Majauskiene ◽  
Ligita Ryliškytė ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Augmentation Index ◽  
Smoking Status ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Structure And Function ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
Arterial Structure ◽  
And Function

Abstract Background: Development of metabolic syndrome (MetS) augments risk for atherosclerotic cardiovascular disease (CVD), but pathophysiological mechanisms of this relation are still under discussion. Overlapping CVD risk factors make it difficult to assess the importance of individual elements. This study aimed to analyze subclinical atherosclerosis based on arterial structure and function parameters in patients with MetS and different triglycerides (TG) levels.Methods: Patients (aged 40-65 years) were divided into two groups: patients with MetS and with or without hypertriglyceridemia (hTG). Noninvasive assessment of vascular parameters—aortic augmentation index adjusted for heart rate 75 bpm (AIxHR75), pulse wave velocity (PWV), and common carotid artery intima-media thickness (CCA IMT)—were performed.Results: Carotid-femoral PWV (cfPWV) and carotid-radial PWV (crPWV) were significantly higher in patients with hTG. After adjusting for age, gender, waist circumference, fasting glucose, smoking status, cardiovascular family history and mean arterial pressure, crPWV (OR: 1.150; CI 95%: 1.04-1.28), cfPWV (OR: 1.283; CI 95%: 1.14-1.42) and CCA IMT (OR: 1.13; CI 95%: 1.02-1.25) were significantly associated with hTG (p<0.05), while AIxHR75 did not show significant association.Conclusion: Increased TG are independently associated with a cfPWV, crPWV, and CCA IMT, but not with a higher AIxHR75.

scholarly journals Arterial Stiffness Assessment Using the Arteriograph in Patients with Moderate–Severe OSA and Metabolic Syndrome—A Pilot Study

2021 ◽  
Vol 10 (18) ◽  
pp. 4238
Author(s):  
Ioana Mădălina Zota ◽  
Cristian Stătescu ◽  
Radu Andy Sascău ◽  
Mihai Roca ◽  
Larisa Anghel ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Pilot Study ◽  
Arterial Stiffness ◽  
Augmentation Index ◽  
Organ Damage ◽  
Aortic Pulse Wave Velocity ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
Before And After ◽  
A Prospective Study

Background: Both obstructive sleep apnea (OSA) and metabolic syndrome (MS) promote arterial stiffening. As a basis for this study, we presumed that arterial stiffness could be assessed using the Arteriograph (TensioMed, Budapest, Hungary) to detect early modifications induced by continuous positive airway therapy (CPAP) in reversing this detrimental vascular remodeling. Arterial stiffness is increasingly acknowledged as a major cardiovascular risk factor and a marker of subclinical hypertension-mediated organ damage. The aim of this pilot study was to evaluate the arterial stiffness changes in patients with moderate–severe OSA and MS after short-term CPAP use. Methodsː We performed a prospective study that included patients with moderate–severe OSA and MS who had not undergone previous CPAP therapy. All subjects underwent clinical examination and arterial stiffness assessment using the oscillometric technique with Arteriograph (TensioMed, Budapest, Hungary) detection before and after 8-week CPAP therapy. Resultsː 39 patients with moderate–severe OSA were included. Eight weeks of CPAP therapy significantly improved central systolic blood pressure (Δ = −11.4 mmHg, p = 0.009), aortic pulse wave velocity (aoPWV: Δ = −0.66 m/s, p = 0.03), and aortic augmentation index (aoAix: Δ = −8.25%, p = 0.01) only in patients who used the device for a minimum of 4 h/night (n = 20). Conclusionsː Arterial stiffness was improved only among CPAP adherent patients and could be detected using the Arteriograph (TensioMed, Budapest, Hungary), which involves a noninvasive procedure that is easy to implement for the clinical evaluation of arterial stiffness.

scholarly journals Hypertriglyceridemia impact on arterial parameters in patients with metabolic syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Egidija Rinkūnienė ◽  
Vilma Dženkevičiūtė ◽  
Žaneta Petrulionienė ◽  
Eglė Majauskienė ◽  
Ligita Ryliškytė ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Smoking Status ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
Arterial Structure ◽  
And Function

Abstract Background The development of metabolic syndrome (MS) augments risk for atherosclerotic cardiovascular disease (CVD), but pathophysiological mechanisms of this relation are still under discussion. Overlapping CVD risk factors make it difficult to assess the importance of individual elements. This study aimed to analyze subclinical atherosclerosis based on arterial structure and function parameters in patients with MS and different triglycerides levels. Methods Patients (aged 40–65 years) were divided into two groups: patients with MS and with or without hypertriglyceridemia (hTG). Noninvasive assessment of vascular parameters—aortic augmentation index adjusted for heart rate 75 bpm (AIxHR75), pulse wave velocity (PWV), and common carotid artery intima-media thickness (cIMT) were performed. Results Carotid-femoral PWV (cfPWV) and carotid-radial PWV (crPWV) were significantly higher in patients with hTG. After adjusting for age, gender, waist circumference, fasting glucose, smoking status, cardiovascular family history and mean arterial pressure, crPWV (OR 1.150; CI 95% 1.04–1.28), cfPWV (OR 1.283; CI 95% 1.14–1.42) and cIMT (OR 1.13; CI 95% 1.02–1.25) were significantly associated with hTG (p < 0.05), while AIxHR75 did not show significant association. Conclusion Increased triglycerides are independently associated with a cfPWV, crPWV, and cIMT and may modify CVD risk in patients with MS.

Abstract 410: Combination Therapy With Lercanidipine and Enalapril Improves Wave Reflection in Hypertensive Patients With Metabolic Sindrome

Hypertension ◽  
2013 ◽  
Vol 62 (suppl_1) ◽  
Author(s):  
Lorenzo Ghiadoni ◽  
Rosa Maria Bruno ◽  
Francesco Stea ◽  
Giulia Cartoni ◽  
Agostino Virdis ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Arterial Stiffness ◽  
Combination Therapy ◽  
Ace Inhibitor ◽  
Wave Reflection ◽  
Augmentation Index ◽  
Applanation Tonometry ◽  
Hypertensive Patients ◽  
Parallel Group ◽  
Significant Difference

Arterial stiffness and wave reflection are independent predictors of cardiovascular events. This study compared the effect on arterial stiffness and wave reflection of a combination therapy with an ACE-inhibitor plus calcium channel blocker or thiazide diuretic in essential hypertensive patients with metabolic syndrome uncontrolled by ACE-inhibitor monotherapy. In a multicenter randomized, open, parallel group study, 76 hypertensive patients with metabolic syndrome, after 4 weeks run-in with Enalapril 20 mg, were randomized to a combination therapy with Lercanidipine (LER, 10-20 mg) or Hydrochlorothiazide (HCT, 12,5-25 mg) for 6 months. Applanation tonometry was used to measure aortic stiffness (carotid to femoral pulse wave velocity, PWV), central blood pressure (BP) and augmentation index (AI), a marker of wave reflection. At screening, office BP was 153±4/95±2 mmHg in both groups. After run in, BP was 139±18/84±12 and 142±17/84±10 mmHg, in the LER and HCT groups, respectively, and after 6-month it was 134±15/79±9 mmHg in the LER group and 134±14/79±10 mmHg in the HCT group. No significant difference between the two groups was observed. Central BP values had a similar behavior (6 months: LER 120±13/80±9 mmHg; HCT 122±13/79±9 mmHg). PWV was similar at baseline and was equally reduced by the two treatments (LER from 8.6±1.5 to 8.1±1.3 m/s; HCT from 8.5±1.2 to 8.2±1.0 m/s). Finally, both drugs reduced AI, but this reduction resulted significantly greater in LER than in HCT arm (LER from 26.8±10.9 to 20.6±9.1%; HCT from 28.2±9.0 to 24.7±8.7%). In conclusion, the addition of LER caused the same PWV reduction as compared to HCT but greater reduction in AI in hypertensive patients with metabolic syndrome not controlled with Enalapril alone. These results indicate a positive effect of the combination with LER on wave reflection, suggesting a potential role for cardiovascular protection.

scholarly journals Blueberries improve biomarkers of cardiometabolic function in participants with metabolic syndrome—results from a 6-month, double-blind, randomized controlled trial

2019 ◽  
Vol 109 (6) ◽  
pp. 1535-1545 ◽  
Author(s):  
Peter J Curtis ◽  
Vera van der Velpen ◽  
Lindsey Berends ◽  
Amy Jennings ◽  
Martin Feelisch ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
High Density Lipoprotein ◽  
Augmentation Index ◽  
Density Lipoprotein ◽  
Cvd Risk ◽  
Double Blind ◽  
Randomized Controlled ◽  
Flow Mediated Dilatation ◽  
Cardiometabolic Function

ABSTRACTBackgroundAnthocyanin-rich blueberry intake is associated with reduced type 2 diabetes and cardiovascular disease (CVD) risk in prospective studies, although long-term randomized controlled trials (RCTs) have not been conducted in at-risk populations.ObjectiveIn the longest-duration RCT to date, we examined the effect of 6-mo blueberry intake on insulin resistance and cardiometabolic function in metabolic syndrome.MethodsA double-blind, parallel RCT (n = 115; age 63 ± 7 y; 68% male; body mass index 31.2 ± 3.0 kg/m2) was conducted, which fed 2 dietarily achievable blueberry intakes [equivalent to 1/2 and 1 cup/d (75/150 g)] compared with matched placebo. Insulin resistance was assessed via the homeostasis model assessment of insulin resistance (primary endpoint) and confirmed by [6-6-2H2]-glucose-labeled, 2-step hyperinsulinemic clamp (n = 20). Clinically relevant cardiometabolic endpoints [including flow-mediated dilatation, augmentation index, lipoprotein status (by nuclear magnetic resonance spectroscopy), and nitric oxide (NO)-related metabolite assay] and anthocyanin metabolism were assessed.ResultsA daily intake of 1 cup of blueberries improved endothelial function (flow-mediated dilatation: +1.45%; 95% CI: 0.83%, 2.1%; P = 0.003), systemic arterial stiffness (augmentation index: –2.24%; 95% CI: –3.97%, –0.61%; P = 0.04) and attenuated cyclic guanosine monophosphate concentrations. In statin nonusers (n = 71), elevated high-density lipoprotein cholesterol (+0.08 mmol/L; P = 0.03), high-density lipoprotein particle density (+0.48n, ×10–6; P = 0.002) and apolipoprotein A-I (+0.05 g/L; P = 0.01) concentrations were observed following the 1-cup/d intervention. Treatment compliance was 94.1% (wrapper returns) and total concentrations of anthocyanin-derived phenolic acid metabolites significantly increased, dose-dependently, in serum and 24-h urine (P < 0.01 and P < 0.001, respectively). Insulin resistance, pulse wave velocity, blood pressure, NO, and overall plasma thiol status were unaffected. Likewise, a half cup per day had no effect on any biomarkers.ConclusionsDespite insulin resistance remaining unchanged we show, to our knowledge, the first sustained improvements in vascular function, lipid status, and underlying NO bioactivity following 1 cup blueberries/d. With effect sizes predictive of 12–15% reductions in CVD risk, blueberries should be included in dietary strategies to reduce individual and population CVD risk. This study was registered at clinicaltrials.gov as NCT02035592.

Metabolic Syndrome Alone Raises CVD Risk

2010 ◽  
Vol 43 (17) ◽  
pp. 63
Author(s):  
HEIDI SPLETE
Keyword(s):  
Metabolic Syndrome ◽  
Cvd Risk

Metabolic Syndrome Fails to Predict CVD Risk

2008 ◽  
Vol 38 (17) ◽  
pp. 21
Author(s):  
LORINDA BULLOCK
Keyword(s):  
Metabolic Syndrome ◽  
Cvd Risk

Applanation Tonometry for Assessment of Left Ventricular Systolic Load

2019 ◽  
Vol 12 (2) ◽  
pp. 94-99
Author(s):  
Rene D. Mileva-Popova ◽  
Nina Y. Belova
Keyword(s):  
Arterial Stiffness ◽  
Augmentation Index ◽  
Age Groups ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Applanation Tonometry ◽  
Non Invasive ◽  
Pressure Area ◽  
Older Subjects ◽  
And Gender

Summary Vascular-ventricular coupling is a major determinant of left ventricular load. The aim of our study was to assess non- invasively left ventricular load and its dependency on central hemodynamics. Sixty-five healthy and gender-matched individuals were divided in two groups according to their age: 20y/o and 50y/o. Applanation tonometry was performed using the Sphygmocor device. Central pressures and pulse wave analysis indices were computed. Central systolic (120±3 vs. 98±2 mm Hg) and pulse pressures (43±3 vs. 29±1 mm Hg) as well as the augmentation index (AIx75) (23±3 vs. 6±2%) were significantly higher in the 50y/o group (p<0.01). These parameters are relevant markers of arterial stiffness and evidenced the development of central arterial morphological and functional alterations in the older subjects. The time-tension index (TTI) computed from the systolic pressure area was significantly higher in the 50y/o subjects as compared to the 20y/o group (2378±66 vs. 1954±73 mmHg×s, p<0.01). Moreover, we have shown the presence of significant correlation between TTI and AIx75 (p<0.01) in both age groups. This finding confirmed the contribution of arterial stiffness for the impaired vascular-ventricular coupling. In conclusion, applanation tonometry might be utilized for non-invasive evaluation of the left ventricular load, which is an important parameter of cardiovascular risk.

Wave reflection augments central systolic and pulse pressures during facial cooling

2008 ◽  
Vol 294 (6) ◽  
pp. H2535-H2539 ◽  
Author(s):  
David G. Edwards ◽  
Matthew S. Roy ◽  
Raju Y. Prasad
Keyword(s):  
Cardiovascular Events ◽  
Wave Reflection ◽  
Augmentation Index ◽  
Systolic Pressure ◽  
Aortic Pressure ◽  
Applanation Tonometry ◽  
Pressure Waveform ◽  
Central Aortic Pressure ◽  
Facial Cooling ◽  
Change In Mean

Cardiovascular events are more common in the winter months, possibly because of hemodynamic alterations in response to cold exposure. The purpose of this study was to determine the effect of acute facial cooling on central aortic pressure, arterial stiffness, and wave reflection. Twelve healthy subjects (age 23 ± 3 yr; 6 men, 6 women) underwent supine measurements of carotid-femoral pulse wave velocity (PWV), brachial artery blood pressure, and central aortic pressure (via the synthesis of a central aortic pressure waveform by radial artery applanation tonometry and generalized transfer function) during a control trial (supine rest) and a facial cooling trial (0°C gel pack). Aortic augmentation index (AI), an index of wave reflection, was calculated from the aortic pressure waveform. Measurements were made at baseline, 2 min, and 7 min during each trial. Facial cooling increased ( P < 0.05) peripheral and central diastolic and systolic pressures. Central systolic pressure increased more than peripheral systolic pressure (22 ± 3 vs. 15 ± 2 mmHg; P < 0.05), resulting in decreased pulse pressure amplification ratio. Facial cooling resulted in a robust increase in AI and a modest increase in PWV (AI: −1.4 ± 3.8 vs. 21.2 ± 3.0 and 19.9 ± 3.6%; PWV: 5.6 ± 0.2 vs. 6.5 ± 0.3 and 6.2 ± 0.2 m/s; P < 0.05). Change in mean arterial pressure but not PWV predicted the change in AI, suggesting that facial cooling may increase AI independent of aortic PWV. Facial cooling and the resulting peripheral vasoconstriction are associated with an increase in wave reflection and augmentation of central systolic pressure, potentially explaining ischemia and cardiovascular events in the cold.

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