Flow-mediated-paradoxical vasoconstriction is independently associated with asymptomatic myocardial ischemia and coronary artery disease in type 2 diabetic patients

Nguyen, Minh Tuan; Pham, Isabelle; Valensi, P.; Rousseau, Hélène; Vicaut, Éric; Laguillier, Christelle; Nitenberg, A; Cosson, E.

doi:10.1186/1475-2840-13-20

Cited by 20 publications

(14 citation statements)

References 33 publications

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“…The systematic search resulted in the inclusion of 193 from a total of 4641 potential articles (Figure ). From the 193 studies included in the analyses, vascular reactivity was assessed in a total of 26570 patients that were considered healthy (n = 7226), overweight (n = 7605), or those with obesity (n = 1758) or that were diagnosed with metabolic sy...…”

Section: Resultsmentioning

confidence: 99%

The continuums of impairment in vascular reactivity across the spectrum of cardiometabolic health: A systematic review and network meta‐analysis

et al. 2019

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This study aimed to assess, for the first time, the change in vascular reactivity across the full spectrum of cardiometabolic health. Systematic searches were conducted in MEDLINE and EMBASE databases from their inception to March 13, 2017, including studies that assessed basal vascular reactivity in two or more of the following health groups (aged ≥18 years old): healthy, overweight, obesity, impaired glucose tolerance, metabolic syndrome, or type 2 diabetes with or without complications. Direct and indirect comparisons of vascular reactivity were combined using a network meta-analysis. Comparing data from 193 articles (7226 healthy subjects and 19344 patients), the network meta-analyses revealed a progressive impairment in vascular reactivity (flow-mediated dilation data) from the clinical onset of an overweight status (−0.41%, 95% CI, −0.98 to 0.15) through to the development of vascular complications in those with type 2 diabetes (−4.26%, 95% CI, −4.97 to −3.54). Meta-regressions revealed that for every 1 mmol/l increase in fasting blood glucose concentration, flow-mediated dilation decreased by 0.52%. Acknowledging that the time course of disease may vary between patients, this study demonstrates multiple continuums of vascular dysfunction where the severity of impairment in vascular reactivity progressively increases throughout the pathogenesis of obesity and/or insulin resistance, providing information that is important to enhancing the timing and effectiveness of strategies that aim to improve cardiovascular outcomes.

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Section: Resultsmentioning

confidence: 99%

The continuums of impairment in vascular reactivity across the spectrum of cardiometabolic health: A systematic review and network meta‐analysis

et al. 2019

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“…Moreover, 23.3% of patients with ED showed a paradoxical vasoconstrictor response. According to Nguyen et al, 23 the presence of flow-mediated paradoxical vasoconstriction has 61.9% sensitivity and 65.6% specificity to identify asymptomatic coronary artery disease in diabetics.…”

Section: Discussionmentioning

confidence: 99%

Endothelial dysfunction assessment by flow-mediated dilation in a high-altitude population

Calderón-Gerstein¹,

López-Peña²,

Macha-Ramírez³

et al. 2017

VHRM

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IntroductionEndothelial function at high altitude has been measured only in populations that are genetically adapted to chronic hypoxia. The objective of this study was to evaluate endothelial dysfunction (ED) in a nongenetically adapted high-altitude population of the Andes mountains, in Huancayo, Peru (3,250 meters above sea level).MethodsParticipants included 61 patients: 28 cases and 33 controls. The cases were subjects with hypertension, diabetes mellitus, obesity, or a history of stroke or coronary artery disease. Flow-mediated vasodilation (FMD) of the brachial artery was measured in the supine position, at noon, after 5 minutes of resting. The brachial artery was identified above the elbow. Its basal diameter was measured during diastole, and FMD was tested after 5 minutes of forearm ischemia. Intima–media complex in the right carotid artery was also determined. An increase in the artery’s baseline diameter <10% indicated a positive test. Endothelium-independent vasodilation was evaluated with sublingual nitrate administration. The intima–media complex in the right carotid artery was also measured.Results100% of diabetics had ED; ED was also found in 68.8% of obese individuals, 55% of hypertensive patients, and 46.5% of controls. Age, height, body mass index, and waist diameter were higher in the cases as compared with the controls. A total of 57.9% (n=11) of the cases and 45.2% (n=19) of the controls presented ED. Patients without ED had a mean increase in brachial artery diameter of 23.16%, while in those with ED it was only 3.84%. Individuals with diabetes or hypertension had a greater thickness of the carotid artery intima media layer (1.092 versus 0.664 cm) (p=0.037). A positive test for ED was associated with a greater basal diameter of the brachial artery (4.66±0.62 versus 4.23±0.59 cm) (p=0.02). A total of 7 patients presented paradoxical response, developing posthyperemia vasoconstriction.DiscussionThe proportion of ED was high among controls and among patients with risk factors. Controls showed better FMD profiles than subjects studied in Tibet and the Himalayas.

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“…Because CHD was defined as being present only in individuals with an obvious history of CHD or those diagnosed according to a coronary angiographic examination, subjects with asymptomatic myocardial ischemia might have been undiagnosed in the present study. This may have affected the outcome of the study, because Nguyen et al reported that the FMD was lower in type 2 diabetic patients with asymptomatic myocardial ischemia [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Flow Mediated Dilatation Is Reduced with the Progressive Stages of Glomerular Filtration Rate and Albuminuria in Type 2 Diabetic Patients without Coronary Heart Disease

Ito

Nakashima

Meguro

et al. 2015

Journal of Diabetes Research

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We aimed to clarify the usefulness of measuring the flow mediated dilatation (FMD) in patients with type 2 diabetes mellitus without and with coronary heart disease (CHD). The FMD was measured in 480 patients with type 2 diabetes and in 240 nondiabetic subjects. The FMD was significantly lower in the subjects with CHD (n = 145, 5.4 ± 3.2%) than in those without CHD (n = 95, 6.9 ± 3.5%) among the nondiabetic subjects. The FMD was also lower in the subjects both with CHD (n = 161, 5.6 ± 2.8%) and without CHD (n = 319, 6.1 ± 3.3%) among the patients with diabetes compared to those without both diabetes and CHD. The FMD showed a significant positive correlation with the estimated glomerular filtration rate (eGFR) in the diabetic patients without CHD, while there was no significant association in those with CHD. The FMD was significantly lower with the progressive stages of the GFR or albuminuria in the patients without CHD among those with diabetes, although the FMD was not different in those with CHD. In conclusion, the FMD is considered to be useful for the detection of atherosclerosis in patients with type 2 diabetes, even if overt macroangiopathy is not diagnosed.

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Flow-mediated-paradoxical vasoconstriction is independently associated with asymptomatic myocardial ischemia and coronary artery disease in type 2 diabetic patients

Cited by 20 publications

References 33 publications

The continuums of impairment in vascular reactivity across the spectrum of cardiometabolic health: A systematic review and network meta‐analysis

The continuums of impairment in vascular reactivity across the spectrum of cardiometabolic health: A systematic review and network meta‐analysis

Endothelial dysfunction assessment by flow-mediated dilation in a high-altitude population

Flow Mediated Dilatation Is Reduced with the Progressive Stages of Glomerular Filtration Rate and Albuminuria in Type 2 Diabetic Patients without Coronary Heart Disease

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