Jornal Vascular Brasileiro
https://app.periodikos.com.br/journal/jvb/article/doi/10.1590/1677-5449.202300762
Jornal Vascular Brasileiro
Original Article

Discriminative value of pulse wave velocity for arterial stiffness and cardiac injury in prediabetic patients

Valor discriminativo da velocidade da onda de pulso para rigidez arterial e lesão cardíaca em pacientes pré-diabéticos

Stella Maris Firmino; Cássia da Luz Goulart; João Paulo Gregorio; Klaus Werner Wende; Fernanda Yuri Yuamoto; Lana Kummer; Emílio Martins Curcelli; Alessandro Domingues Heubel; Erika Zavaglia Kabbach; Polliana Batista Santos; Audrey Borghi-Silva; Renata Gonçalves Mendes; Ângela Mérice de Oliveira Leal; Meliza Goi Roscani

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Abstract

Background: Prediabetes (PD) is defined as impaired fasting glucose and/or impaired glucose tolerance (IGT) and may be associated with high risk of cardiovascular injury. It is recommended that PD patients be screened for signs of arterial stiffness and cardiovascular injury to reinforce therapeutic strategies.

Objectives: To identify pulse wave velocity values discriminative for arterial stiffness and cardiovascular injury in PD patients.

Methods: A cross-sectional study was conducted with PD (N=43) and normoglycemic (N=37) patients who underwent clinical evaluation, arterial stiffness assessment by carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor, laboratory blood analysis, investigation of morphological and functional cardiac variables by transthoracic echocardiogram, and assessment of carotid intima-media-thickness (CIMT) by carotid ultrasonography. A statistical analysis was performed using SPSS software and values of p<0.05 were considered significant.

Results: A cfPWV cut-off value of 6.9 m/s was identified for IGT (Sensitivity [SE]: 74% and Specificity [SP]: 51%). Comparison of general data and risk factors between subsets with values above and below this cutoff value revealed higher rates of fasting glucose (p=0.02), obesity (p=0.03), dyslipidemia (p=0.004), early signs of left ventricle (p=0.017) and right ventricle (p=0.03) impaired diastolic function, and elevated CIMT in subjects with cfPWV ≥ 6.9m/s (p=0.04).

Conclusions: In PD patients, a cfPWV cutoff of 6.9 m/s was considered a discriminative value for arterial stiffness. These findings highlight the value of early investigation of cardiovascular injury and aggressive therapy strategies with good control of risk factors in PD.

Keywords

arterial stiffness, carotid-femoral pulse wave velocity, prediabetics, risk factors

Resumo

Contexto: O pré-diabetes (PD) é definido como glicemia de jejum alterada e/ou tolerância à glicose alterada (TGA) e pode estar associado a alto risco de lesão cardiovascular. Recomenda-se discriminar quais pacientes com PD podem apresentar sinais de rigidez arterial e lesão cardiovascular para reforçar as estratégias terapêuticas.

Objetivos: Identificar os valores discriminativos da velocidade de onda de pulso determinantes de rigidez arterial e lesão cardiovascular em pacientes com PD.

Métodos: Estudo transversal em pacientes com PD (N=43) e normoglicêmicos (N=37) submetidos a avaliação clínica, avaliação da rigidez arterial pela velocidade da onda de pulso carótido-femoral (cfPWV) utilizando SphygmoCor, análise laboratorial de sangue, investigação de alterações morfológicas e variáveis cardíacas funcionais por ecocardiograma transtorácico e avaliação da espessura íntima-média carotídea (EIMC) pela ultrassonografia da carótida. A análise estatística foi realizada no software SPSS, e valores de p<0,05 foram considerados significativos.

Resultados: Foi identificado um valor de corte cfPWV de 6,9 m/s para TGA (sensibilidade 74% e especificidade 51%). A comparação dos dados e fatores de risco entre valores acima e abaixo do valor de corte estabelecido revelou glicemia de jejum elevada (p=0,02), obesidade (p=0,03), dislipidemia (p=0,004), sinais precoces de função diastólica prejudicada do ventrículo esquerdo (p=0,017) e ventrículo direito (p=0,03) e maior EIMC em cfPWV ≥6,9m/s (p=0,04).

Conclusões: Em pacientes com PD, o cfPWV de 6,9 m/s foi considerado um valor discriminativo de rigidez arterial. Esses achados reforçam que a investigação precoce da lesão cardiovascular e uma estratégia com terapia agressiva são valiosas no controle dos fatores de risco na PD.

Palavras-chave

rigidez arterial, velocidade da onda de pulso carotídeo-femoral, pré-diabéticos, fatores de risco

References

1 Bierman EL. George Lyman Duff Memorial Lecture. Atherogenesis in diabetes. Arterioscler Thromb. 1992;12(6):647-56. http://dx.doi.org/10.1161/01.ATV.12.6.647. PMid:1591228.

2 Hung C-S, Lin J-W, Hsu C-N, et al. Using brachial-ankle pulse wave velocity to associate arterial stiffness with cardiovascular risks. Nutr Metab Cardiovasc Dis. 2009;19(4):241-6. http://dx.doi.org/10.1016/j.numecd.2008.07.006. PMid:18815016.

3 Shin JY, Lee HR, Lee DC. Increased arterial stiffness in healthy subjects with high-normal glucose levels and in subjects with pre-diabetes. Cardiovasc Diabetol. 2011;10(1):30. http://dx.doi.org/10.1186/1475-2840-10-30. PMid:21492487.

4 Khaw K-T, Wareham N, Bingham S, Luben R, Welch A, Day N. Association of Hemoglobin A 1c with Cardiovascular Disease and Mortality in Adults: The European Prospective Investigation into Cancer in Norfolk. Ann Intern Med. 2004;141(6):413-20. http://dx.doi.org/10.7326/0003-4819-141-6-200409210-00006. PMid:15381514.

5 Tuomilehto J, Qiao Q, Borch-Johnsen K. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe. Lancet. 1999;354(9179):617-21. http://dx.doi.org/10.1016/S0140-6736(98)12131-1. PMid:10466661.

6 Ben-Shlomo Y, Spears M, Boustred C, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol. 2014;63(7):636-46. http://dx.doi.org/10.1016/j.jacc.2013.09.063. PMid:24239664.

7 Townsend RR, Wilkinson IB, Schiffrin EL, et al. Recommendations for improving and standardizing vascular research on arterial stiffness: a scientific statement from the American Heart Association. Hypertension. 2015;66(3):698-722. http://dx.doi.org/10.1161/HYP.0000000000000033. PMid:26160955.

8 The Reference Values for Arterial Stiffness’ Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors:‘establishing normal and reference values.’. Eur Heart J. 2010;31(19):2338-50. http://dx.doi.org/10.1093/eurheartj/ehq165. PMid:20530030.

9 Cecelja M, Chowienczyk P. Role of arterial stiffness in cardiovascular disease. JRSM Cardiovasc Dis. 2012;1(4):1-10. http://dx.doi.org/10.1258/cvd.2012.012016. PMid:24175067.

10 Li C-H, Wu J-S, Yang Y-C, Shih C-C, Lu F-H, Chang C-J. Increased arterial stiffness in subjects with impaired glucose tolerance and newly diagnosed diabetes but not isolated impaired fasting glucose. J Clin Endocrinol Metab. 2012;97(4):E658-62. http://dx.doi.org/10.1210/jc.2011-2595. PMid:22337914.

11 Prenner SB, Chirinos JA. Arterial stiffness in diabetes mellitus. Atherosclerosis. 2015;238(2):370-9. http://dx.doi.org/10.1016/j.atherosclerosis.2014.12.023. PMid:25558032.

12 Yiming G, Zhou X, Lv W, et al. Reference values of brachial-ankle pulse wave velocity according to age and blood pressure in a central Asia population. PLoS One. 2017;12(4):e0171737. http://dx.doi.org/10.1371/journal.pone.0171737. PMid:28403173.

13 Zhang X, Lim SC, Tavintharan S, et al. Association of central arterial stiffness with the presence and severity of diabetic retinopathy in Asians with type 2 diabetes. Diab Vasc Dis Res. 2019;16(6):498-505. http://dx.doi.org/10.1177/1479164119845904. PMid:31046450.

14 Díaz A, Galli C, Tringler M, Ramírez A, Cabrera Fischer EI. Reference values of pulse wave velocity in healthy people from an urban and rural argentinean population. Int J Hypertens. 2014;2014:653239. http://dx.doi.org/10.1155/2014/653239. PMID: 25215227.

15 Firmino SM, Wende KW, Gregorio JP, et al. Detection of early ultrasonographic markers of cardiovascular dysfunction in prediabetes patients. Ann Vasc Surg. 2022;82:339-46. http://dx.doi.org/10.1016/j.avsg.2021.07.051. PMid:34656709.

16 Firmino SM. Associação de pré-diabetes com marcadores precoces de lesão cardiovascular [tese]. São Carlos: UFSCar; 2021.

17 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-7. http://dx.doi.org/10.1016/S0140-6736(07)61602-X. PMid:18064739.

18 American Diabetes Association Professional Practice Committee. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2022. Diabetes Care. 2022;45(Suppl 1):S17-38. PMid:34964875.

19 Roman AC. Informatização do registro clínico essencial para a atenção primária à saúde: um instrumento de apoio às equipes da estratégia saúde da família [tese]. São Paulo: Universidade de São Paulo; 2009.

20 Van Bortel LM, Laurent S, Boutouyrie P, et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens. 2012;30(3):445-8. http://dx.doi.org/10.1097/HJH.0b013e32834fa8b0. PMid:22278144.

21 Lang RM, Badano LP, Victor MA, et al. Quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14. http://dx.doi.org/10.1016/j.echo.2014.10.003. PMid:25559473.

22 Touboul P-J, Hennerici MG, Meairs S, et al. Mannheim carotid intima-media thickness consensus (2004–2006). Cerebrovasc Dis. 2007;23(1):75-80. http://dx.doi.org/10.1159/000097034. PMid:17108679.

23 Gray-Weale AC, Graham JC, Burnett JR, Byrne K, Lusby RJ. Carotid artery atheroma: comparison of preoperative B-mode ultrasound appearance with carotid endarterectomy specimen pathology. J Cardiovasc Surg (Torino). 1988;29(6):676-81. PMid:3062007.

24 Systat WL. Wiley Interdiscip Rev Comput Stat. 2010;2(2):256-7. http://dx.doi.org/10.1002/wics.66.

25 Kozakova M, Palombo C. Diabetes mellitus, Arterialwall, and cardiovascular risk assessment. Int J Environ Res Public Health. 2016;13(2):201. http://dx.doi.org/10.3390/ijerph13020201. PMid:26861377.

26 Cederqvist J, Rådholm K, Muhammad IF, Engström G, Engvall J, Östgren CJ. Arterial stiffness and subclinical atherosclerosis in the coronary arteries at different stages of dysglycaemia. Diabet Med. 40(7):e15102. http://dx.doi.org/10.1111/dme.15102. PMID: 37004152.

27 Munakata M. Brachial-ankle pulse wave velocity in the measurement of arterial stiffness: recent evidence and clinical applications. Curr Hypertens Rev. 2014;10(1):49-57. http://dx.doi.org/10.2174/157340211001141111160957. PMid:25392144.

28 Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. http://dx.doi.org/10.1093/eurheartj/ehy339. PMid:30165516.

29 Tolezani EC, Costa-Hong V, Correia G, Mansur AJ, Drager LF, Bortolotto LA. Determinantes das propriedades funcionais e estruturais de grandes artérias em indivíduos saudáveis. Arq Bras Cardiol. 2014;103(5):426-32. PMid:25211201.

30 Turgutkaya A, Aşçı G. The association between HbA1c and arterial stiffness among non-diabetic patients with chronic kidney disease. J Vasc Bras. 2021;20:e20200245. http://dx.doi.org/10.1590/1677-5449.200245. PMid:34211541.

31 Monteiro CI, Simões RP, Goulart CL, da Silva CD, Borghi-Silva A, Mendes RG. Arterial stiffness in type 2 diabetes: determinants and indication of a discriminative value. Clinics (São Paulo). 2021;76:e2172. http://dx.doi.org/10.6061/clinics/2021/e2172. PMid:33624706.

32 Fang F-S, Liu M-Y, Cheng X-L, et al. Insulin resistance correlates with the arterial stiffness before glucose intolerance. Intern Med. 2014;53(3):189-94. http://dx.doi.org/10.2169/internalmedicine.53.0690. PMid:24492686.

33 Starzak M, Stanek A, Jakubiak GK, Cholewka A, Cieślar G. Arterial stiffness assessment by pulse wave velocity in patients with metabolic syndrome and its components: is it a useful tool in clinical practice? Int J Environ Res Public Health. 2022;19(16):10368. http://dx.doi.org/10.3390/ijerph191610368. PMid:36012003.

34 Mendes-Pinto D, Ribeiro JM, Rodrigues-Machado MG. Associação entre isquemia crítica do membro e rigidez arterial medida por oscilometria da artéria braquial. J Vasc Bras. 2019;18:e20180073. http://dx.doi.org/10.1590/1677-5449.007318. PMid:31258553.

35 Baier D, Teren A, Wirkner K, Loeffler M, Scholz M. Parameters of pulse wave velocity: determinants and reference values assessed in the population-based study LIFE-Adult. Clin Res Cardiol. 2018;107(11):1050-61. http://dx.doi.org/10.1007/s00392-018-1278-3. PMid:29766282.

36 Huang Z, Chen C, Li S, Kong F, Shan P, Huang W. Serum markers of endothelial dysfunction and inflammation increase in hypertension with prediabetes mellitus. Genet Test Mol Biomarkers. 2016;20(6):322-7. http://dx.doi.org/10.1089/gtmb.2015.0255. PMid:27167462.

37 de Mendonça GS, de Souza DF, de Alvarenga Cunha Brunelli AC, et al. Arterial stiffness in elderly patients with normotension and hypertension in Brazil. J Clin Hypertens (Greenwich). 2018;20(9):1285-93. http://dx.doi.org/10.1111/jch.13358. PMid:30039916.

38 Farro I, Bia D, Zocalo Y, et al. Pulse wave velocity as marker of preclinical arterial disease: reference levels in a uruguayan population considering wave detection algorithms, path lengths, aging, and blood pressure. Int J Hypertens. 2012;2012:169359. http://dx.doi.org/10.1155/2012/169359. PMID: 22666551.

39 Jug J, Prkacin I. Arterial stiffness in prehypertensive patients with prediabetes-a pilot study. J Hypertens. 2023;41(1, Suppl 3):e278. http://dx.doi.org/10.1097/01.hjh.0000941884.90100.31.

40 Wajchenberg BL. Disfunção endotelial no diabetes do tipo 2. Arq Bras Endocrinol Metabol. 2002;46(5):514-9. http://dx.doi.org/10.1590/S0004-27302002000500004.
 


Submitted date:
06/30/2023

Accepted date:
09/12/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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