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P673Improvement of arterial stiffness and myocardial deformation in patients with poorly controlled diabetes mellitus type 2 after optimization of antidiabetic medication.
Eur Heart J Cardiovasc Imaging. 2016 Dec 01; 17(suppl_2):ii136-ii143.EH

Abstract

Background

Arterial stiffness is associated with increased risk for cardiovascular disease. The purpose of this study is to investigate the arterial stiffness and myocardial deformation in patients with poorly controlled diabetes mellitus type 2 before and after glycemic control by optimal medication.

Methods

In 50 patients with uncontrolled type 2 diabetes(age:52±10years)and 25 controls of similar age and sex and no atherosclerotic risk factors we measured at baseline and 6 months after glycemic control a) carotid-femoral pulse wave velocity(PWVc m/sec-Complior SP ALAM),central systolic blood pressure(cSBP -mmHg),augmentation index(AI%), of the aortic pulse wave(ArteriographTensioMed) b)S',E'(m/sec)andE'/A'of mitral annulus by Tissue Doppler c)LV longitudinal strain(GLS-%),systolic(LongSr-l/sec)and diastolic(LongSrE-l/sec)strain rate, twisting(Tw-deg),peak twisting(Tw)and untwisting(unTw-deg/sec)velocity using speckle tracking echocardiography.The degree of LV untwisting was calculated as the percentage difference between peak twisting and untwisting at MVO(%dp PeakTw-UntwMVO)and between peak twisting and untwisting at peak and end of the mitral inflow E wave d)perfusion boundary region(PBR- micrometers)of the sublingual arterial microvessels(ranged from 5-25 micrometers)using Sideview,Darkfield imaging(Microscan,Glycocheck).Increased PBR is considered an accurate index of reduced endothelial glucocalyx thickness because of a deeper RBC penetration in the glucocalyx e) Flow mediated dilatation(FMD) of the brachial artery and percentage difference of FMD (FMD%).

Results

Compared to controls,diabetics had higher PWVa(10.3±2.2 vs. 8.1±1.9), AI(27.9±15 vs. 19.4±14.7), PWVc(11.8±3.2 vs. 8.8±1.3),cSBP(136±20 vs. 119±18),PBR (2.1±0.2 vs 1.89±0.1)and lower GLS(-15±3 vs. -18±3),LongSr(-0.78±0.1 vs. -0.96±0.2),LongSrE(0.77±0.29 vs. 1.2±0.3),S',E' and E/A(p<0.05 for all comparisons). Baseline FMD was related with Untw at peak E%(r=0,65, p<0.05). Six months after the modification of antidiabetic medication all patients achieved glycaemic control and there was a reduction of PWVc(12.3±2.9 vs. 11.3±3.2,p<0.05) in parallel with a increase of Untw velocity (-73±27 vs. -98±43,p<0.05),Untw MVO%(20±9 vs. 30±2),Untw peak E% (40±14 vs. 50±16)and FMD%(7.8±3 vs. 13.6±11,p<0.01).Reduced PWVc was related with reduced SBP(r=0.62),cSBP(r=0.55)and increased LongsrE(r=-0.50), Untw at end E(r=-0.56)respectively(p<0.05 for all associations).

Conclusion

Glycaemic control after optimizing medical treatment improves arterial stiffness, LV myocardial strain, twisting and untwisting velocity in diabetics.

Authors+Show Affiliations

University of Athens, Athens, Greece.University of Athens Medical School, Attikon Hospital, 2nd Department of Cardiology, Athens, Greece.University of Athens Medical School, 2nd Department of Internal Medicine, Athens, Greece, Athens, Greece.University of Athens Medical School, 2nd Department of Internal Medicine, Athens, Greece, Athens, Greece.University of Athens Medical School, Attikon Hospital, 2nd Department of Cardiology, Athens, Greece.University of Athens Medical School, Attikon Hospital, 2nd Department of Cardiology, Athens, Greece.University of Athens Medical School, Attikon Hospital, 2nd Department of Cardiology, Athens, Greece.University of Athens Medical School, Attikon Hospital, 2nd Department of Cardiology, Athens, Greece.University of Athens Medical School, 2nd Department of Internal Medicine, Athens, Greece, Athens, Greece.University of Athens Medical School, Attikon Hospital, 2nd Department of Cardiology, Athens, Greece.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28415103

Citation

Ikonomidis, I, et al. "P673Improvement of Arterial Stiffness and Myocardial Deformation in Patients With Poorly Controlled Diabetes Mellitus Type 2 After Optimization of Antidiabetic Medication." European Heart Journal Cardiovascular Imaging, vol. 17, no. suppl_2, 2016, pp. ii136-ii143.
Ikonomidis I, Pavlidis G, Lambadiari V, et al. P673Improvement of arterial stiffness and myocardial deformation in patients with poorly controlled diabetes mellitus type 2 after optimization of antidiabetic medication. Eur Heart J Cardiovasc Imaging. 2016;17(suppl_2):ii136-ii143.
Ikonomidis, I., Pavlidis, G., Lambadiari, V., Kousathana, F., Triantafyllidi, H., Varoudi, M., Vlastos, D., Vlachos, S., Dimitriadis, G., & Lekakis, J. (2016). P673Improvement of arterial stiffness and myocardial deformation in patients with poorly controlled diabetes mellitus type 2 after optimization of antidiabetic medication. European Heart Journal Cardiovascular Imaging, 17(suppl_2), ii136-ii143. https://doi.org/10.1093/ehjci/jew250.002
Ikonomidis I, et al. P673Improvement of Arterial Stiffness and Myocardial Deformation in Patients With Poorly Controlled Diabetes Mellitus Type 2 After Optimization of Antidiabetic Medication. Eur Heart J Cardiovasc Imaging. 2016 Dec 1;17(suppl_2):ii136-ii143. PubMed PMID: 28415103.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - P673Improvement of arterial stiffness and myocardial deformation in patients with poorly controlled diabetes mellitus type 2 after optimization of antidiabetic medication. AU - Ikonomidis,I, AU - Pavlidis,G, AU - Lambadiari,V, AU - Kousathana,F, AU - Triantafyllidi,H, AU - Varoudi,M, AU - Vlastos,D, AU - Vlachos,S, AU - Dimitriadis,G, AU - Lekakis,J, PY - 2017/4/18/entrez PY - 2017/4/18/pubmed PY - 2018/2/10/medline SP - ii136 EP - ii143 JF - European heart journal cardiovascular Imaging JO - Eur Heart J Cardiovasc Imaging VL - 17 IS - suppl_2 N2 - Background: Arterial stiffness is associated with increased risk for cardiovascular disease. The purpose of this study is to investigate the arterial stiffness and myocardial deformation in patients with poorly controlled diabetes mellitus type 2 before and after glycemic control by optimal medication. Methods: In 50 patients with uncontrolled type 2 diabetes(age:52±10years)and 25 controls of similar age and sex and no atherosclerotic risk factors we measured at baseline and 6 months after glycemic control a) carotid-femoral pulse wave velocity(PWVc m/sec-Complior SP ALAM),central systolic blood pressure(cSBP -mmHg),augmentation index(AI%), of the aortic pulse wave(ArteriographTensioMed) b)S',E'(m/sec)andE'/A'of mitral annulus by Tissue Doppler c)LV longitudinal strain(GLS-%),systolic(LongSr-l/sec)and diastolic(LongSrE-l/sec)strain rate, twisting(Tw-deg),peak twisting(Tw)and untwisting(unTw-deg/sec)velocity using speckle tracking echocardiography.The degree of LV untwisting was calculated as the percentage difference between peak twisting and untwisting at MVO(%dp PeakTw-UntwMVO)and between peak twisting and untwisting at peak and end of the mitral inflow E wave d)perfusion boundary region(PBR- micrometers)of the sublingual arterial microvessels(ranged from 5-25 micrometers)using Sideview,Darkfield imaging(Microscan,Glycocheck).Increased PBR is considered an accurate index of reduced endothelial glucocalyx thickness because of a deeper RBC penetration in the glucocalyx e) Flow mediated dilatation(FMD) of the brachial artery and percentage difference of FMD (FMD%). Results: Compared to controls,diabetics had higher PWVa(10.3±2.2 vs. 8.1±1.9), AI(27.9±15 vs. 19.4±14.7), PWVc(11.8±3.2 vs. 8.8±1.3),cSBP(136±20 vs. 119±18),PBR (2.1±0.2 vs 1.89±0.1)and lower GLS(-15±3 vs. -18±3),LongSr(-0.78±0.1 vs. -0.96±0.2),LongSrE(0.77±0.29 vs. 1.2±0.3),S',E' and E/A(p<0.05 for all comparisons). Baseline FMD was related with Untw at peak E%(r=0,65, p<0.05). Six months after the modification of antidiabetic medication all patients achieved glycaemic control and there was a reduction of PWVc(12.3±2.9 vs. 11.3±3.2,p<0.05) in parallel with a increase of Untw velocity (-73±27 vs. -98±43,p<0.05),Untw MVO%(20±9 vs. 30±2),Untw peak E% (40±14 vs. 50±16)and FMD%(7.8±3 vs. 13.6±11,p<0.01).Reduced PWVc was related with reduced SBP(r=0.62),cSBP(r=0.55)and increased LongsrE(r=-0.50), Untw at end E(r=-0.56)respectively(p<0.05 for all associations). Conclusion: Glycaemic control after optimizing medical treatment improves arterial stiffness, LV myocardial strain, twisting and untwisting velocity in diabetics. SN - 2047-2412 UR - https://www.unboundmedicine.com/medline/citation/28415103/P673Improvement_of_arterial_stiffness_and_myocardial_deformation_in_patients_with_poorly_controlled_diabetes_mellitus_type_2_after_optimization_of_antidiabetic_medication_ L2 - https://academic.oup.com/ehjcimaging/article-lookup/doi/10.1093/ehjci/jew250.002 DB - PRIME DP - Unbound Medicine ER -