Background: Increased carotid intima-media thickness (IMT), endothelial dysfunction and arterial stiffness (AS) have been reported in young subjects with type 1 diabetes (DM1). However, the relations between these vascular abnormalities remain unknown. Aim of the Study: To assess by a multiparametric approach the preclinical vascular involvement in young patients with early onset DM1 and adequate glycaemic control. Methods: 31 DM1 patients, free of macro- and microvascular complications (20 males, age 19.3 ± 3.1, BMI 22.1 ± 2.7 kg/m2, disease duration: 11 ± 5 years, average HbA1c: 7.7 ± 1.0%), and 31 controls (NL: 16 males, age 20.1 ± 1.6; BMI 21.6 ± 2.1 kg/m2) were studied. IMT was measured by radiofrequency-based ultrasound (Q-IMT, Esaote MyLab70). AS was estimated by carotid-femoral pulse wave velocity (PWV, Complior), and endothelial function by forearm reactive hyperemia index (RHI, EndoPAT). Carotid augmentation index (AIx) was measured by applanation tonometry (Pulsepen, Diatecne). Results: Compared to controls, DM1 patients, although normotensive, had significantly higher (p < 0.05) SBP (119 ± 15 vs 110 ± 9 mmHg), Q-IMT (440 ± 64 vs 401 ± 55 μm), PWV (7.4 ± 1.3 vs 6.5 ± 1.1 m/s) and AIx (12 ± 7 vs 1.8 ± 7%). RHI was lower (p < 0.05) in patients with HbA1c >7.5 % than in those with HbA1c < 7,5 % and NL (1.5 ± 0.35; 2.1 ± 0.69 and 2.1 ± 0.53). Lipid profile was comparable in DM1 vs NL. Within vascular parameters, in the entire population, Q-IMT was directly related with AIx (r = 0.53, p < 0.005) and inversely with RHI (r = -0.33, p < 0.05). In multivariate models, DM1 was independent predictor (p < 0.001) of SBP (together with sex and BMI, R2 = 0.62), Q-IMT (together with sex and RHI, R2 = 0.39), PWV (together with age and SBP, R2 = 0.28) and AIx (together with Q-IMT, R2 = 0.45). Conclusions: In young subjects with adequately controlled DM1 free of overt complications, a mildly increased IMT is associated with augmented wave reflection and reduced RHI. Higher HbA1c levels are associated with endothelial dysfunction, suggesting that an aggressive glycaemic control may be a critical factor for preventing preclinical vascular involvement.

Background: prolonged head-down tilt bed rest (HDTBR) is followed by a decrease in circulating volume possibly affecting large artery structure and function. Aim of the study was to investigate common carotid artery (CCA) remodelling and ventricular-arterial (VA) coupling after HDTBR. Methods: ten healthy male volunteers (age 23 ± 2) were studied before and after a 35-day HDTBR. Ultrasound (Esaote MyLab30) was used to estimate LV volumes, transmitral and aortic flow velocity (FV), CCA diameter and FV, high resolution IMT (Q-IMT). Applanation tonometry (PulsePen, DiaTecne), was used to explore large artery dynamics and wave reflection (WR). Carotid-femoral pulse wave velocity (PWV) was also estimated (Complior, Alam). Results: no changes were observed for central BP vs baseline, while LV volumes and stroke volume significantly decreased and HR increased (from 58 ± 2 to 73 ± 6, p < 0.05). Myocardial performance index (MPI), a Doppler derived index of global LV function [isovolumic contraction time+isovolumic relaxation time)/LV ejection time], increased after HDTBR (0.71 ± 0.12 vs 0.52 ± 0.06, p < 0.005), as well as arterial elastance (Ea = end systolic pressure/stroke volume) and LV elastance [Elv = end systolic pressure (ESP)/end systolic volume (ESV)] (for Ea: 1.08 ± 0.198 vs 1.31 ± 0.21, p = 0.01; for Elv 1.478 ± 0.32 vs 1.765 ± 0.42, p = 0.04), with unchanged Ea/Elv (0.74 ± 0.09 vs 0.76 ± 0.1). PWV, CCA diameter, systolic FV and QIMT did not change, while diastolic and mean FV significantly increased (p < 0.05: FVd from 25 ± 4 to 29 ± 4 cm/s, FVm from 42 ± 8 to 52 ± 11 cm/s). Pulsatility index [PI = (peak systolic velocity-diastolic velocity)/Mean velocity] decreased from 2.3 ± 0.3 to 1.9 ± 0.2, p < 0.02). Applanation tonometry showed no significant changes for Augmentation Index (AIx) and time to WR, while PPI (Pulse Pressure Index: PP/MBP) decreased from 0.55 ± 0.14 to 0.45 ± 0.09, p < 0.05). Conclusions: after prolonged HDTBR, a reduction in LV pump function is observed with unchanged VA coupling. No significant changes are found in intrinsic arterial stiffness, CCA remodelling and WR, while changes in arterial dynamics indicate a reduction in the pulsatile component and an increase in the steady component of BP, possibly associated with reduced circulating volume and increased peripheral vasodilation.

Aim of this study was to compare a local carotid pulse wave velocity (C-PWV) measured by high resolution radiofrequency (RF) ultrasound (Q-AS®, Esaote) with carotid-femoral PWV (CF-PWV, Complior), and their relationships with age and BP in normal subjects and in patients (ABN) with risk factors and/or atherosclerotic clinical disease (CVD). We studied 64 subjects (37 men and 27 women, mean age 49 ±15, BP 124±19/73±9 mmHg), including 33 NL and 31 ABN. Arterial distension curves were obtained by averaging 15 parallel RF-lines obtained with a 10 MHz linear probe through a 1-cm long ROI in CCA. Local carotid stiffness index was calculated after introducing BP values, and C-PWV was obtained by Bramwell-Hill’s equation. C-PWV in both sides and CF-PWV obtained in the overall population and separately in NL and ABN are shown in Table: In the whole population, C-PWV and CF-PWV correlated directly (p<0.0001) with age (r=0.82 and r=0.61 respectlvey) and SBP (r=0.72 and r=0.64). In multivariate analysis age was the strongest independent predictor of C-PWV (partial R2 = 0.67), followed by SBP (cumulative R2 = 0.82). By contrast, SBP was the best predictor of CF-PWV (partial R2= 0.41), followed by age (cumulative R2 =0.55). Similar results were obtained after introducing sex, risk factors and CVD as covariates. Conclusions: compared to CF-PWV, local C-PWV shows a stronger association with age and results significantly lower in normal subjects but not in patients with risk factors or CVD.

Background: prolonged circulatory unloading associated with head-down tilt bed rest (HDTBR) is followed by cardiovascular deconditioning. Aim of the study was to investigate to what extent large artery function and arterial-ventricular coupling (VA) are involved. Methods: ten healthy male volunteers (age 23±2) were studied before and after a 35-day HDTBR. Left ventricular (LV) volumes were investigated by echocardiography; carotid diameter and intima media thickness were assessed by high resolution ultrasound (Q-IMT, Esaote Europe). Contour Wave Analysis, performed by tonometer (PulsePen, DiaTecne, Milan Italy), was used to explore large artery function. Carotid-femoral pulse wave velocity (PWV) was also estimated (Complior, Alam, Paris). Results: no changes were observed for systolic and diastolic blood pressure, PWV and QIMT vs baseline, while LV volumes showed a significant reduction (p<0.05). Arterial Elastance (Ea= end systolic pressure/stroke volume) and LV Elastance (Elv= end systolic pressure (ESP)/end systolic volume (ESV)) increased after HDTBR (for Ea: 1.08±0.198 vs 1.31±0.21, p=0.01; for Elv 1.478±0.32 vs 1.765±0.42, p=0.04) with unchanged Ea/Elv (0.74±0.09 vs 0.76±0.1). Contour wave analysis showed no significant changes for Augmentation Index (Aix), a reduction for PPI (Pulse Pressure Index: pulse pressure/mean arterial pressure, from 0.55±0.14 to 0.45±0.09, p<0.05), SEVR (subendocardial variability ratio: 1.84±0.33 vs 1.55±0.25, p=0.008) and LVET (left ventricular ejection time: 304.6±19.8 vs 291.5±11.2 ms, p=0.05), and an increase in heart rate (from 58±2 to 73±6, p<0.05). Conclusions: no significant alterations in intrinsic arterial stiffness and structure were detected after HDTBR. The observed changes in large arteries function appear secondary to changes in LV performance.

Background whether metabolic syndrome (MetS) has an independent impact on development of cardiovascular (CV) disease is uncertain. Aim: to evaluate indices of preclinical CV disease in subjects with MetS. Methods: we studied 160 subjects: 50 with MetS (ATP III criteria, age 49 ± 12, BMI 36 ± 7, 12 diabetics) and 110 healthy age-matched controls (NL: 59 males, age 47 ± 9, BMI 28 ± 6). Left ventricular (LV) mass and function were assessed by echocardiography, and common carotid artery (CCA) stiffness (b index, pressure-strain elastic modulus EP, and local wave speed WS) by wall tracking (Aloka SSD-5500). Results: MetS+ showed higher (p < 0.01) EP (138 ± 62 vs 110 ± 40 kPa), β (9.5 ± 3.8 vs 8.2 ± 2.3), WS (7 ± 1.5 vs 6 ± 1.1 cm/s), cardiac index (3.2 ± 0.7 vs 2.8 ± 0.5 l/min/m 2 ), and LV mass index (LVMI) (102 ± 24 vs 88 ± 21 g/m 2 ), and lower peripheral resistance (TPR: 0.016 ± 0.004 vs 0.018 ± 0.004 dyne/s/cm 5 , p < 0.05) than NL. In multivariate analysis (dependent variable WS and independent variables age, sex, SBP, DBP, waist circumference, BMI, triglyceride, HDL-cholesterol and blood glucose levels), the main independent correlated of WS were age and SBP (adjusted r 2 = 0.53, p < 0.01), while male gender and waist were predictors of LVM (adjusted r 2 = 0.56, p < 0.01). Conclusions: in subjects without clinical CV disease and various clustering of risk factors, MetS does not seem to represent an independent predictor of preclinical CV involvement. Large artery stiffness appears mainly related to age and BP, and LVM by body size.

Background: whether or not the presence of intracranial aneurysms (IAs) is associated with alterations in systemic arteries is not known. Aim of the study was to evaluate morphology and distensibility of common carotid artery (CCA) in patients with IAs and in a control group of comparable age, gender and blood pressure (BP). Methods: twenty-eight IAs patients (19 women, mean age 55±12.2) and 27 control subjects (15 women, mean age 50±7.7) were studied. Vascular ultrasound implemented with arterial wall tracking (Aloka Alpha 10 Tokyo, Japan) was used to investigate elastic and structural properties of CCA. Indices of arterial stiffness and wave reflection (pressure independent index ß, arterial compliance (AC) and Augmentation Index (AIx) were obtained after calibration for BP. Mean CCA diameter was derived averaging systolic and diastolic values over ten cardiac cycle, while Intima Media Thickness (IMT) was measured according to the Mannheim consensus. Results: a significantly higher AIx was observed in patients with IAs (16.84±13.2 vs 11.1±9.6%, p<0.05), while ß didn’t differ between groups (9.08±4 vs 8.77±3.07). IAs patients showed a higher IMT than controls (0.77±0.23 vs 0.61±0.12, p<0.01) without difference in diameter (7.55±0.9 vs 7.4±0.7mm). IMT correlated directly (p<0.05) with ß (r=0.37), AC (r=0.38) and AIx (r=0.32) in IAs patients but not in controls. Conclusions: IAs patients show an increased IMT independent of age, BP and gender, which is related to increased wave reflection and arterial stiffness. This finding suggests an underlying systemic arterial involvement in patients prone to IAs.

a relation between aortic stiffening (AS) and LV systolic dysfunction and hypertrophy is established in the elderly. A relation between AS and LV diastolic function can be hypothesized, mediated by age and increased LV mass (LVM). to verify whether AS may affect LV diastolic function independently of LVM and age in subjects with preserved systolic function. 144 subjects below 65 years, (59 controls: age 40 ± 12, MBP 84 ± 7 mmHg; and 85 patients with at least one major risk factor, free of CV disease, age 42 ± 16, mean BP 96 ± 12 mmHg). LV mass, systolic function, diastolic filling were assessed by Echo-Doppler. Early and late diastolic mitral annulus longitudinal velocities (E’ and A’) were assessed by tissue velocity imaging. AS was estimated by carotid-femoral pulse wave velocity (PWV). compared to controls, patients had higher (p < 0.05–0.001) PWV (9.4 ± 2 vs 8.0 ± 1 m/s) and lower transmitral E/A ratio (1.2 ± 0.5 vs 1.4 ± 0.4, p < 0.01); no significant differences were found for LV midwall shortening (116±13 and 119 ± 13

Arterial stiffness (AS) reflects morfo-functional modifications of elastic arteries due to aging and atherosclerosis. Carotid-femoral pulse wave velocity (PWVcf) represents an estabilished marker of aortic stiffness and predictor of cardiovascular mortality. Recently, a new method for evaluating arterial stiffness based on brachial-ankle pulse wave velocity (PWVba) and capable to provide a stiffness index, CAVI (cardio-ankle vascular index), has been proposed. to compare PWVba with PWVcf and to evaluate the corresponding relationships with age and blood pressure in healthy subjects and patients with major risk factors for atherosclerosis. 46 subjects (19 controls; 27 patients with risk factors but without clinical cardiovascular disease; 31 women; age 43±18) were studied. PWVcf was assessed by the established foot to foot method (Complior Artech, Paris); PWVba and CAVI were obtained by a commercially available system (Vasera Fukuda, Tokyo), recording simultaneously brachial and tibial sphygmogram, ECG and phonocardiogram (PGC). CAVI is derived from the stiffness index Beta, according to Bramwell-Hill formula. PWba was significantly correlated with PWVcf (r = 0.785, p<0.001); in Bland Altman analysis, all points but two were included into ± 2SD of mean difference (mean difference = 0.804 ± 2.17 m/s). CAVI, PWVba, PWVcf were directly correlated with age (r = 0.778, 0.595, 0.687; p<0.001) and pulse pressure (r = 0.504, 0.300, 0.422; p<0.001). PWVba, an integrated index of aortic and femoro-tibial stiffness, shows good agreement with PWVcf. CAVI index seems to provide the best associations with age and pulse pressure.

Aortic and carotid stiffness are independent predictors of all cause, cardiovascular, and cerebrovascular morbidity and mortality in several clinical conditions as well as in the general population. was to investigate the associations between non-invasively determined aortic and carotid artery stiffness with vestimates of absolute cardiovascular (CV) risk in healthy subjects and subjects with risk factors. 139 subjects were recruited [104 with one or more CV risk factors (cases: 46 males, mean age 49 years), 35 healthy controls (16 males, mean age 43 years)]. Common carotid artery stiffness was investigated by an ultrasound system with wall track option (Aloka SSD-5500, Tokyo), providing a single point local wave speed (WS). Aortic stiffness was estimated by the carotid-femoral pulse wave velocity (CF-PWV) (Complior, Paris). Ten-year absolute CV risk was estimated using both the Framingham risk score (FRS) chart and the Edinburgh University Risk Chart (EURC, including echocardiographic left ventricular hypertrophy). Cases had significantly (p<0.001) higher CF-PWV (10.5±2.2 vs 8.6±1.3 m/s), WS (7.6±1.4 vs 5.8±0.8 m/s), FRS (10.8±10.2 vs 3.1±3.1