Why the radial augmentation index is low in patients with diabetes: The J-HOP study
Why the radial augmentation index is low in patients with diabetes: The J-HOP study
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DOI：
10.1016/j.atherosclerosis.2016.01.034
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发表时间：
2016-03-01
期刊：
影响因子：
5.3
通讯作者：
Kario, Kazuomi
中科院分区：
文献类型：
--
作者：
Eguchi, Kazuo;Hoshide, Satoshi;Kario, Kazuomi
背景：径向增强指数 (rAI) 是主动脉波反射的标志物，尽管糖尿病 (DM) 患者的动脉粥样硬化变化较晚，但糖尿病 (DM) 患者的径向增强指数 (rAI) 通常低于非 DM 受试者。目的：我们试图探讨为什么 DM 中的 rAI 低于非 DM 患者。方法：我们对 1787 名至少有一种心血管危险因素的受试者进行了径向压平眼压测量。 rAI 定义为[收缩末期肩压幅度 (PP2)]/[桡动脉脉压 (rPP)]。径向压力波的收缩末期肩部血压 (SBP2) 和 PP2 分别用作中心 SBP 和 PP (cPP) 的估计。结果：DM 和非 DM 之间的年龄（65.8 +/- 9.8 与 65.8 +/- 12.1 岁）和平均肱 SBP（141 +/- 16 与 141 +/- 17 mmHg）相似组。 DM 组的 rAI 显着较低（83.3 +/- 14.1 对比 87.3 +/- 15.7%，p < 0.001），但临床 PP（62 +/- 14 对比 59 +/- 14 mmHg，p < 0.001）和 cPP（51 +/- 15 对比 49 +/- 15 mmHg，p = 0.019）在DM组中显着高于非DM组。在调整协变量的多变量分析中，rAI 的显着决定因素是 DM 组的估计肾小球滤过率 (eGFR)（β = 0.17，p < 0.001），以及非 DM 组的胰岛素抵抗的对数转换稳态模型评估（HOMA-IR）（β = -0.15，p < 0.001）。中枢 SBP 和 cPP 也出现相同的趋势。 结论：与非糖尿病相比，糖尿病患者的 rAI 较低且 cPP 较高，表明以近端导管为主的动脉硬化导致全身反射部位的反射系数降低。随着肾功能下降，DM 组中 cPP 的增加可能会克服增压压力的增加。 (C) 2016 Elsevier Ireland Ltd. 保留所有权利。
Background: Radial augmentation index (rAI), a marker of aortic wave reflection, is usually lower in patients with diabetes (DM) than in non-DM subjects, even though atherosclerotic change is advanced in DM.Objective: We sought to explore why rAI in DM is lower than in non-DM.Methods: We performed radial applanation tonometry in 1787 subjects who had at least one cardiovascular risk factor. The rAI was defined as [late systolic shoulder pressure amplitude (PP2)]/[radial pulse pressure (rPP)]. The late systolic shoulder blood pressure (SBP2) and PP2 of a radial pressure wave were used as estimates of the central SBP and PP (cPP), respectively.Results: The age (65.8 +/- 9.8 vs. 65.8 +/- 12.1 yrs) and mean brachial SBP (141 +/- 16 vs. 141 +/- 17 mmHg) were similar between the DM and non-DM groups. The rAI was significantly lower in the DM group (83.3 +/- 14.1 vs. 87.3 +/- 15.7%, p < 0.001), but clinic PP (62 +/- 14 vs. 59 +/- 14 mmHg, p < 0.001) and cPP (51 +/- 15 vs. 49 +/- 15 mmHg, p = 0.019) were significantly greater in the DM group than in the non-DM group. In multivariable analyses adjusting for covariates, the significant determinants of rAI were the estimated glomerular filtration rate (eGFR) (beta = 0.17, p < 0.001) in the DM group, and the log-transformed homeostatic model assessment of insulin resistance (HOMA-IR) (beta = -0.15, p < 0.001) in the non-DM group. The same trends were also seen for central SBP and cPP.Conclusions: The lower rAI in DM associated with higher cPP compared to non-DM suggests proximal conduit-predominant arterial stiffening causing reduced reflection coefficients at systemic reflection sites. As renal function decreases, a cPP increase may overcome the increase of augmentation pressure in the DM group. (C) 2016 Elsevier Ireland Ltd. All rights reserved.