Pulse-Wave Velocity, Flow-Mediated Dilation, and Carotid Intima-Media Thickness to Assess Cardiovascular Risk in Population with Metabolic Syndrome

Vascular aging and atherogenesis are key mechanisms promoting cardiovascular diseases, particularly in the presence of risk factors like diabetes, hypertension, and other metabolic dysfunctions. Pulse-wave velocity, flow-mediated dilation and carotid intima-media thickness evaluate arterial stiffness, endothelial dysfunction, and subclinical atherogenesis, providing highly valuable information about patients'cardiovascular profile. Using combined methods to assess vascular health, we found that patient with metabolically unhealthy obesity had lower values of flow-mediated dilation, or FMD, and plasma nitric oxide than patient with metabolically healthy obesity.

This finding provide information leading to prevention, early intervention, and reduction of cardiovascular diseases in population at risk. Determination of vascular elasticity and compliance as well as mediators of vasodilation and atherosclerosis provide a more comprehensive evaluation of vascular health and disease, leading to improved risk stratification and early intervention in the metabolic syndrome population. Our hemodynamic parameters, FMD and CIMT, represent useful diagnostic tools for evaluating cardiovascular risk.

Future challenges for these methods include a combined prognostic interpretation where research is still evolving. To begin, place the patient in a supine position for at least five minutes before beginning the assessment. Place a brachial cuff and secure it around the patient's arm centered on the brachial artery.

Then connect the brachial cuff tube to the SphygmoCor device tube. Press the Start button of the device two times for aortic pressure measurement. Obtain pulse-wave analysis, or PWA, by applanation tonometry.

After scaling the arterial pressure waveform, analyze the systolic part of the waveform, also considering biometric and demographic data. Then obtain an automatic report of the test containing aortic parameters. Proceed to perform carotid femoral pulse wave velocity, or cfPWV, determination through applanation tonometry method.

Place a femoral cuff around the patient's thigh as high as possible, ensuring the tube is centered at the top of the leg. To find the carotid pulse on the patient's neck below the jaw, ask the patient to rotate their head slightly aside. Once the carotid pulse is found at the strongest perceived site, place an indicator mark on the patient's skin.

Obtain three measurements:first, the distance between the carotid pulse and the suprasternal notch;second, the distance between the suprasternal notch and the femoral cuff;and, finally, the distance between the femoral artery by palpating the pulse on the patient's groin and the femoral cuff. Then introduce information on the three distances into SphygmoCor XCEL software. Now connect the femoral cuff tube to the SphygmoCor device tube.

Place the tip of the tonometer on the site where the carotid pulse was previously located, then press the Start button and estimate the cfPWV. To perform the flow-mediated dilation, or FMD, place a high-resolution linear transducer in B mode coupled to the compatible analysis software on the brachial artery. Using a sphygmomanometer, place the cuff around the patient's right forearm.

Scan longitudinally five to 10 centimeters above the elbow. After cuff deflation, perform a continuous record of the longitudinal image of the brachial artery for three minutes and determine the diameter again. To perform the carotid intima-media thickness or CIMT measurement, apply a four-megahertz ultrasonographic probe to identify neck vascular structures such as the carotid artery and jugular vein, as well as the thyroid gland, in a transverse orientation at the base of the neck.

Locate the right carotid artery using a transverse orientation of the transducer, moving in a cephalic direction until the carotid bulb and the bifurcation of the internal and external carotid artery are identified. Then rotate the transducer 90 degrees to achieve a longitudinal view of the carotid bulb. Determine CIMT by measuring the distance between the intima-lumen and media adventitia interfaces along a one-centimeter range distal from the carotid bulb.

The subjects in the metabolically unhealthy obese, or MUO, group exhibited lower values of FMD compared to the metabolically healthy obese, or MHO, group. However, no statistical differences were found in CIMT.