Martí Vallés

Doppler ultrasound in the measurement of pulse wave velocity: agreement with the Complior method

Aortic stiffness is an independent predictor factor for cardiovascular risk. Different methods for determining pulse wave velocity (PWV) are used, among which the most common are mechanical methods such as SphygmoCor or Complior, which require specific devices and are limited by technical difficulty in obtaining measurements. Doppler guided by 2D ultrasound is a good alternative to these methods. We studied 40 patients (29 male, aged 21 to 82 years) comparing the Complior method with Doppler. Agreement of both devices was high (R = 0.91, 0.84-0.95, 95% CI). The reproducibility analysis revealed no intra-nor interobserver differences. Based on these results, we conclude that Doppler ultrasound is a reliable and reproducible alternative to other established methods for the measurement of aortic PWV.

The Relationship Between Renal Resistive Index, Arterial Stiffness, and Atherosclerotic Burden: The Link Between Macrocirculation and Microcirculation

The renal resistive index (RRI) measured by Doppler sonography is a marker of microvascular status that can be generalized to the whole of the arterial tree. Its association with large‐vessel dysfunction, such as arterial stiffness or the atherosclerotic burden, can help to establish physiopathological associations between macrocirculation and microcirculation. The authors conducted a cross‐sectional study of hypertensive patients (n=202) and a healthy control group (n=16). Stiffness parameters, atherosclerotic burden, and determination of the RRI in both kidneys were performed. The average RRI was 0.69±0.08 and was significantly greater in patients with diabetes and chronic kidney disease. Renal resistive index positively correlated with age, creatinine, and albuminuria. Positive correlations were found with arterial stiffness parameters (pulse wave velocity, ambulatory arterial stiffness index, and 24‐hour pulse pressure), as well as atherosclerotic burden and endothelial dysfunction measured as asymmetric dimethylarginine in serum. In the multivariate analysis, independent factors for increased RRI were age, renal function, 24‐hour diastolic blood pressure, and arterial stiffness. The authors concluded that there is an independent association between renal hemodynamics and arterial stiffness. This, together with the atherosclerotic burden and endothelial dysfunction, suggests that there is a physiopathologic relationship between macrovascular and microvascular impairment.

Does the obesity survival paradox of dialysis patients differ with age

Background: The obesity paradox of hemodialysis patients (the association between obesity and survival) could be modified by age. We hypothesize that whereas obesity associates with survival in elderly patients, it behaves as a mortality risk marker in younger individuals. Methods: Retrospective study of 2002-2010 adult incident hemodialysis to analyze the relationship between body mass index (BMI) and annual body weight changes with mortality in different age strata. Results: Included in the study were 6,290 individuals. A progressive decrease in mortality was associated with increasing BMI ranges. Both annual body weight gains and losses were associated with mortality. Similar results were observed in elderly individuals, but in the BMI values of young patients, there were no significant differences in mortality. Conclusion: There is a survival benefit with increasing BMI in patients overall. However, while these results persist in patients >65 years, in young people there are no changes in mortality. Patients with the highest inter-annual variability in weight have an increased risk.

Reproducibilidad de la MAPA en pacientes con diabetes mellitus 2

Objetivo Estudiamos la reproducibilidad de las cifras tensionales y de los trastornos del ritmo nictameral en pacientes afectos de diabetes mellitus 2. Asimismo valoramos la concordancia del estudio tensional con las complicaciones micro y macrovasculares presentes. Pacientes y metodo Se estudia a 58 pacientes afectos de diabetes mellitus 2 con dos registros ambulatorios de presion arterial (MAPA) en un periodo inferior a las 8 semanas sin cambios en la medicacion hipotensora. Resultados La concordancia de las cifras de PA sistolica y PA diastolica tanto de las 24 horas como de dia y noche es superior al 73%. La reproducibilidad para la situacion dipper/no dipper es muy baja. Doce de los pacientes se comportan repetidamente como dipper, otros 12 como no dipper y el resto son dipper variables. Sin alcanzar significacion estadistica los diabeticos repetidamente no dipper tienen una excrecion urinaria de albumina mas elevada. Conclusiones En el diabetico tipo 2 las cifras de PA medidas por MAPA tienen una elevada reproducibilidad. Sin embargo, los trastornos del ritmo nictameral la tienen muy baja. La condicion no dipper persistente comporta, probablemente, mayor repercusion visceral.

Nefropatía, ritmo nictemeral y presión de pulso en la diabetes mellitus tipo 2

Fundamento La perdida del ritmo nictemeral de la presion arterial y la presion de pulso elevada se consideran factores de riesgo cardiovascular independientes que pueden relacionarse con la afeccion microvascular de los pacientes con diabetes mellitus tipo 2. Pacientes Y Metodo Estudio observacional, transversal, de una poblacion de pacientes con diabetes mellitus tipo 2. Las variables se estudian mediante registro ambulatorio de la presion arterial. Los resultados se comparan con los diversos grados de nefropatia. Resultados Se estudia a un total de 61 pacientes, 31 de los cuales tienen un comportamiento no dipper. La proporcion de no dipper aumenta con la excrecion urinaria de albumina (p = 0,024). La presion de pulso es superior en los pacientes con macroalbuminuria (p = 0,004). Conclusiones Existe una perdida del ritmo nictemeral mas frecuente, asi como presiones del pulso mas elevadas, entre los pacientes con diabetes mellitus tipo 2 que presentan nefropatia.