Elsevier

Microvascular Research

Volume 95, September 2014, Pages 31-36
Microvascular Research

Hemorheology, ankle brachial pressure index (ABPI) and toe brachial pressure index (TBPI) in metabolic syndrome

https://doi.org/10.1016/j.mvr.2014.06.013Get rights and content

Highlights

  • Erythrocyte aggregation and whole blood viscosity value were increased in MetS subjects.

  • Toe brachial pressure index value was decreased in MetS subjects.

  • Increased Ankle Brachial pressure index in MetS could be due to calcified arteries.

  • Hemorheological parameters were significantly correlated with several MetS components.

  • All of the MetS components independently predicted erythrocyte hyperaggregability.

Abstract

Introduction

Microvascular dysfunction is associated with metabolic syndrome (MetS) and its components. The objective of our study was to assess macro and microvascular abnormalities in MetS and compare the strength of association of the ankle brachial pressure index (ABPI), toe brachial pressure index (TBPI) and hemorheological parameters with MetS.

Materials and methods

100 participants were recruited from a rural Australian town. Anthropometric measurements were taken along with blood pressures (BP) at the arm, the ankle and the big toe for calculating ABPI and TBPI. Whole blood viscosity (WBV), erythrocyte aggregation, erythrocyte deformability, lipid profile and blood sugar level were analyzed. Recruited participants were classified into MetS and non-MetS following National Cholesterol Education Program Adult Treatment Panel III definition. Data were analyzed by IBM SPSS 20 software.

Results

WBV and erythrocyte aggregation were higher whereas erythrocyte deformability was lower in participants with MetS when compared to participants without MetS. Age, sex and diabetes mellitus adjusted odds ratio for predicting MetS was not significant for ABPI and TBPI whereas it was significant for hemorheological parameters. Receiver Operating Characteristics curve showed that TBPI better classified MetS than ABPI but association of hemorheological parameters was superior to that of ABPI and TBPI with MetS.

Conclusions

Both microcirculation defects and macrovascular circulation defects were present in MetS. The concurrences of the components of MetS could have an additive effect in enhancing alterations in hemorheological parameters which may give rise to severe microvasculopathy. The association of hemorheological parameters was stronger than the association of TBPI and ABPI with MetS.

Introduction

Metabolic syndrome (MetS) is the constellation of risk factors, the presence of which is associated with increased risk of developing cardiovascular diseases (CVD) (Isomaa et al., 2001, Lakka et al., 2002). Microvascular dysfunction is associated with MetS and its components (Czernichow et al., 2010, Serné et al., 2007, Vykoukal and Davies, 2011). The experiment of Frisbee and Stepp, on the obese zucker rat model, demonstrated reduced vasodilation of skeletal muscle to nitric oxide stimuli (Frisbee and Stepp, 2001). Same authors through series of experiments showed chronic reductions in the blood flow in a hind limb of obese Zucker rat model with MetS. Wall thickness and lumen of the vessels supplying hind limb were reduced and the compliance of the vessels wall was lost (Frisbee and Stepp, 2001, Stepp and Frisbee, 2002, Stepp et al., 2004). Microvascular abnormalities affect the pressure and the flow of the blood (Levy et al., 2001, Serné et al., 2007). Another important aspect of microcirculation that affects the pressure and flow of blood is hemorheology (Baskurt and Meiselman, 2003, Pirrelli, 1999, Sandhagen, 1999). Hemorheological parameters such as increased whole blood viscosity (WBV), reduced erythrocyte deformability, increased erythrocyte aggregation and altered erythrocyte morphology have been associated with MetS (Gyawali et al., 2012a, Gyawali et al., 2012b, Gyawali, 2014). Altered hemorheology has been shown to negatively affect microcirculation (Konstantinova et al., 2004).

Measurement of ankle brachial pressure index (ABPI) by using Doppler ultrasound device is the commonly used clinical method of assessing peripheral arterial disease and circulation in the lower limb (Vowden et al., 1996). However, the validity of measuring ABPI in diabetic subjects due to lower limb artery calcification has been questioned (Brooks et al., 2001, Mayfield et al., 1998). Recent literature has supported the use of the toe brachial pressure index (TBPI) for assessing circulation as it overcomes the medium vessel calcification problem seen, in the lower limb of patients with type II diabetes mellitus (DM) (Brooks et al., 2001, Mayfield et al., 1998). The objective of our study was to assess macro and microvascular abnormalities in MetS and compare the strength of association of the ABPI, TBPI and hemorheological parameters with MetS.

Section snippets

Subjects

One hundred (100) participants were recruited from a rural town of Australia from June to Dec, 2013. Pregnant women, non-ambulatory patients and children under 18 years of age were excluded from the study. Recruited participants were divided into three groups on the basis of the absence or presence of MetS and its components. A modified NCEP-ATPIII guideline was referred to define MetS (Expert panel on detection evaluation treatment of high blood cholesterol in adults, 2001, Grundy et al., 2004

Anthropometric and blood pressure measurement

Waist circumference of the participants was measured from the upper margin of the posterior iliac crest at the end of normal expiration directly above the skin. Brachial blood pressure was measured with an automated BP machine (Welch Allyn®) in a supine position from both arms. Toe brachial pressure was measured from the great toe of both legs using SysToe (ATYS medical) that uses photoplethysmography (PPG) analyzed by a unique patented algorithm designed by Atys Medical. TBPI was calculated by

Results

Thirty-one participants formed group I, thirty-three formed group II and thirty-six formed group III. Mean age of the participants was compared into the three groups of classification using ANOVA tests. The difference in mean age between the three groups (45.48 ± 8.974, 56.52 ± 12.94 and 63.06 ± 12.13 years) was statistically significant (P < 0.0005). Tukey post-hoc analysis revealed that the increase from group I to II (P = 0.001) and from group I to III (P < 0.0005) was significant but age difference in

Discussion

Our study showed that WBV and erythrocyte aggregation were higher whereas erythrocyte deformability (lower EImax), was lower in the participants with MetS when compared to the participants without MetS. MetS was significantly associated with the highest quartile of critical stress and WBV and with the lowest quartile of erythrocyte deformability. Our findings are in line with reports from Zhang et al. which showed that the mean WBV level was progressively higher in groups with higher number of

Conclusions

Both microcirculation defect and macrovascular circulation defect were present in MetS. All of the hemorheological parameters were significantly associated with MetS. The association of hemorheological parameters was stronger than the association of TBPI and ABPI with MetS. Altered hemorheology could be the bridge that connects MetS with increased CVD. Also, defect in microcirculation due to altered hemorheology could be one of the several pathogenic mechanisms underlying complications of MetS.

References (46)

  • S. Chien

    Blood viscosity: influence of erythrocyte aggregation

    Science

    (1967)
  • P. Connes

    Hemorheology and heart rate variability: is there a relationship?

    Clin. Hemorheol. Microcirc.

    (2008)
  • S. Czernichow

    Macrovascular and microvascular dysfunction in the metabolic syndrome

    Hypertens. Res.

    (2010)
  • P. Dandona

    Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation

    Circulation

    (2005)
  • Expert panel on detection evaluation treatment of high blood cholesterol in adults

    Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III)

    JAMA

    (2001)
  • J.C. Frisbee et al.

    Impaired NO-dependent dilation of skeletal muscle arterioles in hypertensive diabetic obese Zucker rats

    Am. J. Physiol. Heart Circ. Physiol.

    (2001)
  • S.M. Grundy

    Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on scientific issues related to definition

    Circulation

    (2004)
  • P. Gyawali

    Erythrocyte morphology in metabolic syndrome

    Expert. Rev. Hematol.

    (2012)
  • P. Gyawali

    Whole-blood viscosity and metabolic syndrome

    Clin. Lipidol.

    (2012)
  • P. Gyawali

    Erythrocyte aggregation and metabolic syndrome

    Clin. Hemorheol. Microcirc.

    (2014)
  • J.X. Hou et al.

    Transient microfluidic approach to the investigation of erythrocyte aggregation: comparison and validation of the method

    Korea-Aust. Rheol. J.

    (2008)
  • I.W. Husstedt

    Progression of distal symmetric polyneuropathy during diabetes mellitus: clinical, neurophysiological, haemorheological changes and self-rating scales of patients

    Eur. Neurol.

    (1997)
  • B.O. Isomaa

    Cardiovascular morbidity and mortality associated with the metabolic syndrome

    Diabetes Care

    (2001)
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