Metabolic syndrome (MS) is not a single disease but a cluster of metabolic disorders associated with increased risk for development of diabetes mellitus and its complications. Currently, the definition of MS published in 2009 is widely used, but there are more versions of the diagnostic criteria, making it difficult to conduct scientific discourse in this area. Increased arterial stiffness (AS) can predict the development of cardiovascular disease both in the general population and in patients with MS. Pulse wave velocity (PWV), as a standard method to assess AS, may point out subclinical organ damage in patients with hypertension. The decrease in PWV level during antihypertensive therapy can identify a group of patients with better outcomes independently of their reduction in blood pressure. The adverse effect of metabolic disturbances on arterial function can be offset by an adequate program of exercises, which includes mainly aerobic physical training. Non-insulin-based insulin resistance index can predict AS due to a strong positive correlation with PWV. The purpose of this paper is to present the results of the review of the literature concerning the relationship between MS and its components, and AS assessed by PWV, including clinical usefulness of PWV measurement in patients with MS and its components.
Cardiovascular diseases (CVDs) in the course of atherosclerosis are one of the most critical public health problems in the world. Endothelial cells synthesize numerous biologically active substances involved in regulating the functions of the cardiovascular system. Endothelial dysfunction is an essential element in the pathogenesis of atherosclerosis. Thus, the assessment of endothelial function in people without overt CVD allows for a more accurate estimate of the risk of developing CVD and cardiovascular events. The assessment of endothelial function is primarily used in scientific research, and to a lesser extent in clinical practice. Among the tools for assessing endothelial function, we can distinguish biochemical and physical methods, while physical methods can be divided into invasive and non-invasive methods. Flow-mediated dilation (FMD) is based on the ultrasound assessment of changes in the diameter of the brachial artery as a result of increased blood flow. FMD is a non-invasive, safe, and repeatable test, but it must be performed by qualified and experienced medical staff. The purpose of this paper is to present the literature review results on the assessment of endothelial function using the FMD method, including its methodology, applications in clinical practice and research, limitations, and future perspectives.
Background Despite the progress in research, the utility of clinical assessment for the prediction of stroke is limited. The aim herein, was to evaluate the predictive values of major ultrasound indexes of carotid artery and fat depots for stroke in patients with high and very high cardiovascular (CV) risk. Methods The study group included 364 patients (age: 61.3 ± 7.2 years old) with typical CV risk factors scheduled for elective coronary angiography (2012–2013). A comprehensive baseline assessment included the following ultrasound indexes: carotid artery intima–media thickness (IMT), extra–media thickness (EMT), epicardial (EFT) and pericardial fat thickness (PFT), abdominal subcutaneous (ASF) and visceral fat (AVF) and combined periarterial adipose tissue intima–media adventitia (PATIMA) index. Afterwards, all patients were followed for 80.9 ± 7.1 months. Results There were 23 strokes and 25 cases with new-onset atrial fibrillation during follow-up. Receiver operating characteristics (ROC) analysis showed, that selected clinical parameters (age, waist circumference [WC], waist-hip ratio [WHR]) and ultrasound indexes (EFT: area under curve [AUC] 0.672, p < 0.01 and PATIMA index: AUC 0.658, p < 0.01) were predictive for stroke. However, their predictive values showed no significant differences (p = NS). The baseline body mass index (BMI) was the only parameter, which showed a prediction for new-onset atrial fibrillation (BMI > 33 kg/m 2 : sensitivity 65%, specificity 76%). Conclusions It was found that age, WC and echocardiographic EFT revealed significant predictive values for stroke. Both WC and EFT showed a very high NPV suggesting that they should be implemented into the clinical practice as a tool affirming a very low risk of stroke.
The superficial temporal artery (STA), an end branch of the external carotid artery, is a major artery of the head. Due to its location, where skin and fat tissue remain the only protection of the artery, it can be easily damaged while head injury, causing an aneurysm to form. So far around four hundreds of cases of STA aneurysms have been described in the literature. We present a 37-year-old woman with a painless pulsatile mass of approximately one centimeter above the left ear and headaches in the left temporal area. In the past, she was a victim of domestic violence with a few head trauma. The STA aneurysm was confirmed in ultrasound imaging. The patient did not meet the criteria for the diagnosis of giant cell arteritis. She was presented for a vascular surgery consultation and qualified for surgical resection of the aneurysm. In addition, the patient was diagnosed with hepatic hemangioma and mild aortic and mitral valve regurgitation. According to the available literature, STA aneurysms have mostly been reported as post-traumatic. The gold standard for STA aneurysm treatment is surgical resection. The procedure was reported as safe, as well as a low grade of recurrence or complications during the procedure was shown in the literature.
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