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Pulsatile interaction between the macro-vasculature and micro-vasculature: proof-of-concept among patients with type 2 diabetes

Climie, RED, Picone, DS ORCID: 0000-0002-4760-1634, Blackwood, S, Keel, SE, Qasem, A, Rattigan, S ORCID: 0000-0001-6172-3040 and Sharman, JE ORCID: 0000-0003-2792-0811 2018 , 'Pulsatile interaction between the macro-vasculature and micro-vasculature: proof-of-concept among patients with type 2 diabetes' , European Journal of Applied Physiology , pp. 1-9 , doi:

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Purpose: It is widely thought that excess pulsatile pressure from increased stiffness of large central arteries (macro-vasculature) is transmitted to capillary networks (micro-vasculature) and causes target organ damage. However, this hypothesis has never been tested. We sought to examine the association between macro- and micro-vasculature waveform features in patients with type 2 diabetes (i.e., those with elevated stiffness; T2D) compared with non-diabetic controls.Methods: Among 13 T2D (68 ± 6 years, 39% male) and 15 controls (58 ± 11 years, 40% male) macro-vascular stiffness was determined via aortic pulse wave velocity (aPWV) and macro-vascular waveforms were measured using radial tonometry. Forearm micro-vascular waveforms were measured simultaneously with macro-vascular waveforms via low power laser Doppler fluxmetry. Augmentation index (AIx) was derived on macro- and micro-vascular waveforms. Target organ damage was assessed by estimated glomerular filtration rate (eGFR) and central retinal artery equivalent (CRAE).Results: aPWV was higher among T2D (9.3 ± 2.5 vs 7.5 ± 1.4 m/s, p = 0.046). There was an obvious pulsatile micro-vascular waveform with qualitative features similar to macro-vasculature pressure waveforms. In all subjects, macro- and micro-vasculature AIx were significantly related (r = 0.43, p = 0.005). In T2D alone, micro-vasculature AIx was associated with eGFR (r = - 0.63, p = 0.037), whereas in controls, macro-vasculature AIx and AP were associated with CRAE (r = - 0.58, p = 0.025 and r = - 0.61, p = 0.015).Conclusions: Macro- and micro-vasculature waveform features are related; however, micro-vasculature features are more closely related to markers of target organ damage in T2D. These findings are suggestive of a possible interaction between the macro- and micro-circulation.

Item Type: Article
Authors/Creators:Climie, RED and Picone, DS and Blackwood, S and Keel, SE and Qasem, A and Rattigan, S and Sharman, JE
Keywords: aorta, arterial stiffness, blood pressure, physiology
Journal or Publication Title: European Journal of Applied Physiology
Publisher: Springer-Verlag
ISSN: 1439-6319
DOI / ID Number:
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Copyright 2018 Springer-Verlag GmbH Germany, part of Springer Nature

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