title: Contrast-enhanced ultrasound evaluation of peripheral microcirculation in diabetic patients: effects of cigarette smoking.
abstract: OBJECTIVE
  Cigarette smoking and diabetes mellitus predisposes to vascular disease. Our study aimed to evaluate the chronic effects of cigarette smoking on peripheral microcirculation assessed with contrast-enhanced ultrasound (CEUS) in diabetic patients.
  
  
  METHODS
  The study population comprised ten smoker (7/3 M/W, age 42-76 years) and 16 nonsmoker (8/8 men/women, age 47-80 years) diabetic patients. The ankle-brachial index (ABI) was determined, and colour Doppler ultrasound (CDUS) of the lower legs was performed to determine the presence of peripheral arteriopathy disease (PAD). Microvascular blood flow in the gastrocnemius muscle was evaluated with CEUS.
  
  
  RESULTS
  No differences were observed in ABI and CDUS examination between smokers and nonsmokers. Smoking had a significant effect on microcirculatory function. Timeto-peak (TTP), arrival time in tissue (ATt) and artery/ tissue transit time (A/Ttt) were significantly prolonged in smokers (TTP 43.76 ± 9.38 s vs. 34.12 ± 6.8 s, p=0.011, ATt 28.9 ± 7.5s vs. 22.4 ± 6.4 s, p=0.017 and A/Ttt 6.81 ± 4.52 s vs. 3.25 ± 3.27 s, p=0.02), with no significant differences between patients with and without PAD.
  
  
  CONCLUSIONS
  The long-term exposure to cigarette smoke affects microcirculatory function. Contrast imaging is a noninvasive technique that can document these effects.
authors.affiliation: Institute of Biostructure and Bioimage, National Council of Research (CNR), Federico II University School of Medicine, Via Pansini 5, Edificio 10, 80131, Naples, Italy. marcello.mancini@libero.it
authors.forename: M
authors.initials: M
authors.lastname: Mancini
authors.forename: O
authors.initials: O
authors.lastname: Di Donato
authors.forename: G
authors.initials: G
authors.lastname: Saldalamacchia
authors.forename: R
authors.initials: R
authors.lastname: Liuzzi
authors.forename: A
authors.initials: A
authors.lastname: Rivellese
authors.forename: M
authors.initials: M
authors.lastname: Salvatore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D003287:Contrast Media; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010743:Phospholipids; D012907:Smoking / Q000009:adverse effects*; D018709:Statistics, Nonparametric; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride