title: Elevated plasma B-type natriuretic peptide concentration and resistive index, but not decreased aortic distensibility, associate with impaired blood flow at popliteal artery in type 2 diabetic patients.
abstract: Blood flow in lower extremity arteries is frequently impaired in diabetic patients even though they have a normal ankle-brachial index (ABI 1.0-1.4). Risk factors contributing to this lower extremity arterial disease have not been fully elucidated. We enrolled 52 type 2 diabetic patients with normal ABI and 30 age-matched nondiabetic subjects consecutively admitted to our hospital. Plasma B-type natriuretic peptide (BNP) concentrations were measured. Distensibility in ascending thoracic and abdominal aortas as well as total flow volume and resistive index at popliteal artery were evaluated by gated magnetic resonance imaging. An automatic device was used to measure ABI and brachial-ankle pulse-wave velocity (baPWV). Diabetic patients showed lower distensibility in ascending thoracic aorta (p<0.001) and total flow volume (p<0.001) and higher baPWV (p<0.001) and resistive index (p=0.005) and similar BNP and distensibility in abdominal aorta compared to nondiabetic subjects. Simple linear regression analyses revealed that distensibility in ascending thoracic (p=0.019) and abdominal (p=0.030) aortas positively as well as baPWV (p=0.020), resistive index (p<0.001) and BNP (p<0.001) negatively correlated with total flow volume. Stepwise multiple regression analysis demonstrated that increased BNP and resistive index were independent risk factors for total flow volume in diabetic patients (r(2)=0.639, p<0.001). These results indicate that increased plasma BNP levels and peripheral vascular resistance, but not decreased aortic distensibility, associate with impaired blood flow in lower extremity arteries in diabetic patients.
authors.affiliation: Department of Diabetes and Endocrinology, Gifu Prefectural General Medical Center, Gifu 500-8717, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Tajima
authors.forename: Eiji
authors.initials: E
authors.lastname: Suzuki
authors.forename: Jun
authors.initials: J
authors.lastname: Saito
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Murase
authors.forename: Yukio
authors.initials: Y
authors.lastname: Horikawa
authors.forename: Jun
authors.initials: J
authors.lastname: Takeda
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D001011:Aorta / Q000737:chemistry / Q000503:physiopathology; D001027:Aortography; D015415:Biomarkers / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D004548:Elasticity; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D011150:Popliteal Artery / Q000737:chemistry / Q000000981:diagnostic imaging / Q000503:physiopathology*; D063177:Pulse Wave Analysis; D012039:Regional Blood Flow; D012307:Risk Factors; D015854:Up-Regulation; D014655:Vascular Resistance
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain