title: Advances in the non-invasive assessment of vascular dysfunction in metabolic syndrome and diabetes: Focus on endothelium, carotid mechanics and renal vessels.
abstract: The present paper is a selective review on the methodology and clinical significance of techniques to assess specifically endothelial function, carotid mechanics and renal vascular function, particularly in the light of vascular dysfunction in metabolic syndrome and type 2 diabetes.
  
  
  
  Endothelial dysfunction appears to be earlier detectable in the microcirculation of patients with altered glucose metabolism, while it attains significance in the macrocirculation at more advanced disease stages. Smooth muscle cell dysfunction is now increasingly recognized to play a role both in the development of endothelial dysfunction and abnormal arterial distensibility. Furthermore, impaired glucose metabolism affects carotid mechanics through medial calcification, structural changes in extracellular matrix due to advanced glycation and modification of the collagen/elastin material stiffness. The assessment of renal vascular function by dynamic ultrasound or magnetic resonance imaging has recently emerged as an appealing target for identifying subtle vascular alterations responsible for the development of diabetic nephropathy.
  
  
  
  Vascular dysfunction represents a major mechanism for the development of cardiovascular disease in patients with abnormal glucose metabolism. Hence, the currently available non-invasive techniques to assess early structural and vascular abnormalities merit recommendation in this population, although their predictive value and sensitivity to monitor treatment-induced changes have not yet been established and are still under investigation.
authors: Department of Clinical and Experimental Medicine, University of Pisa, Italy.
authors: R M
authors: RM
authors: Bruno
authors: Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Netherlands; Department of Biomedical Engineering, Cardiovascular Center, Maastricht University Medical Center, Netherlands.
authors: K D
authors: KD
authors: Reesink
authors: Department of Clinical and Experimental Medicine, University of Pisa, Italy. Electronic address: lorenzo.ghiadoni@med.unipi.it.
authors: L
authors: L
authors: Ghiadoni
mesh_terms: D000818:Animals; D002339:Carotid Arteries / Q000503:physiopathology*; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D003935:Diagnostic Techniques, Cardiovascular; D042241:Early Diagnosis; D004730:Endothelium, Vascular / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D007668:Kidney / Q000098:blood supply*; D024821:Metabolic Syndrome / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis
keywords: Arterial stiffness; Biomechanics; Carotid artery; Endothelium; Flow mediated dilation; Nephropathy; Renal blood flow; Wall stress