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Microangiopathy of large artery wall: A neglected complication of diabetes mellitus

  • Author Footnotes
    1 These authors contributed equally to this study.
    Maria Vittoria Arcidiacono
    Footnotes
    1 These authors contributed equally to this study.
    Affiliations
    Department of Nephrology, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198 Lleida, Spain

    Unitat de Detecció i Tractament de Malalties Aterotrombòtiques, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198 Lleida, Spain

    Institut de Recerca Biomedica de Lleida, University of Lleida, Rovira Roure, 80, 25198 Lleida, Spain
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  • Author Footnotes
    1 These authors contributed equally to this study.
    Alicia Traveset
    Footnotes
    1 These authors contributed equally to this study.
    Affiliations
    Department of Ophthalmology, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198 Lleida, Spain
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  • Esther Rubinat
    Affiliations
    Unitat de Detecció i Tractament de Malalties Aterotrombòtiques, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198 Lleida, Spain

    Institut de Recerca Biomedica de Lleida, University of Lleida, Rovira Roure, 80, 25198 Lleida, Spain

    Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198 Lleida, Spain
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  • Emilio Ortega
    Affiliations
    Department of Endocrinology and Nutrition, Institut d'Investigacions Biomediques August Pi Suñer, Spain

    CIBER de Diabetes y Enfermedades Metabólicas asociadas, Hospital Clinic, Villarroel, 170, 08036 Barcelona, Spain
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  • Angels Betriu
    Affiliations
    Department of Nephrology, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198 Lleida, Spain

    Unitat de Detecció i Tractament de Malalties Aterotrombòtiques, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198 Lleida, Spain

    Institut de Recerca Biomedica de Lleida, University of Lleida, Rovira Roure, 80, 25198 Lleida, Spain
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  • Marta Hernández
    Affiliations
    Unitat de Detecció i Tractament de Malalties Aterotrombòtiques, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198 Lleida, Spain

    Institut de Recerca Biomedica de Lleida, University of Lleida, Rovira Roure, 80, 25198 Lleida, Spain

    Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198 Lleida, Spain
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  • Elvira Fernández
    Affiliations
    Department of Nephrology, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198 Lleida, Spain

    Unitat de Detecció i Tractament de Malalties Aterotrombòtiques, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198 Lleida, Spain

    Institut de Recerca Biomedica de Lleida, University of Lleida, Rovira Roure, 80, 25198 Lleida, Spain
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  • Didac Mauricio
    Correspondence
    Corresponding author. Department of Endocrinology & Nutrition, Hospital Arnau de Vilanova, Rovira Roure, 80, 25198 Lleida, Spain. Tel.: +34 973705183; fax: +34 973705189.
    Affiliations
    Unitat de Detecció i Tractament de Malalties Aterotrombòtiques, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198 Lleida, Spain

    Institut de Recerca Biomedica de Lleida, University of Lleida, Rovira Roure, 80, 25198 Lleida, Spain

    Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198 Lleida, Spain
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this study.

      Abstract

      Objective

      To test the concept that diabetic patients with microangiopathy of the retinal microcirculation would also show an involvement of the carotid adventitial microcirculation, we aimed to assess the status of the vasa vasorum (VV) signal, measured by contrast-enhanced carotid ultrasound imaging, in type 2 diabetic patients with and without retinopathy.

      Methods and results

      Using contrast-enhanced ultrasound imaging, we quantified the signal of the VV of the common carotid artery. We investigated two subgroups of type 2 diabetic patients who did not have previous cardiovascular disease: 51 with retinopathy and 56 without retinopathy. The reference VV signal was measured in a group of 65 healthy volunteers as the ratio of the contrast agent signal of the VV and that of the lumen of the artery. Patients and volunteers also underwent a clinical evaluation. The reference VV signal in the group of 65 healthy volunteers was 0.562 (SD = 0.142). Patients with diabetic retinopathy showed a higher mean adventitial VV signal (0.700; SD = 0.150) than those without retinopathy (0.621; SD = 0.120) (P < 0.0039). This difference remained highly significant after adjusting for cardiovascular risk factors. Common carotid intima–media thickness and carotid plaque prevalence were not different between diabetic subgroups.

      Conclusions

      Type 2 diabetic patients with retinopathy show increased angiogenesis of the VV of the common carotid artery. This suggests the existence of a diabetic microangiopathic complication affecting the wall of the large arteries that may be an important contributor to the cardiovascular disease burden in diabetes mellitus.

      Highlights

      • We explored the carotid artery vasa vasorum on contrast-enhanced ultrasonography.
      • Increased carotid wall neoangiogenesis is associated with diabetic retinopathy.
      • The results suggest that vasa vasorum are also a site for diabetic microangiopathy.
      • Microangiopathy of large vessel wall may contribute to diabetic atherosclerosis.

      Keywords

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      Linked Article

      • Pseudo-enhancement does not explain the increased carotid adventitial vasa vasorum signal in diabetic patients
        AtherosclerosisVol. 229Issue 2
        • Preview
          We read with great interest the comments of Van der Oord et al. on our recently published study [1]. Unfortunately, at the time at which our study was designed and conducted [2], the two interesting articles on the artifacts produced by pseudo-enhancement during contrast-enhanced ultrasound (CEUS) imaging of the carotid arteries had not yet been issued [3,4]. We acknowledge that a pseudo-enhancement artifact may exist under several conditions, as reported by these authors [3,4], but as they pointed out, there are currently no commercially available tools to avoid this artifact.
        • Full-Text
        • PDF
      • Far wall pseudo-enhancement: A neglected artifact in carotid contrast-enhanced ultrasound?
        AtherosclerosisVol. 229Issue 2
        • Preview
          With interest we read the recent article by Arcidiacono et al. [1]. This research article reported an increased angiogenesis of the vasa vasorum (VV) network in the common carotid artery of diabetic patients with retinopathy when compared to the VV network in diabetic patients without retinopathy. Contrast-enhanced ultrasound (CEUS) of the carotid arteries was used to visualize the adventitial network of VV in these patients. We agree with the authors that increased density of the physiological VV network is an interesting topic in the search to biomarkers for early vascular complications of diabetes mellitus.
        • Full-Text
        • PDF