Early detection of subclinical organ damage in patients with risk factors – an ongoing journey

Introduction: Despite evolving preventive therapies, cardiovascular morbidity and mortality remains high among patients with risk factors (RF) for atherosclerosis, especially among those with diabetes mellitus (DM). Early detection of markers of subclinical vascular and organ damage remains essential for modern cardiovascular medicine.

Objective: To evaluate parameters of cardiac and vascular function in patients with RF for atherosclerosis (smoking, arterial hypertension-AHT, dyslipidemia, DM), without overt vascular disease, and to evaluate the additional influence of diabetes on these parameters.

Methods: 56 subjects (60 ± 8 years, 42 women) with risk factors for atherosclerosis (36.6% current or for-mer smokers, 69.6% arterial hypertension, 67.9% dyslipidemia, 35.7% DM, 26.7% more than 2 RF), without overt cardio-, cerebro- or peripheral artery disease, were studied. LV ejection fraction (2DEF), determined through standard 2D echocardiography, and left ventricular 2D longitudinal strain (2DLS), determined through Speckle Tracking echocardiography, were used as markers of cardiac dysfunction. Also, we determi-ned left and right ankle brachial index (L-ABI and R-ABI) and cardiac ankle index (L-CAVI and R-CAVI), using a dedicated equipment (VaSera VS-1500 Fuku-da-Denshi, Japan) as markers of vascular dysfunction. Results in patients with DM (20 pts) were compared to those without DM (36 pts).

Results: Mean 2DEF and 2DLS were in normal limits in all patients (59.9 ± 4.3% and -19.9 ± 3.0%), without significant differences between DM and non DM (for 2DLS -19.6 ± 3.1 in DM vs. -20.3 ± 2.9% in non DM, p= NS). Also, parameters of vascular function were simi-lar in both study groups (for R-ABI 1.04 ± 0.09 in DM vs.1.06 ± 0.08 in non-DM, p= NS and for R- CAVI 7.6 ± 1.1 in DM vs. 8.5 ± 1.5 in non DM, p= NS).

Conclusions: Currently used parameters of cardiac and vascular function do not signal early organ damage even when measured in asymptomatic patients, suggesting that more subtle imaging or biological de-tection methods should be used in populations with RF for atherosclerosis.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)