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1 Vol. 29, pp.509 ~ 518, opening velocity; OV OV OV HbA1c pulse wave velocity; PWV intima-media complex thickness; IMT IMT OV OV OV HbA1c OV PWV IMT OV OV OV IMT microangiopathy macroangiopathy 2 impaired glucose tolerance; IGT 1 opening velocity, OV 2 OV Riva-Rocci OV 3 67
2 OV HbA1c 3 OV pulse wave velocity PWV intima-media complex thickness IMT OV IMT IMT of the brachial artery bimt IMT OV IMT IMT of the common carotid artery cimt PWV bimt Table 1 Clinical profiles of subjects Table 2 Classification of the intima-media complex thickness (IMT) of the common carotid arteries (Salonen's classification) : 54.0 ± : 59.0 ± 10.7 Table 1 OV 3 20 OV mg/dl PWV POLYGRAPH MIC-9400, cimt bimt 7.5 MHz SSA-380A, cimt 1.5 cm 2.5 cm Salonen 4 Table 2 Salonen 4 Category Category 2 1 cimt cimt+ Category 1 cimt cimt 2 bimt IMT Fig. 1A, B bimt bimt bimt bimt unilateral bimt ubimt+ bimt bilateral bimt bbimt+ 3 ubimt+ bbimt+ bimt+ bimt 2 A1c HbA1c HbA1c, OV Pearson's correlation coefficient 5% 2 Student's t-test Chi-square test 68
3 Fig. 1A Method for measurement of intima-media complex thickness of the brachial artery. Fig. 2 BIMS-V: This apparatus can measure the opening velocity. Fig. 3 The principle of opening velocity (OV). The upper figure is a longitudinal section of the brachium and the lower is a wave form of OV. A: The point where the pressure on the manchette is greature that systolic pressure. B: The point where the pressure is near to the systolic pressure. T: The time of the opening propagation. Sp: Sensing point of proximal side. Sd: Sensing point of distal side. Fig. 1B Intima-media complex thickness of the brachial artery was defined as a distance between the intimal-luminal interface and the medial-adventitial interface in the brachial arteries. 5% OV BIMS-V, Fig. 2 5 mm 50 mm 2 80 mm 2 OV Sp Fig. 3A Sd Sd Fig. 3B 69
4 Fig. 4A Relationship between opening velocity and age in diabetic patients. OV 80 mm second; s OV m/s 5 OV r=0.99, p<0.001 r=0.98, p< OV 1 OV OV 0.56 ± 0.15m/s 0.53 ± 0.15 m/s 0.54 ± 0.15 m/s r= 0.40, p< r= 0.42, p< r= 0.36 p<0.005 OV Fig. 4A OV 7 OV Fig. 4B Fig. 4B Comparison of opening velocity and age of the cases in each group. The regression line of OV: diabetes (solid line) between normal range of OV 8) and arteriosclerotic disease 19). Fig. 5 Relationship between opening velocity and PWV. 2 OV 1 OV OV OV HbA1c OV HbA1c 3 3 OV OV
5 Fig. 6 Relationship between opening velocity and the IMT of the brachial artery (bimt). bimt : without bilateral bimt. ubimt+: with unilateral bimt. bbimt+: with bilateral bimt. Fig. 7 Appearance ratio of abnormal IMT of the carotid artery (cimt+) in the IMT of the brachial artery (bimt). bimt : without bilateral bimt (31.6%). ubimt+: with unilateral bimt (50.0%). bbimt+:with bilateral bimt (75.0%). 2 3 OV PWV OV PWV r= 0.40, p< r= 0.34, p<0.01 r= 0.41, p<0.001fig. 5 4 bimt bimt mm 6.5 mm bimt 0.7 mm bimt 0.1 mm 1 Mönckeberg OV 5 bimt PWV bbimt+ bimt PWV p<0.05 IMT ubimt+ bbimt+ PWV p<0.03fig. 6ubIMT+ bbimt+ bimt+ bimt 6 bimt cimt bbimt+ 75.0% cimt bimt cimt 31.6% cimt p<0.03fig. 7 cimt Category 3 4 Category 1 bimt 60.9% bimt+ 39.1% Category 2 bimt+ 70% bimt Category % bimt 82.4% cimt 7 OV bimt cimt OV cimt cimt+ OV p<0.01 Salonen Category 4 Category 2 Category 1 OV p<0.01 Fig. 8 OV IMT ubimt+ bbimt+ bimt bimt bimt+ bimt OV p<0.03 Fig. 9 cimt bimt OV 71
6 Fig. 8 Relationship between opening velocity and the IMT of the common carotid artery (cimt). Salonen's category 2 4 is abnormal IMT of the common carotid artery (cimt+) m/s cimt+ Category 2 bimt OV 0.475m/s, 0.443m/s p<0.01, p<0.03 cimt bimt+ OV m/s bimt Fig. 10 Fig. 9 Relationship between opening velocity and the IMT of the brachial artery (bimt). bimt : without bilateral bimt. ubimt+: with unilateral bimt. bbimt+: with bilateral bimt. bimt+: with either unilateral or bilateral bimt, that is to say ubimt+ and bbimt+. 1 OV OV OV OV Fig. 10 Relationship between opening velocity and the IMT of brachial artery (bimt) in appearance of the IMT of carotid artery (cimt). bimt : without bilateral bimt. bimt+: with either unilateral or bilateral bimt that is to say ubimt+ and bbimt+. 8 elasticity stiffness 72
7 stress strain distensibility Roy Hallock and Benson cm 9 Hooke plasticity PWV Hooke PWV PWV 9 PWV PWV OV OV 2 OV OV PWV 14 IMT 4 PWV OV OV OV 1,058 7 OV OV OV OV OV OV OV 0.28 m/s OV 0.35 m/s m/s OV OV OV OV OV 0.26 m/s OV OV 0.35 m/s 93.3 OV OV 73
8 OV OV 40% 2 SD 7 OV OV HbA1c 3 OV HbA1c 1 2 OV cimt 1.1 mm cimt 0.8 mm mm Category 2 Salonen Category 2 Category 1 OV Category 3 4 OV Category Gore-Tejada PWV OV OV bimt OV OV IMT bimt IMT bimt PWV bimt IMT bimt 0.1 mm bimt 0.1 mm bimt OV PWV 0.1 mm bimt 74
9 Mönckeberg 1 OV Mönckeberg OV 31.6% 75.0% OV OV OV OV OV bimt OV OV OV OV PWV cimt OV OV bimt OV bimt 1 Fuller JH, Shipley MJ, Rose G, Jarrett RJ and Keen H. Coronary-heart-disease risk and impaired glucose tolerance the Whitehall study. Lancet 1980; 28: , ; 30: ,,,, ; 24: Salonen JT and Salonen R. Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arterioscler Thromb 1991; 11: ,,..,,,,, 1999: ,, ; 21: ,,,,. (OV). 1998; 28: ,,,,, 1974: ,, II,,, 1986: Roy CS. The elastic properties of the arterial wall. J Physiol 1880; 3: Hallock P and Benson IC. Studies on the elastic properties of human isolated aorta. J Clin Invest 1937; 16:
10 . 1970; 85: ,,,,,,,,,,,, ; 24: ,,,,, ; 25: ,,,,,,,, ; 39: Modern Physician 1998; 18: ,. 1972; 35: Spina M, Garbisa S, Hinnie J, Hunter JC and Fracassini AS. Age-related changes in composition and mechanical properties of the tunica media of the upper thoracic human aorta. Arteriosclerosis 1983; 3: ; 33: Gore I and Tejada C. The quantitative appraisal of atherosclerosis. Am J Pathol 1957; 33: Roberts JC Jr, Moses C and Wilkins RH. Autopsy studies in atherosclerosis-i. Distribution and severity of atherosclerosis in patients dying without morphologic evidence of atherosclerotic catastrophe. Circulation 1959; 20: Roberts JC Jr, Wilkins RH and Moses C. Autopsy studies in atherosclerosis-ii. Distribution and severity of atherosclerosis in patients dying with morphologic evidence of atherosclerotic catastrophe. Circulation 1959; 20: ,,,, 1974: Abstract Opening Velocity of Arterial Wall in Diabetic Patients Yutaka Ogawa, Akio Ohta, Takehiro Kawata, and Nobuhiko Saito Arteriosclerosis, a chronic complication of diabetes, has a profound and direct effect on the prognosis of diabetic patients. The opening velocity (OV) of brachial arterial wall reflects arterial viscoelasticity and a lowered OV indicates the progress of arteriosclerosis. In the present study, we measured the OV of diabetic patients to examine the effect of aging and the relationship between the duration of diabetes and HbA1c. The association between the pulse wave velocity (PWV) of the aorta and the intima-media complex thickness (IMT) of the common carotid artery, both of which are indices of arteriosclerosis, was also examined. Moreover, the IMT of the brachial artery was measured to examine the effect of organic changes of the arterial wall on OV. The OV of diabetic patients decreased with aging and showed lower values than those of healthy adults in each age groups. But the OV did not correlate with the duration of diabetes and HbA1c. OV had a significant negative correlation with PWV; the OVs of both the common carotid and brachial arteries were lower in the group with abnormal IMTs. Both repeatability and reproducibility of OV are excellent, and OV is a useful noninvasive method of evaluating arteriosclerosis. Moreover, it is suggested that early evaluation of arteriosclerotic change is possible by simultaneously measuring OV and IMT of the brachial artery. (St. Marianna Med. J., 29: , 2001) Division of Metabolism and Endocrinology, Department of Internal Medicine (Director: Prof. Nobuhiko Saito) St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki , Japan 76
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