VASCULAR ABNORMALITIES IN NON-INSULIN-DEPENDENT DIABETES-MELLITUS IDENTIFIED BY ARTERIAL WAVE-FORM ANALYSIS

PURPOSE: The arterial pressure waveform is derived from the complex in teraction of the left ventricular stroke volume and the physical prope rties of the arterial circulation. Widespread abnormalities in the phy sical characteristics of the arterial vessels associated with diabetes mellitus can produce consistent changes in the shape of the pressure pulse waveform, providing information about arterial structure and ton e that can be quantitated by pulse contour analysis. PATIENTS AND METH ODS: We analyzed intraarterial brachial artery waveforms in 28 patient s with non-insulin-dependent diabetes mellitus and 22 control subjects matched for age and sex. A computer-based assessment of the diastolic pressure decay and a modified Windkessel model of the circulation wer e employed to quantify changes in arterial waveform morphology in term s of the large-artery compliance (C1), the oscillatory diastolic wavef orm (C2), inertance, and systemic resistance. RESULTS: No differences were found in heart rate, mean arterial pressure, cardiac output, or s troke volume between groups. The mean oscillary arterial compliance es timate was significantly reduced in diabetic subjects versus controls: 0.02 (95% confidence interval [CI], 0.01 to 0.03) mL/mm Hg versus 0.0 8 (95% Cl, 0.04 to 0.12) mL/mm Hg (p <0.001). Oscillatory compliance v alues were uniformly reduced in the diabetic subjects regardless of th e presence or absence of physical complications of the No differences in large-artery compliance, inertance, or systemic resistance were fou nd between groups. No positive correlations were found between indices of glycemic control, the known duration of diabetes, and any of the h emodynamic variables. CONCLUSIONS: Quantitative changes in the arteria l pressure pulse waveform, reflected by a reduced oscillatory complian ce estimate, were found in patients with non-insulin-dependent diabete s mellitus. This estimate appears to act as an early marker for the va scular abnormalities associated with diabetes before complications of the disease become clinically apparent. By contrast, no changes in lar ge-artery compliance were found in this patient population free from c linically obvious macrovascular disease.