J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 9, Number 7, July 2017, pages 579-585

Impact of Hemorheology Assessed by the Microchannel Method on Pulsatility Index of the Common Carotid Artery in Patients With Type 2 Diabetes Mellitus

Figure 1. Histogram of PI and WBPT. (a) The mean and median values of PI were 1.69 (± 0.63; range, 0.69 - 2.92) and 1.61, respectively. (b) The mean and median values of WBPT were 62.9 (± 18.0; range, 31.2 - 113.50) s and 59.6 s, respectively. PI: pulsatility index; WBPT: whole blood passage time.

Figure 2. The correlation between PI and WBPT. A statistically significant positive correlation (r = 0.49, P < 0.001) was observed between PI and WBPT. PI: pulsatility index; WBPT: whole blood passage time.

Figure 3. Results of multiple logistic regression analysis for high PI. Patients with high WBPT (≥ 70 s) had significantly higher risk (odds ratio, 5.2; 95% confidence interval, 2.4 - 9.2; P < 0.001) of being detected with a high PI of CCA than those with low WBPT (≤ 52.0 s). A high PI of CCA was defined as a PI of > 2. Adjustment factors: age, max-IMT, current smoker, d-ROMs test, and skin autofluorescence. PI: pulsatility index; WBPT: whole blood passage time.

**Table 1.** Baseline Clinical Characteristics
Continuous values are mean ± SD. HbA1c: hemoglobin A1c; HOMA-IR: homeostasis assessment insulin resistance; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; d-ROMs: derivatives of reactive oxygen metabolites; PI: pulsatility index; CCA: common carotid artery; IMT: intima-media thickness; WBPT: whole blood passage time; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.
n (male/female)	349 (131/218)
Age (years)	65 ± 11
Body mass index	24.0 ± 3.8
Current smoker, n (%)	79 (23)
Systolic blood pressure (mm Hg)	141 ± 17
Diastolic blood pressure (mm Hg)	82 ± 11
White blood cell (/μL)	6,490 ± 1,370
Red blood cell (10⁴/μL)	426 ± 41
Hematocrit (%)	38.4 ± 4.0
Platelet (10⁴/μL)	21.9 ± 6.4
Fasting blood glucose (mg/dL)	131 ± 27
Immunoreactive insulin (μg/mL)	7.4 ± 4.6
HbA1c (%)	7.0 ± 0.8
HOMA-IR	2.5 ± 1.6
Skin autofluoresence (AU)	2.6 ± 0.5
Total cholesterol (mg/dL)	215 ± 39
LDL-cholesterol (mg/dL)	138 ± 38
Triglyceride (mg/dL)	137 ± 64
HDL-cholesterol (mg/dL)	49 ± 14
eGFR (mL/min/1.73 m²)	60 ± 21
d-ROMs test (U.Carr)	333 ± 98
PI of CCA	1.69 ± 0.63
Max-IMT	1.4 ± 0.4
WBPT (s)	62.9 ± 18.0
Medication
Sulfonylurea, n (%)	188 (54)
DPP-4 inhibitor, n (%)	132 (38)
Insulin, n (%)	28 (8)
Statin, n (%)	181 (52)
RAS inhibitor, n (%)	161 (46)
Eicosapentaenoic acid, n (%)	14 (4)

Table 1. Baseline Clinical Characteristics

Continuous values are mean ± SD. HbA1c: hemoglobin A1c; HOMA-IR: homeostasis assessment insulin resistance; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; d-ROMs: derivatives of reactive oxygen metabolites; PI: pulsatility index; CCA: common carotid artery; IMT: intima-media thickness; WBPT: whole blood passage time; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.

n (male/female)

349 (131/218)

Age (years)

65 ± 11

Body mass index

24.0 ± 3.8

Current smoker, n (%)

79 (23)

Systolic blood pressure (mm Hg)

141 ± 17

Diastolic blood pressure (mm Hg)

82 ± 11

White blood cell (/μL)

6,490 ± 1,370

Red blood cell (10⁴/μL)

426 ± 41

Hematocrit (%)

38.4 ± 4.0

Platelet (10⁴/μL)

21.9 ± 6.4

Fasting blood glucose (mg/dL)

131 ± 27

Immunoreactive insulin (μg/mL)

7.4 ± 4.6

HbA1c (%)

7.0 ± 0.8

HOMA-IR

2.5 ± 1.6

Skin autofluoresence (AU)

2.6 ± 0.5

Total cholesterol (mg/dL)

215 ± 39

LDL-cholesterol (mg/dL)

138 ± 38

Triglyceride (mg/dL)

137 ± 64

HDL-cholesterol (mg/dL)

49 ± 14

eGFR (mL/min/1.73 m²)

60 ± 21

d-ROMs test (U.Carr)

333 ± 98

PI of CCA

1.69 ± 0.63

Max-IMT

1.4 ± 0.4

WBPT (s)

62.9 ± 18.0

Medication

Sulfonylurea, n (%)

188 (54)

DPP-4 inhibitor, n (%)

132 (38)

Insulin, n (%)

28 (8)

Statin, n (%)

181 (52)

RAS inhibitor, n (%)

161 (46)

Eicosapentaenoic acid, n (%)

14 (4)

**Table 2.** Relationship Between PI of CCA, WBPT and Various Clinical Parameters
	r
r expressed correlation coefficient. P < 0.001, P < 0.01, **P < 0.05. HbA1c: hemoglobin A1c; HOMA-IR: homeostasis assessment insulin resistance; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; d-ROMs: derivatives of reactive oxygen metabolites; PI: pulsatility index; CCA: common carotid artery; IMT: intima-media thickness; WBPT: whole blood passage time; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.
Sex (female = 0, male = 1)	0.10	0.17**
Age	0.22*	0.06
Body mass index	0.09	0.12***
Current smoker (no = 0, yes = 1)	0.36*	0.35*
Systolic blood pressure	0.25*	0.03
Diastolic blood pressure	0.09	0.04
White blood cell	0.06	0.16**
Red blood cell	0.10	0.17**
Hematocrit	0.09	0.19**
Platelet	0.08	0.09
Fasting blood glucose	0.06	0.22*
Immunoreactive insulin	0.10	0.15**
HbA1c	0.10	0.18**
HOMA-IR	0.09	0.18**
Skin autofluorescence	0.40*	0.49*
Total cholesterol	-0.08	-0.08
LDL-cholesterol	-0.04	-0.04
Triglyceride	0.10	0.11***
HDL-cholesterol	0.09	0.09
eGFR	-0.11***	-0.08
d-ROMs test	0.44*	0.40*
Max-IMT	0.43*	0.26*
Sulfonylurea (no = 0, yes = 1)	0.03	0.04
DPP-4 inhibitor (no = 0, yes = 1)	0.05	0.06
Insulin (no = 0, yes = 1)	0.07	0.07
Statin (no = 0, yes = 1)	-0.09	-0.08
RAS inhibitor (no = 0, yes = 1)	-0.09	-0.09
Eicosapentaenoic acid (no = 0, yes = 1)	-0.04	-0.03

Table 2. Relationship Between PI of CCA, WBPT and Various Clinical Parameters

PI of CCA

WBPT

r expressed correlation coefficient. *P < 0.001, **P < 0.01, ***P < 0.05. HbA1c: hemoglobin A1c; HOMA-IR: homeostasis assessment insulin resistance; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; d-ROMs: derivatives of reactive oxygen metabolites; PI: pulsatility index; CCA: common carotid artery; IMT: intima-media thickness; WBPT: whole blood passage time; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.

Sex (female = 0, male = 1)

0.10

0.17**

Age

0.22*

0.06

Body mass index

0.09

0.12***

Current smoker (no = 0, yes = 1)

0.36*

0.35*

Systolic blood pressure

0.25*

0.03

Diastolic blood pressure

0.09

0.04

White blood cell

0.06

0.16**

Red blood cell

0.10

0.17**

Hematocrit

0.09

0.19**

Platelet

0.08

0.09

Fasting blood glucose

0.06

0.22*

Immunoreactive insulin

0.10

0.15**

HbA1c

0.10

0.18**

HOMA-IR

0.09

0.18**

Skin autofluorescence

0.40*

0.49*

Total cholesterol

-0.08

LDL-cholesterol

-0.04

Triglyceride

0.10

0.11***

HDL-cholesterol

0.09

eGFR

-0.11***

-0.08

d-ROMs test

0.44*

0.40*

Max-IMT

0.43*

0.26*

Sulfonylurea (no = 0, yes = 1)

0.03

0.04

DPP-4 inhibitor (no = 0, yes = 1)

0.05

0.06

Insulin (no = 0, yes = 1)

0.07

Statin (no = 0, yes = 1)

-0.09

-0.08

RAS inhibitor (no = 0, yes = 1)

-0.09

Eicosapentaenoic acid (no = 0, yes = 1)

-0.04

-0.03

**Table 3.** Multiple Regression Analysis for PI of CCA
Explanatory factor	β	t value	P value
R² = 0.43, F = 44.3, P < 0.001 (n = 349). HbA1c: hemoglobin A1c; HOMA-IR: homeostasis assessment insulin resistance; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; d-ROMs: derivatives of reactive oxygen metabolites; PI: pulsatility index; CCA: common carotid artery; IMT: intima-media thickness; WBPT: whole blood passage time; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.
Age	0.27	5.2	< 0.001
WBPT	0.24	5.1	< 0.001
Max-IMT	0.22	4.9	< 0.001
Current smoker	0.19	4.2	< 0.001
d-ROMs test	0.17	3.6	< 0.001
Skin autofluorescence	0.16	3.2	< 0.01
HOMA-IR	0.10	1.8	0.075
HbA1c	0.08	1.6	0.148
Sex	0.07	1.5	0.179
Hematocrit	0.06	1.3	0.193
eGFR	-0.04	-0.9	0.342
Red blood cell	0.04	0.8	0.364
Immunoreactive insulin	0.04	0.8	0.379
Systolic blood pressure	0.04	0.7	0.412
Body mass index	0.03	0.5	0.457
White blood cell	0.03	0.4	0.610
Fasting blood glucose	0.02	0.1	0.910
Triglyceride	-0.05	-1.0	0.254

Table 3. Multiple Regression Analysis for PI of CCA

Explanatory factor

t value

P value

R² = 0.43, F = 44.3, P < 0.001 (n = 349). HbA1c: hemoglobin A1c; HOMA-IR: homeostasis assessment insulin resistance; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; d-ROMs: derivatives of reactive oxygen metabolites; PI: pulsatility index; CCA: common carotid artery; IMT: intima-media thickness; WBPT: whole blood passage time; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.

Age

0.27

5.2

< 0.001

WBPT

0.24

5.1

< 0.001

Max-IMT

0.22

4.9

< 0.001

Current smoker

0.19

4.2

< 0.001

d-ROMs test

0.17

3.6

< 0.001

Skin autofluorescence

0.16

3.2

< 0.01

HOMA-IR

0.10

1.8

0.075

HbA1c

0.08

1.6

0.148

Sex

0.07

1.5

0.179

Hematocrit

0.06

1.3

0.193

eGFR

-0.04

-0.9

0.342

Red blood cell

0.04

0.8

0.364

Immunoreactive insulin

0.04

0.8

0.379

Systolic blood pressure

0.04

0.7

0.412

Body mass index

0.03

0.5

0.457

White blood cell

0.03

0.4

0.610

Fasting blood glucose

0.02

0.1

0.910

Triglyceride

-0.05

-1.0

0.254