Contrast-enhanced ultrasound evaluation of peripheral microcirculation in diabetic patients: Effects of cigarette smoking

Purpose: Cigarette smoking and diabetes mellitus predisposes to vascular disease. Our study aimed to evaluate the chronic effects of cigarette smoking on peripheral microcirculation assessed with contrast-enhanced ultrasound (CEUS) in diabetic patients. Materials and methods: The study population comprised ten smoker (7/3 M/W, age 42-76 years) and 16 nonsmoker (8/8 men/women, age 47-80 years) diabetic patients. The ankle-brachial index (ABI) was determined, and colour Doppler ultrasound (CDUS) of the lower legs was performed to determine the presence of peripheral arteriopathy disease (PAD). Microvascular blood flow in the gastrocnemius muscle was evaluated with CEUS. Results: No differences were observed in ABI and CDUS examination between smokers and nonsmokers. Smoking had a significant effect on microcirculatory function. Timeto-peak (TTP), arrival time in tissue (ATt) and artery/ tissue transit time (A/Ttt) were significantly prolonged in smokers (TTP 43.76±9.38 s vs. 34.12±6.8 s, p=0.011, ATt 28.9±7.5s vs. 22.4±6.4 s, p=0.017 and A/Ttt 6.81±4.52 s vs. 3.25±3.27 s, p=0.02), with no significant differences between patients with and without PAD. Conclusions: The long-term exposure to cigarette smoke affects microcirculatory function. Contrast imaging is a noninvasive technique that can document these effects