51
|
The Current Management of Aortic, Common Iliac, and External Iliac Artery Disease: Basic Data Underlying Clinical Decision Making. Ann Vasc Surg 2011; 25:990-1003. [DOI: 10.1016/j.avsg.2011.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 04/26/2011] [Accepted: 05/15/2011] [Indexed: 10/17/2022]
|
52
|
Wassel CL, Loomba R, Ix JH, Allison MA, Denenberg JO, Criqui MH. Family history of peripheral artery disease is associated with prevalence and severity of peripheral artery disease: the San Diego population study. J Am Coll Cardiol 2011; 58:1386-92. [PMID: 21920269 PMCID: PMC3215334 DOI: 10.1016/j.jacc.2011.06.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 06/14/2011] [Accepted: 06/14/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the association of family history of peripheral artery disease (PAD) with PAD prevalence and severity. BACKGROUND PAD is a significant public health problem. Shared genetic and environmental factors may play an important role in the development of PAD. However, family history of PAD has not been investigated adequately. METHODS The San Diego Population Study enrolled 2,404 ethnically diverse men and women 29 to 91 years of age who attended a baseline visit from 1994 through 1998 to assess PAD and venous disease. Ankle brachial index measurement was performed at the baseline clinic examination, and family history of PAD was obtained via questionnaire. Family history of PAD was defined primarily as having any first-degree relative with PAD. Prevalent PAD was defined as ankle brachial index ≤ 0.90, and severe prevalent PAD was defined as ankle brachial index ≤ 0.70, with both definitions also including any previous leg revascularization. Logistic regression was used to evaluate the association of family history of PAD with prevalent PAD. RESULTS The mean age was 59 ± 11 years, 66% were women, and 58% were Caucasian, with 42% representing other racial or ethnic groups. Prevalence of PAD was 3.6%, and severe prevalent PAD was 1.9%. In fully adjusted models, family history of PAD was associated with a 1.83-fold higher odds of PAD (95% confidence interval: 1.03 to 3.26, p = 0.04), an association that was stronger for severe prevalent PAD (odds ratio: 2.42, 95% confidence interval: 1.13 to 5.23, p = 0.02). CONCLUSIONS Family history of PAD is independently strongly associated with PAD prevalence and severity. This indicates a role for genetic factors or other shared environmental factors, or both, contributing to PAD.
Collapse
Affiliation(s)
- Christina L. Wassel
- Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, CA
| | - Rohit Loomba
- Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, CA
- Division of Gastroenterology, Department of Medicine, University of California-San Diego, La Jolla, CA
| | - Joachim H. Ix
- Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, CA
- Division of Nephrology, Department of Medicine, University of California-San Diego, La Jolla, CA
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Matthew A. Allison
- Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, CA
| | - Julie O. Denenberg
- Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, CA
| | - Michael H. Criqui
- Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, CA
- Division of Cardiology, Department of Medicine, University of California-San Diego, La Jolla, CA
| |
Collapse
|
53
|
Vodnala D, Rajagopalan S, Brook RD. Medical Management of the Patient with Intermittent Claudication. Cardiol Clin 2011; 29:363-79. [DOI: 10.1016/j.ccl.2011.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
54
|
Krucoff MW, Jones WS, Patel MR. Learning to Walk Before We Run. J Am Coll Cardiol 2011; 58:1077-9. [DOI: 10.1016/j.jacc.2011.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 04/07/2011] [Indexed: 10/17/2022]
|
55
|
Makowsky M, McMurtry MS, Elton T, Rosenthal M, Gunther M, Percy M, Wong K, Fok J, Sebastianski M, Tsuyuki R. Prevalence and Treatment Patterns of Lower Extremity Peripheral Arterial Disease Among Patients at Risk in Ambulatory Health Settings. Can J Cardiol 2011; 27:389.e11-8. [DOI: 10.1016/j.cjca.2010.12.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 10/08/2010] [Indexed: 10/18/2022] Open
|
56
|
Salmerón Febres L, Al-Raies Bolaños B, Blanes Mompó J, Collado Bueno G, Cuenca Manteca J, Fernandez Gonzalez S, Linares Palomino J, López Espada C, Martínez Gámez J, Serrano Hernando J. Guía de actuación en técnicas y procedimientos endovasculares del sector infrainguinal. ANGIOLOGIA 2011. [DOI: 10.1016/j.angio.2011.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
57
|
Olin JW, Allie DE, Belkin M, Bonow RO, Casey DE, Creager MA, Gerber TC, Hirsch AT, Jaff MR, Kaufman JA, Lewis CA, Martin ET, Martin LG, Sheehan P, Stewart KJ, Treat-Jacobson D, White CJ, Zheng ZJ. ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 performance measures for adults with peripheral artery disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures, the American College of Radiology, the Society for Cardiac Angiography and Interventions, the Society for Interventional Radiology, the Society for Vascular Medicine, the Society for Vascular Nursing, and the Society for Vascular Surgery (Writing Committee to Develop Clinical Performance Measures for Peripheral Artery Disease). Developed in collaboration with the American Association of Cardiovascular and Pulmonary Rehabilitation; the American Diabetes Association; the Society for Atherosclerosis Imaging and Prevention; the Society for Cardiovascular Magnetic Resonance; the Society of Cardiovascular Computed Tomography; and the PAD Coalition. Endorsed by the American Academy of Podiatric Practice Management. J Vasc Surg 2011; 52:1616-52. [PMID: 21146750 DOI: 10.1016/j.jvs.2010.10.065] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
58
|
Olin JW, Allie DE, Belkin M, Bonow RO, Casey DE, Creager MA, Gerber TC, Hirsch AT, Jaff MR, Kaufman JA, Lewis CA, Martin ET, Martin LG, Sheehan P, Stewart KJ, Treat-Jacobson D, White CJ, Zheng ZJ, Masoudi FA, Bonow RO, DeLong E, Erwin JP, Goff DC, Grady K, Green LA, Heidenreich PA, Jenkins KJ, Loth AR, Peterson ED, Shahian DM. ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 performance measures for adults with peripheral artery disease. JOURNAL OF VASCULAR NURSING 2011; 29:23-60. [DOI: 10.1016/j.jvn.2010.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
59
|
Olin JW, Allie DE, Belkin M, Bonow RO, Casey DE, Creager MA, Gerber TC, Hirsch AT, Jaff MR, Kaufman JA, Lewis CA, Martin ET, Martin LG, Sheehan P, Stewart KJ, Treat-Jacobson D, White CJ, Zheng ZJ. ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 performance measures for adults with peripheral artery disease. Vasc Med 2010; 15:481-512. [DOI: 10.1177/1358863x10390838] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | - David E Allie
- Society of Cardiovascular Computed Tomography Representative
| | | | | | | | | | - Thomas C Gerber
- Society for Atherosclerosis Imaging and Prevention Representative
| | - Alan T Hirsch
- Recused from voting on Measure 4 (Antiplatelet Therapy)
| | | | | | | | - Edward T Martin
- Society for Cardiovascular Magnetic Resonance Representative
| | | | - Peter Sheehan
- American Diabetes Association and the PAD Coalition Representative
| | - Kerry J Stewart
- American Association of Cardiovascular and Pulmonary Rehabilitation Representative
| | | | | | | |
Collapse
|
60
|
Olin JW, Allie DE, Belkin M, Bonow RO, Casey DE, Creager MA, Gerber TC, Hirsch AT, Jaff MR, Kaufman JA, Lewis CA, Martin ET, Martin LG, Sheehan P, Stewart KJ, Treat-Jacobson D, White CJ, Zheng ZJ. ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 Performance Measures for Adults With Peripheral Artery Disease. Circulation 2010; 122:2583-618. [DOI: 10.1161/cir.0b013e3182031a3c] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - David E. Allie
- Society of Cardiovascular Computed Tomography Representative
| | | | | | | | | | - Thomas C. Gerber
- Society for Atherosclerosis Imaging and Prevention Representative
| | | | | | | | | | | | | | - Peter Sheehan
- American Diabetes Association and the PAD Coalition Representative
| | - Kerry J. Stewart
- American Association of Cardiovascular and Pulmonary Rehabilitation Representative
| | | | | | | |
Collapse
|
61
|
Jackson EA, Eagle KA. Smoking interventions: the beginning of the end or the end of the beginning? J Am Coll Cardiol 2010; 56:2113-4. [PMID: 21144972 DOI: 10.1016/j.jacc.2010.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 07/28/2010] [Indexed: 10/18/2022]
|
62
|
Olin JW, Allie DE, Belkin M, Bonow RO, Casey DE, Creager MA, Gerber TC, Hirsch AT, Jaff MR, Kaufman JA, Lewis CA, Martin ET, Martin LG, Sheehan P, Stewart KJ, Treat-Jacobson D, White CJ, Zheng ZJ. ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 Performance Measures for Adults With Peripheral Artery Disease. J Am Coll Cardiol 2010; 56:2147-81. [DOI: 10.1016/j.jacc.2010.08.606] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
63
|
Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2010; 55:2614-62. [PMID: 20513610 PMCID: PMC3042771 DOI: 10.1016/j.jacc.2009.11.011] [Citation(s) in RCA: 450] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
64
|
Kane GC, Xu N, Mistrik E, Roubicek T, Stanson AW, Garovic VD. Renal artery revascularization improves heart failure control in patients with atherosclerotic renal artery stenosis. Nephrol Dial Transplant 2010; 25:813-820. [DOI: 10.1093/ndt/gfp393] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
65
|
Aboyans V, Desormais I, Lacroix P, Salazar J, Criqui MH, Laskar M. The General Prognosis of Patients With Peripheral Arterial Disease Differs According to the Disease Localization. J Am Coll Cardiol 2010; 55:898-903. [DOI: 10.1016/j.jacc.2009.09.055] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 07/22/2009] [Accepted: 09/24/2009] [Indexed: 11/16/2022]
|
66
|
Andreozzi GM. Propionyl l-carnitine: intermittent claudication and peripheral arterial disease. Expert Opin Pharmacother 2010; 10:2697-707. [PMID: 19827991 DOI: 10.1517/14656560903215871] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Peripheral arterial disease (PAD) is a clinical manifestation of underlying aorto-iliac and leg atherosclerosis that is characterized by different stages of stenosis and obstruction. It affects approximately 12% of the adult population and about 20% of people over the age of 70 years, and is associated with increased cardiovascular (CV) and cerebrovascular morbidity. Intermittent claudication (IC) is the major symptom of PAD; it is defined as cramping leg pain (in the buttock, thigh, or calf) while/after clim bing one or two flights of stairs, or during walking. The goals of IC management are to: slow the progression of local and systemic atherosclerosis, prevent major fatal and nonfatal CV events (myocardial infarction and stroke), improve walking capacity, prevent and reduce resting pain and cutaneous lesions. Propionyl L-carnitine is an acyl derivative of levocarnitine (L-carnitine) and is indicated for patients with peripheral arterial occlusive disease. It corrects secondary muscle carnitine deficiency in patients with PAD, significantly improving the walking capacity; it is a free radical that produces positive effects on endothelial function; it protects from oxidative stress; and it enhances most measures of quality of life. The recent Trans-Atlantic Inter-Society Consensus II update recommends the use of propionyl L-carnitine in combination with physical training to improve the symptoms associated with PAD.
Collapse
Affiliation(s)
- G M Andreozzi
- University Hospital, Angiology Care Unit, via Giustiniani 2, Padua 35128, Italy.
| |
Collapse
|
67
|
Abstract
OBJECTIVES To evaluate the potential use of a novel 3D turbo spin-echo (TSE) T2-weighted (T2w) technique for assessing the vessel wall in the superficial femoral artery at 3.0 T. BACKGROUND Magnetic resonance imaging can be used for the noninvasive assessment of atherosclerotic plaque burden in the peripheral circulation. Although black-blood 2D TSE techniques have been used for femoral arterial wall imaging, these techniques require prolonged imaging time to cover a large field of view required to cover the leg. Recently, variable-flip-angle 3D TSE T2w (SPACE) has been introduced as a fast vessel wall imaging technique with submillimeter spatial resolution. A systematic investigation of the application of this technique to femoral arterial wall imaging has yet to be performed. METHODS Fifteen healthy volunteers and 3 patients with peripheral arterial disease (PAD) underwent 3D SPACE imaging of the superficial femoral artery at 3.0 T, with the conventional 2D TSE T2w imaging as a reference. Muscle-lumen contrast to noise ratio (CNR) and wall/lumen volumes (WV, LV) were measured at the matched locations on the 3D and 2D image sets. Statistical comparison on a per-subject basis was conducted to determine the difference and agreement between 3D SPACE and the 2D TSE techniques. RESULTS The 3D SPACE data sets enabled vessel visualization from arbitrary orientation through multiplanar reformation technique. Muscle-lumen CNR was significantly higher with 3D SPACE than with the 2D TSE (3.12 +/- 0.84 vs. 2.17 +/- 0.34, P < 0.01). This trend was confirmed when CNR efficiency (CNR(eff)) values were further compared. A similar trend was observed in PAD patients (SPACE vs. 2D TSE T2w: CNR 2.35 +/- 0.13 vs. 1.77 +/- 0.25; CNR(eff) 15.35 +/- 0.61 vs. 3.59 +/- 2.62. all P < 0.05). Measurements of WV and LV from the 3D and 2D techniques were highly correlated in volunteers and PAD patients (volunteers, WV: linear regression r2 = 0.98, LV: r2 = 0.98, P < 0.001 for both; patients, WV: linear regression r2 = 0.96, LV: r2 = 0.94, P < 0.001 for both). CONCLUSION We established the feasibility of using the 3D SPACE technique for vessel wall imaging in the superficial femoral artery at 3.0T. High, isotropic-resolution SPACE images, with the aid of multiplanar reformation, enable superior vessel wall visualization. Superior blood signal suppression comparable to vessel wall morphologic measurements, and superior time efficiency compared to conventional 2D TSE imaging indicate the great potential of the SPACE method as a noninvasive imaging technique for the assessment of atherosclerotic plaque burden in PAD patients.
Collapse
|
68
|
Kravos A, Bubnič-Sotošek K. Ankle–Brachial Index Screening for Peripheral Artery Disease in Asymptomatic Patients between 50 and 70 Years of Age. J Int Med Res 2009; 37:1611-9. [DOI: 10.1177/147323000903700540] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Asymptomatic peripheral arterial disease (PAD) can be easily identified using the ankle–brachial index (ABI). This study was designed to investigate the benefits of performing ABI in patients aged 50-70 years. A random sample of 107 patients was chosen and data on gender, age, risk factors and laboratory tests were collected and the ABI measured. Twenty (19%) patients were found to have PAD. Smoking, high total cholesterol, high triglycerides and diabetes mellitus were shown to be associated with a low ABI and the presence of PAD. Age, diabetes and smoking were identified as the strongest predictors of PAD. Having more risk factors for PAD also predicted a lower ABI. These results suggest that measuring ABI is not necessary in patients aged 50-70 years if they only have one risk factor, with the exception of patients with diabetes and those who smoke. In contrast, measuring ABI seems to be useful for patients with multiple risk factors for PAD, although additional studies are required.
Collapse
Affiliation(s)
- A Kravos
- Department of Family Medicine, Medical Faculty, University of Maribor, Maribor, Slovenia
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - K Bubnič-Sotošek
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
69
|
Prediction of Hypertension Improvement After Stenting of Renal Artery Stenosis. J Am Coll Cardiol 2009; 53:2363-71. [DOI: 10.1016/j.jacc.2009.03.031] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 02/17/2009] [Accepted: 03/03/2009] [Indexed: 11/16/2022]
|
70
|
Prevalence of peripheral artery disease varies significantly depending upon the method of calculating ankle brachial index. ACTA ACUST UNITED AC 2009; 16:377-81. [DOI: 10.1097/hjr.0b013e32832955e2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
71
|
Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol 2008; 52:1527-39. [PMID: 19007588 DOI: 10.1016/j.jacc.2008.07.051] [Citation(s) in RCA: 1343] [Impact Index Per Article: 83.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 07/14/2008] [Accepted: 07/28/2008] [Indexed: 12/16/2022]
Abstract
The term cardiorenal syndrome (CRS) increasingly has been used without a consistent or well-accepted definition. To include the vast array of interrelated derangements, and to stress the bidirectional nature of heart-kidney interactions, we present a new classification of the CRS with 5 subtypes that reflect the pathophysiology, the time-frame, and the nature of concomitant cardiac and renal dysfunction. CRS can be generally defined as a pathophysiologic disorder of the heart and kidneys whereby acute or chronic dysfunction of 1 organ may induce acute or chronic dysfunction of the other. Type 1 CRS reflects an abrupt worsening of cardiac function (e.g., acute cardiogenic shock or decompensated congestive heart failure) leading to acute kidney injury. Type 2 CRS comprises chronic abnormalities in cardiac function (e.g., chronic congestive heart failure) causing progressive chronic kidney disease. Type 3 CRS consists of an abrupt worsening of renal function (e.g., acute kidney ischemia or glomerulonephritis) causing acute cardiac dysfunction (e.g., heart failure, arrhythmia, ischemia). Type 4 CRS describes a state of chronic kidney disease (e.g., chronic glomerular disease) contributing to decreased cardiac function, cardiac hypertrophy, and/or increased risk of adverse cardiovascular events. Type 5 CRS reflects a systemic condition (e.g., sepsis) causing both cardiac and renal dysfunction. Biomarkers can contribute to an early diagnosis of CRS and to a timely therapeutic intervention. The use of this classification can help physicians characterize groups of patients, provides the rationale for specific management strategies, and allows the design of future clinical trials with more accurate selection and stratification of the population under investigation.
Collapse
Affiliation(s)
- Claudio Ronco
- Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy.
| | | | | | | | | |
Collapse
|
72
|
Cooke JP. Critical determinants of limb ischemia. J Am Coll Cardiol 2008; 52:394-6. [PMID: 18652949 DOI: 10.1016/j.jacc.2008.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 05/06/2008] [Indexed: 02/08/2023]
|
73
|
McDermott MM, Tian L, Liu K, Guralnik JM, Ferrucci L, Tan J, Pearce WH, Schneider JR, Criqui MH. Prognostic value of functional performance for mortality in patients with peripheral artery disease. J Am Coll Cardiol 2008; 51:1482-9. [PMID: 18402904 DOI: 10.1016/j.jacc.2007.12.034] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 12/03/2007] [Accepted: 12/05/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Among persons with lower extremity peripheral artery disease (PAD), we determined whether objective measures of walking performance predict mortality independently of the ankle brachial index (ABI). BACKGROUND The ability of office-based functional performance measures to predict mortality in patients with PAD is unknown. METHODS Participants were 444 persons with PAD followed prospectively for 4.8 years. The 6-min walk and 4-m walks at usual and fastest pace were measured at baseline. Cox proportional hazard models were used to assess relations between baseline measures of lower extremity performance with mortality, adjusting for confounders. RESULTS One hundred twenty-seven patients (28.6%) died during follow-up. Adjusting for age, gender, race, comorbidities, ABI, and other confounders, participants in the poorest baseline quartile of 6-min walk performance had significantly increased total mortality (hazard ratio [HR] 2.36 [95% confidence interval (CI) 1.33 to 4.18]) and cardiovascular mortality (HR 5.59 [95% CI 1.97 to 15.9]) compared with the best quartile of baseline performance. Participants in the poorest baseline quartile of normal-paced 4-m walking speed had significantly increased total mortality (HR 1.86 [95% CI 1.06 to 3.29]) and cardiovascular mortality (HR 2.55 [95% CI 1.01 to 6.46]) compared with the best quartile of baseline performance. CONCLUSIONS This study demonstrates for the first time that performance-based measures, which can be administered in an office setting, provide prognostic information regarding mortality in persons with PAD beyond that provided by the ABI.
Collapse
Affiliation(s)
- Mary M McDermott
- Department of Medicine, Northwestern University's Feinberg School of Medicine, Chicago, Illinois, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
74
|
Andreozzi GM, Leone A, Laudani R, Martin R, Deinit G, Cataldi V. Levo-Propionyl-Carnitine Improves the Effectiveness of Supervised Physical Training on the Absolute Claudication Distance in Patients With Intermittent Claudication. Angiology 2008; 59:84-9. [DOI: 10.1177/0003319707304567] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The mechanisms by which supervised physical training improves walking ability in patients with intermittent claudication (IC) are microcirculatory, rheological, and metabolic. The main mechanism of levo-propionylcarnitine (LPC) is metabolic; it increases the walking ability in claudicants, providing an additional energy to the ischemic muscle by an anaplerotic activity. Therefore, the current study was carried out to ascertain whether the combined treatment has a synergistic effect. The results confirm the effectiveness of supervised physical training in patients with IC, and we recommend the use of LPC during the exercise training program, at least in patients with severe claudication. Finally, underlining the similar mechanisms of physical training and LPC treatment, the study suggests that a cycle of LPC infusions could be advised in patients with severe claudication who cannot be included, for various reasons, in an exercise rehabilitation program.
Collapse
Affiliation(s)
| | - Alfredo Leone
- Vascular Rehabilitation Unit of Rehabilitation Clinic “Casa di Cura Carmide" Catania, Italy
| | - Rita Laudani
- Vascular Rehabilitation Unit of Rehabilitation Clinic “Casa di Cura Carmide" Catania, Italy
| | - Romeo Martin
- Angiology Care Unit of University Hospital of Padua, Italy
| | - Gregorio Deinit
- Vascular Rehabilitation Unit of Rehabilitation Clinic “Casa di Cura Carmide" Catania, Italy
| | | |
Collapse
|
75
|
Makowsky MJ, McAlister FA, Galbraith PD, Southern DA, Ghali WA, Knudtson ML, Tsuyuki RT. Lower extremity peripheral arterial disease in individuals with coronary artery disease: prognostic importance, care gaps, and impact of therapy. Am Heart J 2008; 155:348-55. [PMID: 18215607 DOI: 10.1016/j.ahj.2007.09.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 09/13/2007] [Indexed: 12/21/2022]
Abstract
BACKGROUND Our objective was to examine the effect of concomitant lower extremity peripheral arterial disease (PAD) on long-term prognosis and pharmacotherapy in patients with coronary artery disease (CAD). METHODS Prospective cohort study enrolling all patients with angiographically proven CAD between April 1, 2000, and December 31, 2004, in Alberta, Canada. RESULTS Of 28,649 patients (mean age 64 years) with CAD, 2509 (9%) had a physician-assigned diagnosis of lower extremity PAD. Mortality was higher in the patients with CAD and PAD over a mean follow-up of 3.1 years, even after adjusting for the fact that patients with PAD had more severe CAD and more comorbidities (adjusted hazard ratio [HR] 1.41, 95% CI 1.28-1.55). Fewer patients with CAD and PAD received antiplatelet agents (83% vs 86%, odds ratio 0.86, 95% CI 0.77-0.97) or beta-blockers (63% vs 67%, odds ratio 0.89, 95% CI 0.82-0.98), but users of these agents exhibited lower mortality (adjusted HR 0.68, 95% CI 0.60-0.77, for antiplatelet agents and adjusted HR 0.72, 95% CI 0.64-0.80, for beta-blockers). Approximately half of these patients were prescribed statins or angiotensin-converting enzyme inhibitors, and 27% were using all 3 evidence-based anti-atherosclerotic therapies (antiplatelets, statin, and angiotensin-converting enzyme inhibitor). CONCLUSIONS In patients with CAD, lower extremity PAD is independently associated with poorer outcomes. Although all evidence-based therapies are underused in patients with CAD, patients with concomitant PAD are less likely to be prescribed antiplatelet agents or beta-blockers--both agents are associated with improved survival in patients with CAD and PAD.
Collapse
|
76
|
Gregg EW, Gu Q, Williams D, de Rekeneire N, Cheng YJ, Geiss L, Engelgau M. Prevalence of lower extremity diseases associated with normal glucose levels, impaired fasting glucose, and diabetes among U.S. adults aged 40 or older. Diabetes Res Clin Pract 2007; 77:485-8. [PMID: 17306411 DOI: 10.1016/j.diabres.2007.01.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 01/08/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Peripheral arterial disease (PAD) and peripheral neuropathy (PN) are serious complications of diabetes, but early detection and intervention may reduce this morbidity. The degree to which PAD and PN develop before diabetes diagnosis has not been established among a representative sample of U.S. adults. OBJECTIVE To compare the prevalence of lower extremity diseases (LEDs) among U.S. adults aged 40 or older with previously diagnosed diabetes, undiagnosed diabetes, impaired fasting glucose, and normal glucose levels. RESEARCH DESIGN AND METHODS We analyzed cross-sectional data of a nationally representative sample of 3607 U.S. adults from the 1999-2004 National Health and Nutrition Examination Surveys (NHANES). Subjects were divided into four groups on the basis of their fasting plasma glucose (FPG) levels and interview responses: normal glucose levels (FPG<100mg/dl), impaired fasting glucose (IFG; FPG 100-125 mg/dl), undiagnosed diabetes (FPG> or =126 and no self-reported diabetes), and diagnosed diabetes. PN was assessed by monofilament testing at three sites on each foot and defined as > or =1 insensate area. PAD was defined as an ankle-brachial blood pressure index <0.9. Any LED was defined as the presence of PAD or PN or a history of non-healing ulcer or amputation. RESULTS The prevalence of PN was lowest among persons with normal glucose (10.5%) and IFG (11.9%) and highest among those with undiagnosed (16.6%) and diagnosed diabetes (19.4%). PAD prevalence was also lowest among persons with normal glucose (3.9%), similar among those with IFG (5.4%), and significantly higher among those with undiagnosed (9.2%) and diagnosed diabetes (7.5%). Any LED was present in about 27% of persons with both undiagnosed diabetes and diagnosed diabetes. CONCLUSIONS LED prevalence was nearly as high among persons with previously undiagnosed diabetes as among those with diagnosed diabetes, but it was not appreciably higher among persons with impaired fasting glucose than among those with normal glucose levels. These results suggest that LED detection efforts should be focused on persons with diabetes, including those with undiagnosed diabetes.
Collapse
Affiliation(s)
- Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA.
| | | | | | | | | | | | | |
Collapse
|
77
|
Golzar JA, Belur A, Carter LI, Choksi N, Safian RD, O'Neill WW. Contemporary percutaneous treatment of infrapopliteal arterial disease: a practical approach. J Interv Cardiol 2007; 20:222-30. [PMID: 17524115 DOI: 10.1111/j.1540-8183.2007.00264.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jaafer A Golzar
- Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA.
| | | | | | | | | | | |
Collapse
|
78
|
Filipovic M, Seagroatt V, Goldacre MJ. Differences between women and men in surgical treatment and case fatality rates for ruptured aortic abdominal aneurysm in England. Br J Surg 2007; 94:1096-9. [PMID: 17514635 DOI: 10.1002/bjs.5784] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Differences between women and men in treatment and outcome after admission with a ruptured abdominal aortic aneurysm (AAA) in England were studied.
Methods
Routinely collected data in Hospital Episode Statistics, linked to death records, for emergency admissions for ruptured AAA in England were analysed. The percentage of patients who underwent surgical repair was calculated, together with 30-day case fatality rates and age-adjusted odds ratios (ORs), comparing women with men.
Results
A total of 2463 women and 7615 men were admitted with a primary diagnosis of ruptured AAA (mean age 79·8 and 74·9 years respectively); 39·6 per cent of women and 66·4 per cent of men underwent surgical repair (OR 0·47 (95 per cent confidence interval 0·42 to 0·52)). Overall, 75·6 per cent of women and 61·7 per cent of men died within 30 days of admission (OR 1·36 (1·22 to 1·52)). The death rate for women and men who had surgery was similar (OR 1·01 (0·88 to 1·17)); when no operation was performed the mortality rate was higher in women, but not significantly so (OR 1·14 (0·91 to 1·42)).
Conclusion
Women with a ruptured AAA were less likely to be treated surgically than men, and their overall mortality rate was higher. Lower rates of surgery in women than in men may contribute to the higher mortality in women, but other explanations are possible.
Collapse
Affiliation(s)
- M Filipovic
- Unit of Health Care Epidemiology, Department of Public Health, University of Oxford, Oxford, UK.
| | | | | |
Collapse
|
79
|
Abstract
Patients with peripheral arterial disease experience significant functional limitations due to ischemic symptoms (claudication) and are at high risk for cardiovascular disease morbidity and mortality resulting from untreated cardiovascular disease risk factors and aggressive atherosclerosis. Peripheral arterial disease is commonly undiagnosed and cardiovascular disease risk factors are frequently untreated in this population. The increased risk associated with peripheral arterial disease necessitates greater emphasis on detection and management, not only to improve survival but to improve functional capacity and quality of life. This article briefly describes the detection and medical management with emphasis on lifestyle modification for elders with peripheral arterial disease.
Collapse
Affiliation(s)
- Roberta K Oka
- School of Nursing, University of California, San Francisco 94143-0608, USA.
| |
Collapse
|
80
|
Niazi K, Khan TH, Easley KA. Diagnostic utility of the two methods of ankle brachial index in the detection of peripheral arterial disease of lower extremities. Catheter Cardiovasc Interv 2006; 68:788-92. [PMID: 17039537 DOI: 10.1002/ccd.20906] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is a common disease that is diagnosed with a screening test called the Ankle Brachial Index (ABI). Different methods of ABI have been described in the literature. We wanted to estimate and compare the sensitivity and specificity of an alternative method of calculating the ABI (LAP ABI, low ankle pressure ABI) with the current method (named high ankle pressure (HAP)), using digital subtraction angiography (DSA) as the gold standard. METHODS We reviewed the records of all patients who had undergone DSA at a major academic center between August 2003 and October 2005. The study includes 107 patients/208 limbs. Inclusion criteria included patients with an ABI performed within 30 days prior to the DSA. Patients with non-compressible vessels and ABI >1.40 were excluded. Abnormal ABI was defined as < or = 0.9 for both methods. Disease on angiogram was defined as the presence of 50% or more stenosis of any lower extremity artery from the aorto-iliac bifurcation to the ankle arteries. RESULTS The sensitivity of the HAP and LAP ABI for the diagnosis of PAD was 69 and 84%, respectively (P < 0.001). The specificity of the HAP and the LAP method was 83 and 64% respectively (P < 0.01). The overall accuracy of LAP ABI and HAP ABI was 80 and 72%, respectively. CONCLUSIONS The LAP ABI has better sensitivity and overall accuracy in comparison to the HAP ABI to diagnose PAD.
Collapse
Affiliation(s)
- Khusrow Niazi
- Division of Cardiology, Emory Crawford Long Hospital, Emory University School of Medicine, Atlanta, Georgia 30308, USA.
| | | | | |
Collapse
|