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Garcia T, Petrera A, Hauck SM, Baber R, Wirkner K, Kirsten H, Pott J, Tönjes A, Henger S, Loeffler M, Peters A, Scholz M. Relationship of proteins and subclinical cardiovascular traits in the population-based LIFE-Adult study. Atherosclerosis 2024; 398:118613. [PMID: 39340936 DOI: 10.1016/j.atherosclerosis.2024.118613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 09/06/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND AND AIMS Understanding molecular processes of the early phase of atherosclerotic cardiovascular disease conditions is of utmost importance for early prediction and intervention measures. METHODS We measured 92 cardiovascular-disease-related proteins (Olink, Cardiovascular III) in 2024 elderly participants of the population-based LIFE-Adult study. We analysed the impact of 27 covariables on these proteins including blood counts, cardiovascular risk factors and life-style-related parameters. We also analysed protein associations with 13 subclinical cardiovascular traits comprising carotid intima media thickness, plaque burden, three modes of Vicorder-based pulse-wave velocities, ankle-brachial index and ECLIA-based N-terminal prohormone of brain natriuretic peptide (NT-proBNP). RESULTS Estimated glomerular filtration rate, triglycerides and sex where the most relevant covariables explaining more than 1 % variance of 49, 22 and 20 proteins, respectively. A total of 43 proteins were significantly associated with at least one of the analysed subclinical cardiovascular traits. NT-pro-BNP, brachial-ankle pulse-wave velocity (baPWV) and parameters of carotid plaque burden accounted for the largest number of associations. Association overlaps were relatively sparse. Only growth/differentiation factor 15, low density lipoprotein receptor and interleukin-1 receptor type 2 are associated with these three different cardiovascular traits. We confirmed several literature findings and found yet unreported associations for carotid plaque presence (von-Willebrand factor, galectin 4), carotid intima-media thickness (carboxypeptidase A1 andB1), baPWV (cathepsin D) and NT-proBNP (cathepsin Z, low density lipoprotein receptor, neurogenic locus homolog protein 3, trem-like transcript 2). Sex-interaction effects were observed, e.g. for spondin-1 and growth/differentiation factor 15 likely regulated by androgen response elements. CONCLUSIONS We extend the catalogue of proteome biomarkers possibly involved in early stages of cardiovascular disease pathologies providing targets for early risk prediction or intervention strategies.
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Affiliation(s)
- Tarcyane Garcia
- Institute for Medical Informatics, Statistics and Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Agnese Petrera
- Metabolomics and Proteomics Core, Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Stefanie M Hauck
- Metabolomics and Proteomics Core, Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; German Center for Diabetes Research (DZD), München, Neuherberg, Germany
| | - Ronny Baber
- LIFE Research Center for Civilization Diseases, Medical Faculty, University of Leipzig, Leipzig, Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostic, University Hospital Leipzig, Leipzig, Germany
| | - Kerstin Wirkner
- Institute for Medical Informatics, Statistics and Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; LIFE Research Center for Civilization Diseases, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Holger Kirsten
- Institute for Medical Informatics, Statistics and Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; LIFE Research Center for Civilization Diseases, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Janne Pott
- Institute for Medical Informatics, Statistics and Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Anke Tönjes
- Department of Medicine, Division of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany
| | - Sylvia Henger
- Institute for Medical Informatics, Statistics and Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; LIFE Research Center for Civilization Diseases, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; LIFE Research Center for Civilization Diseases, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Annette Peters
- German Center for Diabetes Research (DZD), München, Neuherberg, Germany; Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; LIFE Research Center for Civilization Diseases, Medical Faculty, University of Leipzig, Leipzig, Germany.
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Romero-Ante JD, Chicharro-Luna E, Manrique-Córdoba J, Vicente-Samper JM, Gracia-Sánchez A, Sabater-Navarro JM. Validation of a New Ankle Brachial Index Measurement System Using Pulse Wave Velocity. BIOSENSORS 2024; 14:251. [PMID: 38785725 PMCID: PMC11117512 DOI: 10.3390/bios14050251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
Peripheral artery disease (PAD) is a common circulatory disorder characterized by the accumulation of fats, cholesterol, and other substances in the arteries that restrict blood flow to the extremities, especially the legs. The ankle brachial index (ABI) is a highly reliable and valid non-invasive test for diagnosing PAD. However, the traditional method has limitations. These include the time required, the need for Doppler equipment, the training of clinical staff, and patient discomfort. PWV refers to the speed at which an arterial pressure wave propagates along the arteries, and this speed is conditioned by arterial elasticity and stiffness. To address these limitations, we have developed a system that uses electrocardiogram (ECG) and photoplethysmography (PPG) signals to calculate pulse wave velocity (PWV). We propose determining the ABI based on this calculation. Validation was performed on 22 diabetic patients, and the results demonstrate the accuracy of the system, maintaining a margin of ±0.1 compared with the traditional method. This confirms the correlation between PWV and ABI and positions this technique as a promising alternative to overcome some of the limitations of the conventional method.
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Affiliation(s)
- Juan David Romero-Ante
- Neuroengineering Biomedical Group, Medical Robotics Unit, Institute of Bioengineering, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Esther Chicharro-Luna
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, Miguel Hernández University of Elche, 03550 San Juan de Alicante, Spain
| | - Juliana Manrique-Córdoba
- Neuroengineering Biomedical Group, Medical Robotics Unit, Institute of Bioengineering, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - José María Vicente-Samper
- Neuroengineering Biomedical Group, Medical Robotics Unit, Institute of Bioengineering, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Alba Gracia-Sánchez
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, Miguel Hernández University of Elche, 03550 San Juan de Alicante, Spain
| | - José María Sabater-Navarro
- Neuroengineering Biomedical Group, Medical Robotics Unit, Institute of Bioengineering, Miguel Hernández University of Elche, 03202 Elche, Spain
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Lee DW, Hwang YS, Byeon JY, Kim JH, Choi HJ. Does the advantage of transcutaneous oximetry measurements in diabetic foot ulcer apply equally to free flap reconstruction? World J Clin Cases 2023; 11:7570-7582. [DOI: 10.12998/wjcc.v11.i31.7570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 09/25/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Transcutaneous oxygen pressure (TcpO2) is a precise method for determining oxygen perfusion in wounded tissues. The device uses either electrochemical or optical sensors.
AIM To evaluate the usefulness of TcpO2 measurements on free flaps (FFs) in diabetic foot ulcers (DFUs).
METHODS TcpO2 was measured in 17 patients with DFUs who underwent anterolateral thigh (ALT)-FF surgery and compared with 30 patients with DFU without FF surgery.
RESULTS Significant differences were observed in the ankle-brachial index; duration of diabetes; and haemoglobin, creatinine, and C-reactive protein levels between the two groups. TcpO2 values were similar between two groups except on postoperative days 30 and 60 when the values in the ALT-FF group remained < 30 mmHg and did not increase > 50 mmHg.
CONCLUSION Even if the flap is clinically stable, sympathectomy due to adventitia stripping during anastomosis and arteriovenous shunt progression due to diabetic polyneuropathy could lead to low TcpO2 values in the ALT-FF owing to its thick fat tissues, which is supported by the slow recovery of the sympathetic tone following FF. Therefore, TcpO2 measurements in patients with DFU who underwent FF reconstruction may be less accurate than in those who did not.
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Affiliation(s)
- Da Woon Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Yong Seon Hwang
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Je Yeon Byeon
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Jun Hyuk Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Hwan Jun Choi
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
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Bucciarelli V, Bianco F, Di Blasio A, Morano T, Tuosto D, Mucedola F, Di Santo S, Cimini A, Napolitano G, Bucci I, Di Baldassarre A, Cianchetti E, Gallina S. Cardiometabolic Profile, Physical Activity, and Quality of Life in Breast Cancer Survivors after Different Physical Exercise Protocols: A 34-Month Follow-Up Study. J Clin Med 2023; 12:4795. [PMID: 37510910 PMCID: PMC10381308 DOI: 10.3390/jcm12144795] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Breast cancer (BC) and cardiovascular (CV) disease share many risk factors associated with worse outcomes, in terms of cancer relapse, CV events, and quality of life (QoL), that could be counteracted by physical exercise (PE). We aimed to assess the impact of a 12-week differential PE protocol on cardiometabolic profile, QoL, CV- and BC-related long-term outcomes, and physical activity (PA) in a cohort of BC survivors (BCS) not treated with chemotherapy. METHODS 57 BCS participated in a 12-week PE protocol [aerobic exercise training (AET) or resistance exercise training (RET)]. Anthropometric and CV evaluation, health-related (HR)-QoL, daily PA, cortisol, and dehydroepiandrosterone sulfate (DHEA-S) levels were assessed before (T0) and after (T1) PE. We assessed BC and CV outcomes, HR-QoL, CV-QoL, and PA at the follow-up. RESULTS RET improved waist circumference, DHEA-S, cortisol/DHEA-S, systolic and mean blood pressure, and ventricular/arterial coupling; AET ameliorated sagittal abdomen diameter and pulse wave velocity. Regarding HR-QoL, physical function improved only in AET group. At a mean 34 ± 3.6-month follow-up, we documented no significant differences in CV-QoL, HR-QoL, and PA or CV and BC outcomes. CONCLUSIONS AET and RET determine specific, positive adaptations on many parameters strongly related to CV risk, CV and BC outcomes, and QoL, and should be included in any cardio-oncology rehabilitation program.
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Affiliation(s)
- Valentina Bucciarelli
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
- Department of Neurosciences, Imaging and Clinical Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Francesco Bianco
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
- Department of Neurosciences, Imaging and Clinical Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Andrea Di Blasio
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Teresa Morano
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Desiree Tuosto
- Department of Neurosciences, Imaging and Clinical Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Francesco Mucedola
- Department of Neurosciences, Imaging and Clinical Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Serena Di Santo
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Alessandra Cimini
- Eusoma Breast Centre, "G. Bernabeo" Hospital, ASL02 Lanciano-Vasto-Chieti, 66026 Ortona, Italy
| | - Giorgio Napolitano
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Ines Bucci
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Angela Di Baldassarre
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Ettore Cianchetti
- Eusoma Breast Centre, "G. Bernabeo" Hospital, ASL02 Lanciano-Vasto-Chieti, 66026 Ortona, Italy
| | - Sabina Gallina
- Department of Neurosciences, Imaging and Clinical Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
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Amrani S, Eveilleau K, Fassbender V, Obeid H, Abi-Nasr I, Giordana P, Hallab M, Leftheriotis G. Assessment of the systolic rise time by photoplethysmography in peripheral arterial diseases: a comparative study with ultrasound Doppler. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac032. [PMID: 35919340 PMCID: PMC9242071 DOI: 10.1093/ehjopen/oeac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Peripheral arterial disease (PAD) is a major public health burden requiring more intensive population screening. Ankle brachial index (ABI) using arm and ankle cuffs is considered as the reference method for the detection of PAD. Although it requires a rigorous methodology by trained operators, it remains time-consuming and more technically difficult in patients with diabetes due to mediacalcosis. Techniques based on the study of hemodynamic, such as the systolic rise time (SRT), appear promising but need to be validated. We retrospectively compared the reliability and accuracy of SRT using a photoplethysmography (PPG) technique to the SRT measured by ultrasound doppler (UD) in PAD patients diagnosed with the ABI (137 patients, 200 lower limbs).
Methods and results
There was a significant correlation between SRT measured with UD (SRTud) compared with that with PPG (SRTppg, r = 0.25; P = 0.001). Best correlation was found in patients without diabetes (r = 0.40; P = 0.001). Bland and Altman analysis showed a good agreement between the SRTud and SRTppg. In contrast, there was no significant correlation between UD and PPG in diabetes patients. Furthermore, patients with diabetes exhibited a significant increase of SRTppg (P = 0.02) compared with patients without diabates but not with the SRTud (P = 0.18). The SRTppg was significantly linked to the arterial velocity waveforms, the type of arterial lesion but not vascular surgery revascularization technique.
Conclusion
This monocentric pilot study shows that SRT measured with the PPG signal reliably correlates with SRT recorded with UD. The PPG is an easy to use technique in the hand of non-expert with a potential interest for general screening of PAD, especially in diabetes patients, due to its ease to use.
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Affiliation(s)
- Samantha Amrani
- University Hospital of Nice, Vascular Medicine unit, Unité de Médecine et d’Explorations Vasculaires , CHU de Nice Pasteur 1, 30 voie Romaine Nice, France
| | | | - Verena Fassbender
- University Hospital of Nice, Vascular Medicine unit, Unité de Médecine et d’Explorations Vasculaires , CHU de Nice Pasteur 1, 30 voie Romaine Nice, France
| | - Hasan Obeid
- Clinique Bizet, Cardiology unit , Paris, France
| | | | - Pascal Giordana
- University Hospital of Nice, Vascular Medicine unit, Unité de Médecine et d’Explorations Vasculaires , CHU de Nice Pasteur 1, 30 voie Romaine Nice, France
| | | | - Georges Leftheriotis
- University Hospital of Nice, Vascular Medicine unit, Unité de Médecine et d’Explorations Vasculaires , CHU de Nice Pasteur 1, 30 voie Romaine Nice, France
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Danieluk A, Chlabicz S. Automated Measurements of Ankle-Brachial Index: A Narrative Review. J Clin Med 2021; 10:jcm10215161. [PMID: 34768679 PMCID: PMC8585080 DOI: 10.3390/jcm10215161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 12/24/2022] Open
Abstract
Peripheral artery disease (PAD) is an atherosclerotic disease that causes obstruction in lower limb arteries. It increases cardiovascular risk even in asymptomatic patients. Accurate diagnostic tools for identification of affected individuals are needed. Recently, there have been attempts to establish a reliable method of automated ankle-brachial index (ABI) identification. A search of PubMed database to identify studies assessing automatic ABI measurements in agreement with standard PAD diagnosis methods was conducted in December 2020. A total of 57 studies were analyzed in the review. The majority of analyzed studies found ABI measured by automatic oscillometric devices to be potentially feasible for use. Some note that, even though the Doppler and oscillometric methods are not fully interchangeable, the oscillometric devices could be used in screening. Significantly fewer publications are available on automatic plethysmographic devices. For photoplethysmography, most studies reported either good or moderate agreement with reference standards. For air plethysmography, poorer agreement with Doppler ABI is suggested. It is noted that pulse volume recording (PVR) function may improve the diagnostic accuracy of the devices.
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Bentham M, Stansby G, Allen J. Innovative Multi-Site Photoplethysmography Analysis for Quantifying Pulse Amplitude and Timing Variability Characteristics in Peripheral Arterial Disease. Diseases 2018; 6:diseases6030081. [PMID: 30227612 PMCID: PMC6165367 DOI: 10.3390/diseases6030081] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 11/17/2022] Open
Abstract
Photoplethysmography (PPG) is a simple-to-perform vascular optics measurement technique that can detect blood volume changes in the microvascular bed of tissue. Beat-to-beat analysis of the PPG waveform enables the study of the variability of pulse features, such as the amplitude and the pulse arrival time (PAT), and when quantified in the time and frequency domains, has considerable potential to shed light on perfusion changes associated with peripheral arterial disease (PAD). In this pilot study, innovative multi-site bilateral finger and toe PPG recordings from 43 healthy control subjects and 31 PAD subjects were compared (recordings each at least five minutes, collected in a warm temperature-controlled room). Beat-to-beat normalized amplitude variability and PAT variability were then quantified in the time-domain using two simple statistical measures and in the frequency-domain bilaterally using magnitude squared coherence (MSC). Significantly reduced normalized amplitude variability (healthy control 0.0384 (interquartile range 0.0217–0.0744) vs. PAD 0.0160 (0.0080–0.0338) (p < 0.0001)) and significantly increased PAT variability (healthy control 0.0063 (0.0052–0.0086) vs. PAD 0.0093 (0.0078–0.0144) (p < 0.0001)) was demonstrated for the toe site in PAD using the time-domain analysis. Frequency-domain analysis demonstrated significantly lower MSC values across a range of frequency bands for PAD patients. These changes suggest a loss of right-to-left body side coherence and cardiovascular control in PAD. This study has also demonstrated the feasibility of using these measurement and analysis methods in studies investigating multi-site PPG variability for a wide range of cardiac and vascular patient groups.
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Affiliation(s)
- Michael Bentham
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
| | - Gerard Stansby
- Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK.
| | - John Allen
- Northern Medical Physics and Clinical Engineering, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK.
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Godet R, Bruneau A, Vielle B, Vincent F, Le Tourneau T, Carre F, Hupin D, Hamel JF, Abraham P, Henni S. Post-exercise ankle blood pressure and ankle to brachial index after heavy load bicycle exercise. Scand J Med Sci Sports 2018; 28:2144-2152. [PMID: 29858514 DOI: 10.1111/sms.13234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2018] [Indexed: 11/30/2022]
Abstract
The American Heart Association (AHA) recommendations for diagnosing peripheral artery disease (PAD) after exercise are a decrease >20% of ankle brachial index (ABI) or >30 mm Hg of ankle systolic blood pressure (ASBP) from resting values. We evaluated ABI and ASBP values during incremental maximal exercise in physically active and asymptomatic patients. Patients (n = 726) underwent incremental bicycle tests with pre- and post-exercise recording of all four limbs arterial pressures simultaneously. Univariate and multivariate analyses were performed to define the correlation between post-exercise ABI with various clinical factors, including age. Thereafter, the population was divided into groups of age: less than 40 (G < 40), from 40 to 44 (G40/44) from 45 to 49 (G45/49), from 50 to 54 (G50/54), from 55 to 59 (G55/59), from 60 to 64 (G60/64), and 65 and above (G ≥ 65) years. Results are mean ± SD. * is two-tailed P < .05 for ANOVA with Dunnett's post-hoc test from G40. Changes from rest in ASBP were -3 ± 22 (G < 40), -2 ± 20 (G40/44), 4 ± 22* (G45/49), 10 ± 25* (G50/54), 18 ± 21* (G55/59), 23 ± 27* (G60/64), and 16 ± 22* (G ≥ 65) mm Hg. Decreases from rest in ABI were 32 ± 9 (G < 40), 33 ± 9 (G40/44), 29 ± 8 (G45/49), 27 ± 10* (G50/54), 24 ± 7* (G55/59), 22 ± 12* (G60/64), and 21 ± 12* (G ≥ 65) % of resting ABI. Maximal incremental exercise results in ABI and ASBP changes are mostly dependent on age. The AHA limits for post-exercise ABI are inadequate following maximal incremental bicycle testing. Future studies detecting PAD in active patients should account for the effect of age.
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Affiliation(s)
- R Godet
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France
| | - A Bruneau
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France
| | - B Vielle
- Maison de la recherche, University Hospital, Angers, France
| | - F Vincent
- University Hospital, Limoges, France
| | - T Le Tourneau
- Inserm U1087, Institute of Thorax, University Hospital, Nantes, France
| | - F Carre
- University Hospital, Rennes, France
| | - D Hupin
- Department of Clinical and Exercise Physiology, EA SNA EPIS 4607, University Hospital of Saint-Etienne, University of Lyon, Saint-Etienne, France
| | - J F Hamel
- Maison de la recherche, University Hospital, Angers, France
| | - P Abraham
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France.,CNRS6015-INSERM1228 University of Angers, Angers, France
| | - S Henni
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France.,CNRS6015-INSERM1228 University of Angers, Angers, France
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Høyer C, Nielsen NS, Jordansen MKO, Zacho HD. Comparison of two methods based on photoplethysmography for the diagnosis of peripheral arterial disease. Scandinavian Journal of Clinical and Laboratory Investigation 2017; 77:622-627. [PMID: 29043840 DOI: 10.1080/00365513.2017.1390784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM To examine the interchangeability of two methods for distal pressure measurement based on photoplethysmography using a truncated or full display of the arterial inflow curve, respectively. METHODS Toe and ankle pressures were obtained from 69 patients suspected of peripheral arterial disease (PAD). Observer reproducibility of the curve readings was examined by blinded reassessment of the pressure curves in a randomly selected subgroup (60 limbs). RESULTS There were no significant differences in mean pressures between the two methods (p for all > .455). The limits of agreement for the differences were -15.0-15.4 mmHg for right toe pressures, -16.3-16.2 mmHg for left toe pressures, -14.2-15.7 mmHg for right ankle pressures, and -18.3-17.7 mmHg for left ankle pressures. Correlation analysis revealed intraclass correlation coefficients ≥0.960 for all measuring sites. Cohen's Kappa showed excellent agreement in diagnostic classification, with κ = 0.930 for the diagnosis of PAD and perfect agreement in the diagnosis of critical limb ischemia (κ = 1.000). The analysis of intra-observer variation for curve reading showed limits of agreement of -3.9-4.0 for toe pressures and -7.6-7.7 for ankle pressures for the method involving truncated display and -3.1-3.2 for toe pressures and -6.3-8.6 for ankle pressures for the method involving full display of the signal. CONCLUSION The present study shows minimal differences in diagnostic classification, as well as in ankle and toe pressures, between the full display and the truncated display of the photoplethysmographic pulse signal. Furthermore, the inter-observer variation was low for both of the photoplethysmographic methods investigated.
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Affiliation(s)
- Christian Høyer
- a Department of Clinical Physiology , Viborg Regional Hospital , Viborg , Denmark.,b Department of Nuclear Medicine , Aalborg University Hospital , Aalborg , Denmark
| | | | | | - Helle Damgaard Zacho
- b Department of Nuclear Medicine , Aalborg University Hospital , Aalborg , Denmark
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10
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Szentkirályi A, Völzke H, Hoffmann W, Dörr M, Hense HW, Berger K. Ankle-brachial index and peripheral artery disease are not related to restless legs syndrome. Sleep Med 2017; 35:74-79. [PMID: 28619186 DOI: 10.1016/j.sleep.2017.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Our aim was to investigate the relationship between impaired peripheral arterial circulation as measured by ankle-brachial index (ABI) and restless legs syndrome (RLS) in the general population. METHODS Data are derived from three independent, German population-based, prospective studies: the control sample of BiDirect (N = 966), the second follow-up of SHIP (N = 2333), and a subsample of SHIP-Trend (N = 1269). RLS was assessed with questions based on the RLS minimal criteria. ABI was measured with an automated method in BiDirect and with Doppler ultrasound in both SHIP studies. An ABI score below 0.9 was indicative of peripheral arterial disease (PAD). Co-morbidities, medications and behavioural factors were self-reported. Additional measurements included body mass index and haemoglobin from blood serum. For BiDirect, a follow-up with identical methodology was performed after a median of 2.5 years. RESULTS In cross-sectional analyses, decreased ABI was not significantly associated with RLS as outcome in multivariable logistic regression models adjusted for several potential confounders (BiDirect: odds ratio (OR) = 1.07 for a -0.1 change in ABI, 95% confidence interval (CI): 0.81-1.42, p = 0.62; SHIP-2: OR = 0.99, CI: 0.85-1.16, p = 0.94; SHIP-Trend: OR = 0.99, CI: 0.87-1.13, p = 0.88). Similar non-significant results were achieved using PAD (instead of ABI) as an independent variable. In BiDirect, baseline ABI was not a significant predictor of incident RLS in longitudinal analysis (OR = 0.77, CI: 0.53-1.12, p = 0.17). CONCLUSION Results from three independent studies suggest that reduced ABI is not a risk factor for RLS in the general population.
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Affiliation(s)
- A Szentkirályi
- Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-Universität Münster, Germany.
| | - H Völzke
- Institute for Community Medicine, University Medicine Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Germany
| | - W Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, Germany; German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - M Dörr
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Germany; Department of Internal Medicine B, University Medicine Greifswald, Germany
| | - H W Hense
- Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-Universität Münster, Germany
| | - K Berger
- Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-Universität Münster, Germany; German Centre for Diabetes Research, Partner Site Münster, Germany
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11
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Pressler A, Suchy C, Friedrichs T, Dallinger S, Grabs V, Haller B, Halle M, Scherr J. Running multiple marathons is not a risk factor for premature subclinical vascular impairment. Eur J Prev Cardiol 2017; 24:1328-1335. [DOI: 10.1177/2047487317713326] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Axel Pressler
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany
| | - Christiane Suchy
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany
| | - Tasja Friedrichs
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany
| | - Sophia Dallinger
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany
| | - Viola Grabs
- Department of Cardiology, Klinikum Garmisch-Partenkirchen, Germany
| | - Bernhard Haller
- Institute for Medical Statistics and Epidemiology, Technische Universität München, Germany
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
- Else Kröner-Fresenius-Zentrum, Germany
| | - Johannes Scherr
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany
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12
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Abstract
BACKGROUND AND AIMS Hyperhomocysteineamia (HHcy) has long been suggested as a risk factor for atherosclerosis. However, the association between HHcy and peripheral arterial disease (PAD) is still controversial. There is a lack of research on this topic in the Chinese population. This study aims to provide further results. METHODS 240 PAD patients and 240 control subjects were evaluated for both serum total homocysteine levels and ankle brachial indexes (ABIs). Multivariable logistic regression models were used to estimate the association between HHcy and the risk of developing PAD. Interaction and stratified analyses were conducted according to age, sex, smoking status, drinking status, and histories of chronic disease. RESULTS The multivariate logistic regression analyses revealed that the risk of PAD was significantly associated with serum homocysteine levels. The interaction analysis showed no interactive role in the association between HHcy and PAD, indicating that homocysteine was associated with PAD independently of classical vascular risk factors. CONCLUSIONS In conclusion, HHcy is an independent risk factor for PAD in the Chinese Han population. A prospective and randomized clinical trial of homocysteine lowering therapy in the Chinese population is needed to assess the causal nature of the relationship.
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13
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Crawford F, Welch K, Andras A, Chappell FM. Ankle brachial index for the diagnosis of lower limb peripheral arterial disease. Cochrane Database Syst Rev 2016; 9:CD010680. [PMID: 27623758 PMCID: PMC6457627 DOI: 10.1002/14651858.cd010680.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Peripheral arterial disease (PAD) of the lower limb is common, with prevalence of both symptomatic and asymptomatic disease estimated at 13% in the over 50 age group. Symptomatic PAD affects about 5% of individuals in Western populations between the ages of 55 and 74 years. The most common initial symptom of PAD is muscle pain on exercise that is relieved by rest and is attributed to reduced lower limb blood flow due to atherosclerotic disease (intermittent claudication). The ankle brachial index (ABI) is widely used by a variety of healthcare professionals, including specialist nurses, physicians, surgeons and podiatrists working in primary and secondary care settings, to assess signs and symptoms of PAD. As the ABI test is non-invasive and inexpensive and is in widespread clinical use, a systematic review of its diagnostic accuracy in people presenting with leg pain suggestive of PAD is highly relevant to routine clinical practice. OBJECTIVES To estimate the diagnostic accuracy of the ankle brachial index (ABI) - also known as the ankle brachial pressure index (ABPI) - for the diagnosis of peripheral arterial disease in people who experience leg pain on walking that is alleviated by rest. SEARCH METHODS We carried out searches of the following databases in August 2013: MEDLINE (Ovid SP),Embase (Ovid SP), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO), Latin American and Caribbean Health Sciences (LILACS) (Bireme), Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database in The Cochrane Library, the Institute for Scientific Information (ISI) Conference Proceedings Citation Index - Science, the British Library Zetoc Conference search and Medion. SELECTION CRITERIA We included cross-sectional studies of ABI in which duplex ultrasonography or angiography was used as the reference standard. We also included cross-sectional or diagnostic test accuracy (DTA) cohort studies consisting of both prospective and retrospective studies.Participants were adults presenting with leg pain on walking that was relieved by rest, who were tested in primary care settings or secondary care settings (hospital outpatients only) and who did not have signs or symptoms of critical limb ischaemia (rest pain, ischaemic ulcers or gangrene).The index test was ABI, also called the ankle brachial pressure index (ABPI) or the Ankle Arm Index (AAI), which was performed with a hand-held doppler or oscillometry device to detect ankle vessels. We included data collected via sphygmomanometers (both manual and aneroid) and digital equipment. DATA COLLECTION AND ANALYSIS Two review authors independently replicated data extraction by using a standard form, which included an assessment of study quality, and resolved disagreements by discussion. Two review authors extracted participant-level data when available to populate 2×2 contingency tables (true positives, true negatives, false positives and false negatives).After a pilot phase involving two review authors working independently, we used the methodological quality assessment tool the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), which incorporated our review question - along with a flow diagram to aid reviewers' understanding of the conduct of the study when necessary and an assessment of risk of bias and applicability judgements. MAIN RESULTS We screened 17,055 records identified through searches of databases. We obtained 746 full-text articles and assessed them for relevance. We scrutinised 49 studies to establish their eligibility for inclusion in the review and excluded 48, primarily because participants were not patients presenting solely with exertional leg pain, investigators used no reference standard or investigators used neither angiography nor duplex ultrasonography as the reference standard. We excluded most studies for more than one reason.Only one study met the eligibility criteria and provided limb-level accuracy data from just 85 participants (158 legs). This prospective study compared the manual doppler method of obtaining an ABI (performed by untrained personnel) with the automated oscillometric method. Limb-level data, as reported by the study, indicated that the accuracy of the ABI in detecting significant arterial disease on angiography is superior when stenosis is present in the femoropopliteal vessels, with sensitivity of 97% (95% confidence interval (CI) 93% to 99%) and specificity of 89% (95% CI 67% to 95%) for oscillometric ABI, and sensitivity of 95% (95% CI 89% to 97%) and specificity of 56% (95% CI 33% to 70%) for doppler ABI. The ABI threshold was not reported. Investigators attributed the lower specificity for doppler to the fact that a tibial or dorsalis pedis pulse could not be detected by doppler in 12 of 27 legs with normal vessels or non-significant lesions. The superiority of the oscillometric (automated) method for obtaining an ABI reading over the manual method with a doppler probe used by inexperienced operators may be a clinically important finding. AUTHORS' CONCLUSIONS Evidence about the accuracy of the ankle brachial index for the diagnosis of PAD in people with leg pain on exercise that is alleviated by rest is sparse. The single study included in our review provided only limb-level data from a few participants. Well-designed cross-sectional studies are required to evaluate the accuracy of ABI in patients presenting with early symptoms of peripheral arterial disease in all healthcare settings. Another systematic review of existing studies assessing the use of ABI in alternative patient groups, including asymptomatic, high-risk patients, is required.
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Affiliation(s)
- Fay Crawford
- NHS Fife, Queen Margaret HospitalDunfermlineUKKY12 0SU
| | - Karen Welch
- University of EdinburghUsher Institute of Population Health Sciences and InformaticsTeviot PlaceEdinburghUKEH8 9AG
| | - Alina Andras
- Keele University, Guy Hilton Research CentreInstitute for Science and Technology in MedicineThornburrow DriveHartshillStoke‐on‐TrentUKST4 7QB
| | - Francesca M Chappell
- University of EdinburghDivision of Clinical NeurosciencesWestern General HospitalEdinburghUKEH4 2XU
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14
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Betge S, Kretzschmar D, Figulla HR, Lichtenauer M, Jung C. Predictive value of the augmentation index derived vascular age in patients with newly diagnosed atherosclerosis. Heart Vessels 2016; 32:252-259. [PMID: 27401737 PMCID: PMC5334397 DOI: 10.1007/s00380-016-0868-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 07/01/2016] [Indexed: 11/23/2022]
Abstract
Early detection of atherosclerosis, i.e., in occupational health screening programs could reduce the rate of cardiovascular events in the working population. Changes of the augmentation index (AIX) correlate with changes of the arterial stiffness induced by aging, atherosclerosis, or arterial hypertension and have a prognostic value for cardiovascular events. Their diagnostic yield should be increased by normalizing the AIX to age, in terms of a calculating the vascular age (VA). In this pilot study, 30 patients (mean age 65.3 ± 8.8 years, 21 male) with suspected coronary heart disease underwent a duplex ultrasound of the carotid arteries and a measurement of the ankle brachial index in addition to the coronary angiography. The AIX was recorded with a portable device (Vascular Explorer), and the VA was calculated. Atherosclerosis was found in 24 patients. They were older than the patients without atherosclerosis, but there was no age dependency found for the distribution pattern or severity of atherosclerosis. In patients with findings of atherosclerosis, the calculated VA was higher than the chronological age, and these differences were significant in patients below 65 years of age. Comparing patients in higher blood pressure classes with patients in lower classes, significantly higher AIX, VA, and differences to the chronological age were found. The VA, deduced from the noninvasively obtained AIX, is a promising candidate for screening programs for atherosclerosis, i.e., in occupational health screening programs.
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Affiliation(s)
- Stefan Betge
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
| | - Daniel Kretzschmar
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Hans-Reiner Figulla
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Michael Lichtenauer
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Muellner Hauptstraße 48, Salzburg, 5020, Austria
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, Duesseldorf, 40225, Germany
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15
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Teren A, Beutner F, Wirkner K, Löffler M, Scholz M. Relationship Between Determinants of Arterial Stiffness Assessed by Diastolic and Suprasystolic Pulse Oscillometry: Comparison of Vicorder and Vascular Explorer. Medicine (Baltimore) 2016; 95:e2963. [PMID: 26962797 PMCID: PMC4998878 DOI: 10.1097/md.0000000000002963] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Pulse wave velocity (PWV) and augmentation index (AI) are independent predictors of cardiovascular health. However, the comparability of multiple oscillometric modalities currently available for their assessment was not studied in detail. In the present study, we aimed to evaluate the relationship between indices of arterial stiffness assessed by diastolic and suprasystolic oscillometry.In total, 56 volunteers from the general population (23 males; median age 70 years [interquartile range: 65-72 years]) were recruited into observational feasibility study to evaluate the carotid-femoral/aortic PWV (cf/aoPWV), brachial-ankle PWV (baPWV), and AI assessed by 2 devices: Vicorder (VI) applying diastolic, right-sided oscillometry for the determination of all 3 indices, and Vascular explorer (VE) implementing single-point, suprasystolic brachial oscillometry (SSBO) pulse wave analysis for the assessment of cfPWV and AI. Within- and between-device correlations of measured parameters were analyzed. Furthermore, agreement of repeated measurements, intra- and inter-observer concordances were determined and compared for both devices.In VI, both baPWV and cfPWV inter-correlated well and showed good level of agreement with bilateral baPWV measured by VE (baPWV[VI]-baPWV[VE]R: overall concordance correlation coefficient [OCCC] = 0.484, mean difference = 1.94 m/s; cfPWV[VI]-baPWV[VE]R: OCCC = 0.493, mean difference = 1.0 m/s). In contrast, SSBO-derived aortic PWA (cf/aoPWA[VE]) displayed only weak correlation with cfPWV(VI) (r = 0.196; P = 0.04) and ipsilateral baPWV (cf/aoPWV[VE]R-baPWV[VE]R: r = 0.166; P = 0.08). cf/aoPWA(VE) correlated strongly with AI(VE) (right-sided: r = 0.725, P < 0.001). AI exhibited marginal between-device agreement (right-sided: OCCC = 0.298, mean difference: 6.12%). All considered parameters showed good-to-excellent repeatability giving OCCC > 0.9 for 2-point-PWV modes and right-sided AI(VE). Intra- and inter-observer concordances were similarly high except for AI yielding a trend toward better reproducibility in VE (interobserver-OCCC[VI] vs [VE] = 0.774 vs 0.844; intraobserver-OCCC[VI] vs [VE] = 0.613 vs 0.769).Both diastolic oscillometry-derived PWV modes, and AI measured either with VI or VE, are comparable and reliable alternatives for the assessment of arterial stiffness. Aortic PWV assessed by SSBO in VE is not related to the corresponding indices determined by traditional diastolic oscillometry.
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Affiliation(s)
- Andrej Teren
- From the LIFE-Leipzig Research Center for Civilization Diseases (AT, FB, KW, ML, MS) and Institute for Medical Informatics, Statistics and Epidemiology (ML, MS), University of Leipzig and Department of Internal Medicine/Cardiology, Heart Center of the University Leipzig (AT, FB), Leipzig, Germany
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16
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Forsythe RO, Hinchliffe RJ. Assessment of foot perfusion in patients with a diabetic foot ulcer. Diabetes Metab Res Rev 2016; 32 Suppl 1:232-8. [PMID: 26813616 DOI: 10.1002/dmrr.2756] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Assessment of foot perfusion is a vital step in the management of patients with diabetic foot ulceration, in order to understand the risk of amputation and likelihood of wound healing. Underlying peripheral artery disease is a common finding in patients with foot ulceration and is associated with poor outcomes. Assessment of foot perfusion should therefore focus on identifying the presence of peripheral artery disease and to subsequently estimate the effect this may have on wound healing. Assessment of perfusion can be difficult because of the often complex, diffuse and distal nature of peripheral artery disease in patients with diabetes, as well as poor collateralisation and heavy vascular calcification. Conventional methods of assessing tissue perfusion in the peripheral circulation may be unreliable in patients with diabetes, and it may therefore be difficult to determine the extent to which poor perfusion contributes to foot ulceration. Anatomical data obtained on cross-sectional imaging is important but must be combined with measurements of tissue perfusion (such as transcutaneous oxygen tension) in order to understand the global and regional perfusion deficit present in a patient with diabetic foot ulceration. Ankle-brachial pressure index is routinely used to screen for peripheral artery disease, but its use in patients with diabetes is limited in the presence of neuropathy and medial arterial calcification. Toe pressure index may be more useful because of the relative sparing of pedal arteries from medial calcification but may not always be possible in patients with ulceration. Fluorescence angiography is a non-invasive technique that can provide rapid quantitative information about regional tissue perfusion; capillaroscopy, iontophoresis and hyperspectral imaging may also be useful in assessing physiological perfusion but are not widely available. There may be a future role for specialized perfusion imaging of these patients, including magnetic resonance imaging techniques, single-photon emission computed tomography and PET-based molecular imaging; however, these novel techniques require further validation and are unlikely to become standard practice in the near future.
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Affiliation(s)
- Rachael O Forsythe
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Robert J Hinchliffe
- St George's Vascular Institute, St James Wing, St George's Hospital, London, UK
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17
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Automated plethysmographic measurement of the ankle-brachial index: a comparison with the doppler ultrasound method. Hypertens Res 2015; 39:100-6. [DOI: 10.1038/hr.2015.124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/16/2015] [Accepted: 09/24/2015] [Indexed: 11/08/2022]
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18
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Weissgerber A, Scholz M, Teren A, Sandri M, Teupser D, Gielen S, Thiery J, Schuler G, Beutner F. The value of noncoronary atherosclerosis for identifying coronary artery disease: results of the Leipzig LIFE Heart Study. Clin Res Cardiol 2015; 105:172-81. [PMID: 26362881 PMCID: PMC4735267 DOI: 10.1007/s00392-015-0900-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/30/2015] [Indexed: 11/11/2022]
Abstract
Background Despite the widespread use of noninvasive testing prior to invasive coronary diagnostic the diagnostic yield of elective coronary angiography has been reported low in subjects with suspected obstructive CAD. Objective To determine the predictive value of noncoronary atherosclerosis (NCA) in subjects with suspected stable coronary artery disease (CAD) intended to invasive coronary angiography. Methods Ultrasound-based assessment of carotid artery plaque (CAP), carotid intima-media thickness (CIMT) and ankle-brachial index (ABI) was performed in 2216 subjects with suspected CAD prior to coronary angiography. Logistic regression and c-statistics were used to analyze the diagnostic value of NCA for the presence of obstructive CAD and the intention to revascularization. Results Percentage of positive results of elective coronary angiography was low but comparable to other studies (41 % obstructive CAD). We identified 1323 subjects (60 %) with NCA, most of them were characterized by CAP (93 %). CAP independently predicted obstructive CAD in addition to traditional risk factors and clinical factors while CIMT and ABI failed to improve the prediction. The presence of NCA and typical angina were the strongest predictors for obstructive CAD (OR 4.0 and 2.4, respectively). A large subgroup of patients (n = 703, 32 %) with atypical clinical presentation and lack of NCA revealed a low indication for revascularization <15 % indicating a large proportion of subjects with non-obstructive CAD in this subgroup. Conclusion The evaluation of noncoronary atherosclerosis has the potential to impact clinical decision making and to direct subsequent diagnostic procedures in subjects with suspected coronary artery disease. Clinical trial registration NCT00497887. Electronic supplementary material The online version of this article (doi:10.1007/s00392-015-0900-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Weissgerber
- Department of Cardiology, Heart Center University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.,LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany
| | - Markus Scholz
- LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.,Institute of Medical Informatics, Statistic and Epidemiology, University Leipzig, Leipzig, Germany
| | - Andrej Teren
- Department of Cardiology, Heart Center University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.,LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany
| | - Marcus Sandri
- Department of Cardiology, Heart Center University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
| | - Daniel Teupser
- LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.,Institute of Laboratory Medicine, Ludwig-Maximilian University, Munich, Germany
| | - Stephan Gielen
- LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.,Department of Medicine III, University Hospital Halle (Saale), Halle/Saale, Germany
| | - Joachim Thiery
- LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
| | - Gerhard Schuler
- Department of Cardiology, Heart Center University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.,LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany
| | - Frank Beutner
- Department of Cardiology, Heart Center University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany. .,LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.
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19
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Loeffler M, Engel C, Ahnert P, Alfermann D, Arelin K, Baber R, Beutner F, Binder H, Brähler E, Burkhardt R, Ceglarek U, Enzenbach C, Fuchs M, Glaesmer H, Girlich F, Hagendorff A, Häntzsch M, Hegerl U, Henger S, Hensch T, Hinz A, Holzendorf V, Husser D, Kersting A, Kiel A, Kirsten T, Kratzsch J, Krohn K, Luck T, Melzer S, Netto J, Nüchter M, Raschpichler M, Rauscher FG, Riedel-Heller SG, Sander C, Scholz M, Schönknecht P, Schroeter ML, Simon JC, Speer R, Stäker J, Stein R, Stöbel-Richter Y, Stumvoll M, Tarnok A, Teren A, Teupser D, Then FS, Tönjes A, Treudler R, Villringer A, Weissgerber A, Wiedemann P, Zachariae S, Wirkner K, Thiery J. The LIFE-Adult-Study: objectives and design of a population-based cohort study with 10,000 deeply phenotyped adults in Germany. BMC Public Health 2015. [PMID: 26197779 PMCID: PMC4509697 DOI: 10.1186/s12889-015-1983-z] [Citation(s) in RCA: 239] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background The LIFE-Adult-Study is a population-based cohort study, which has recently completed the baseline examination of 10,000 randomly selected participants from Leipzig, a major city with 550,000 inhabitants in the east of Germany. It is the first study of this kind and size in an urban population in the eastern part of Germany. The study is conducted by the Leipzig Research Centre for Civilization Diseases (LIFE). Our objective is to investigate prevalences, early onset markers, genetic predispositions, and the role of lifestyle factors of major civilization diseases, with primary focus on metabolic and vascular diseases, heart function, cognitive impairment, brain function, depression, sleep disorders and vigilance dysregulation, retinal and optic nerve degeneration, and allergies. Methods/design The study covers a main age range from 40-79 years with particular deep phenotyping in elderly participants above the age of 60. The baseline examination was conducted from August 2011 to November 2014. All participants underwent an extensive core assessment programme (5-6 h) including structured interviews, questionnaires, physical examinations, and biospecimen collection. Participants over 60 underwent two additional assessment programmes (3-4 h each) on two separate visits including deeper cognitive testing, brain magnetic resonance imaging, diagnostic interviews for depression, and electroencephalography. Discussion The participation rate was 33 %. The assessment programme was accepted well and completely passed by almost all participants. Biomarker analyses have already been performed in all participants. Genotype, transcriptome and metabolome analyses have been conducted in subgroups. The first follow-up examination will commence in 2016.
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Affiliation(s)
- Markus Loeffler
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany. .,Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), University of Leipzig, Haertelstrasse 16-18, 04107, Leipzig, Germany.
| | - Christoph Engel
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), University of Leipzig, Haertelstrasse 16-18, 04107, Leipzig, Germany
| | - Peter Ahnert
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), University of Leipzig, Haertelstrasse 16-18, 04107, Leipzig, Germany
| | - Dorothee Alfermann
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Sport and Exercise Psychology, University of Leipzig, Leipzig, Germany
| | - Katrin Arelin
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic of Cognitive Neurology, University of Leipzig, Leipzig, Germany
| | - Ronny Baber
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Frank Beutner
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Internal Medicine/Cardiology, Leipzig Heart Centre, Leipzig, Germany
| | - Hans Binder
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Interdisciplinary Centre for Bioinformatics, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Universal Medical Centre Mainz, Mainz, Germany
| | - Ralph Burkhardt
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Uta Ceglarek
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Cornelia Enzenbach
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Michael Fuchs
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Otorhinolaryngology, Section of Phoniatrics and Audiology, University of Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Friederike Girlich
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), University of Leipzig, Haertelstrasse 16-18, 04107, Leipzig, Germany
| | - Andreas Hagendorff
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Cardiology-Angiology, University of Leipzig, Leipzig, Germany
| | - Madlen Häntzsch
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Ulrich Hegerl
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Sylvia Henger
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Tilman Hensch
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Andreas Hinz
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Volker Holzendorf
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Clinical Trial Centre Leipzig - Coordinating Centre for Clinical Trials, University of Leipzig, Leipzig, Germany
| | - Daniela Husser
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Electrophysiology, Leipzig Heart Centre, Leipzig, Germany
| | - Anette Kersting
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Clinic of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Alexander Kiel
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Toralf Kirsten
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Interdisciplinary Centre for Bioinformatics, University of Leipzig, Leipzig, Germany
| | - Jürgen Kratzsch
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Knut Krohn
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Interdisciplinary Centre for Clinical Research (IZKF), University of Leipzig, Leipzig, Germany
| | - Tobias Luck
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Susanne Melzer
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Pediatric Cardiology, Leipzig Heart Centre, Leipzig, Germany
| | - Jeffrey Netto
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Matthias Nüchter
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Matthias Raschpichler
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Radiology, University of Leipzig, Leipzig, Germany
| | - Franziska G Rauscher
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Ophthalmology, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Christian Sander
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Markus Scholz
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), University of Leipzig, Haertelstrasse 16-18, 04107, Leipzig, Germany
| | - Peter Schönknecht
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Matthias L Schroeter
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic of Cognitive Neurology, University of Leipzig, Leipzig, Germany
| | - Jan-Christoph Simon
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Dermatology, Venereology and Allergology, University of Leipzig, Leipzig, Germany
| | - Ronald Speer
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Julia Stäker
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Clinic of Cognitive Neurology, University of Leipzig, Leipzig, Germany
| | - Robert Stein
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), University of Leipzig, Haertelstrasse 16-18, 04107, Leipzig, Germany
| | - Yve Stöbel-Richter
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Michael Stumvoll
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Medical Department, Division of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany
| | - Attila Tarnok
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Pediatric Cardiology, Leipzig Heart Centre, Leipzig, Germany
| | - Andrej Teren
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Internal Medicine/Cardiology, Leipzig Heart Centre, Leipzig, Germany
| | - Daniel Teupser
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Francisca S Then
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Anke Tönjes
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Medical Department, Division of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany
| | - Regina Treudler
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Dermatology, Venereology and Allergology, University of Leipzig, Leipzig, Germany
| | - Arno Villringer
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic of Cognitive Neurology, University of Leipzig, Leipzig, Germany
| | - Alexander Weissgerber
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Peter Wiedemann
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Ophthalmology, University of Leipzig, Leipzig, Germany
| | - Silke Zachariae
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), University of Leipzig, Haertelstrasse 16-18, 04107, Leipzig, Germany
| | - Kerstin Wirkner
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Joachim Thiery
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
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20
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Teren A, Beutner F, Wirkner K, Loeffler M, Scholz M. Validity, intra- and inter-observer reliability of automated devices for the assessment of ankle brachial index using photo-plethysmography. BMC Cardiovasc Disord 2013; 13:81. [PMID: 24103352 PMCID: PMC3851735 DOI: 10.1186/1471-2261-13-81] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 10/03/2013] [Indexed: 11/15/2022] Open
Abstract
Background Ankle-brachial-Index (ABI) measured by manual Dopplersonography is an easily assessable marker of global cardiovascular risk. The aim of this study was to establish novel photo-plethysmography (PPG)-based ABI assessments in an epidemiologic context and to compare its results with those of Doppler. Methods Two devices for PPG-based ABI assessments (Vicorder, Vascular Explorer) were tested and compared against Doppler in 56 putatively healthy subjects. We determined acceptance, time requirements, agreement of repeat measurements, agreement with Doppler and intra- and inter-observer concordances for both devices and compared the results. Differences between cuff inflation- and deflation-based methods were also studied for Vascular Explorer. Results Acceptance was similar for both devices but Vascular Explorer was more time consuming. Agreement of multiple measurements was moderate for both methods highlighting the importance of measurement replicates. Both automated devices showed significantly higher ABI compared to Doppler which can be traced back to higher brachial pressures (Vicorder) or higher ankle pressures (Vascular Explorer). This effect is more pronounced for Vascular Explorer but can be ameliorated using the deflation method of measurement. Intra-observer concordances were similar. Inter-observer concordance was non-significantly better for Vicorder. Conclusions Both devices proved to be feasible in epidemiologic studies, but compared to Doppler, do not constitute an advantage regarding time requirement and accuracy of ABI assessment. Since PPG-based ABI values are inflated compared to Doppler, it will be necessary to adjust Doppler-based cut-offs for risk stratification.
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Affiliation(s)
- Andrej Teren
- LIFE- Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.
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21
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Balta S, Balta I, Demirkol S, Cakar M, Sarlak H, Kurt O. Subclinical peripheral arterial disease and ankle-brachial index. Angiology 2013; 64:395-6. [PMID: 23716726 DOI: 10.1177/0003319712475206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Balta S, Demirkol S, Yesil FG, Cakar M, Sarlak H, Celik T. Only ankle-brachial index may not be an accurate information about the prevalence of peripheral arterial disease. Angiology 2013; 64:481-2. [PMID: 23539614 DOI: 10.1177/0003319713482748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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