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Ripollés-Melchor J, Monge García MI, Ruiz-Escobar A, Sáez-Ruiz E, Algar-Yañez B, Abad-Motos A, Abad-Gurumeta A. Validity of estimated aortic pulse wave velocity measured during the 6-min walk test to predict anaerobic fitness before major non-cardiac surgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024:S2341-1929(24)00126-4. [PMID: 39245143 DOI: 10.1016/j.redare.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND This study aimed to assess the efficacy of estimated preoperative aortic pulse wave velocity (AoPWV) to discriminate between low and high 6 min walk test (6MWT) distance in patients awaiting major non-cardiac surgery. METHODS Prospective observational study in 133 patients undergoing non cardiac surgery. AoPWV and the distance walked during a 6MWT were assessed. Receiver operating characteristic (ROC) curve analysis was used to determine two different AoPWV cut-points for predicting a distance of 427 m in the 6MWT. We also calculated lower and upper AoPWV cut-points (probability ≥ 0.75) for predicting a distance of < 427 m, ≥427 m, and also 563 m in the 6MWT. RESULTS The ROC curve analysis for the < 427 m distance revealed an area under the curve (AUC) of 0.68 (95% confidence interval 0.56-0.79) and an AUC of 0.72 (95% confidence interval 0.61-0.83) for >563 m. Patients with AoPWV > 10.97 m/s should be considered high risk, while those with <9.42 m/s can be considered low risk. CONCLUSIONS AoPWV is a simple, non-invasive, useful clinical tool for identifying and stratifying patients awaiting major non-cardiac surgery. In situations of clinical uncertainty, additional measures should be taken to assess the risk.
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Affiliation(s)
- J Ripollés-Melchor
- Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain.
| | - M I Monge García
- Departamento de Cuidados Intensivos, Hospital Universitario SAS de Jerez, Jerez de la Frontera, Cádiz, Spain
| | - A Ruiz-Escobar
- Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - E Sáez-Ruiz
- Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - B Algar-Yañez
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | - A Abad-Motos
- Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain
| | - A Abad-Gurumeta
- Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain
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Salah NY, Madkour SS, Ahmed KS, Abdelhakam DA, Abdullah FA, Mahmoud RAEH. Adiponectin rs1501299 and chemerin rs17173608 gene polymorphism in children with type 1 diabetes mellitus: relation with macroangiopathy and peripheral artery disease. J Endocrinol Invest 2024; 47:983-994. [PMID: 37831337 PMCID: PMC10965736 DOI: 10.1007/s40618-023-02215-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
AIM Although macrovascular complications represent the leading cause of mortality in type 1 diabetes mellitus (T1DM), the prevalence of subtle macrovascular affection including peripheral artery disease (PAD) among children with T1DM and its genetic predictors remains to be unraveled. Increasing evidence suggests a link between adiponectin rs1501299 and chemerin rs17173608 gene polymorphism and atherogenesis, and insulin resistance. Hence, this study assess the prevalence of these variants among children with T1DM in comparison to healthy controls and their association with macrovascular complications, namely PAD and hyperlipidemia. METHODS Fifty children with T1DM and 50 matched controls underwent a thorough assessment including adiponectin rs1501299 and chemerin rs17173608 gene polymorphisms, fasting lipids, glycated hemoglobin (HbA1c), and ankle-brachial index (ABI). Cochran-Armitage trend test was used to decide the risk allele and evaluate the association between the candidate variant and PAD using a case-control design. RESULTS Children with T1DM were found to have significantly higher ABI (p = 0.011) than controls. Chemerin gene polymorphism was detected in 41 children with T1DM (82.0%), while adiponectin gene polymorphism was detected in 19 children (38.0%). Children with T1DM having GG chemerin variant and those having TT adiponectin variant had significantly higher cholesterol with significantly lower HDL-C and ABI than those having the other two variants (p < 0.005). Children with T1DM having abnormal ABI had significantly higher chemerin G (p = 0.017) and adiponectin T (p = 0.022) alleles than those with normal ABI. Cholesterol and ABI were independently associated with chemerin and adiponectin gene polymorphism by multivariable regression analysis. CONCLUSION Children with T1DM having chemerin and adiponectin gene polymorphisms have significantly higher cholesterol and ABI than those without these polymorphisms and controls. TRIAL REGISTRATION The Research Ethics Committee of Ain Shams University, approval number R 31/2021.
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Affiliation(s)
- N Y Salah
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - S S Madkour
- Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Diagnostic and Interventional Radiology and Molecular Imaging, Ain Shams University, Cairo, Egypt
| | - K S Ahmed
- Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Diagnostic and Interventional Radiology and Molecular Imaging, Ain Shams University, Cairo, Egypt
| | - D A Abdelhakam
- Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - F A Abdullah
- Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - R A E H Mahmoud
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Fendrik K, Biró K, Endrei D, Koltai K, Sándor B, Tóth K, Késmárky G. Oscillometric measurement of the ankle-brachial index and the estimated carotid-femoral pulse wave velocity improves the sensitivity of an automated device in screening peripheral artery disease. Front Cardiovasc Med 2023; 10:1275856. [PMID: 38155988 PMCID: PMC10754531 DOI: 10.3389/fcvm.2023.1275856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/24/2023] [Indexed: 12/30/2023] Open
Abstract
Background and aims To overcome the time and personnel constraints of the Doppler method, automated, four-limb blood pressure monitors were recently developed. Their additional functions, such as measuring the estimated carotid-femoral pulse wave velocity (ecfPWV), have been, thus far, less studied. We aimed to compare the sensitivity and specificity of different ankle-brachial index (ABI), toe-brachial index (TBI), and ecfPWV measurement methodologies to evaluate their contribution to peripheral artery disease (PAD) screening. Methods Among 230 patients (mean age 64 ± 14 years), ABI measurements were performed using a Doppler device and a manual sphygmomanometer. The Doppler ABI was calculated by taking the higher, while the modified Doppler ABI by taking the lower systolic blood pressure of the two ankle arteries as the numerator, and the higher systolic blood pressure of both brachial arteries as the denominator. The automated ABI measurement was carried out using an automatic BOSO ABI-system 100 PWV device, which also measured ecfPWV. TBI was obtained using a laser Doppler fluxmeter (Periflux 5000) and a photoplethysmographic device (SysToe). To assess atherosclerotic and definitive PAD lesions, vascular imaging techniques were used, including ultrasound in 160, digital subtraction angiography in 66, and CT angiography in four cases. Results ROC analysis exhibited a sensitivity/specificity of 70.6%/98.1% for the Doppler ABI (area under the curve, AUC = 0.873), 84.0%/94.4% for the modified Doppler ABI (AUC = 0.923), and 61.5%/97.8% for the BOSO ABI (AUC = 0.882) at a cutoff of 0.9. Raising the cutoff to 1.0 increased the sensitivity of BOSO to 80.7%, with the specificity decreasing to 79.1%. The ecfPWV measurement (AUC = 0.896) demonstrated a 63.2%/100% sensitivity/specificity in predicting atherosclerotic lesions at a cutoff of 10 m/s. Combining BOSO ABI and ecfPWV measurements recognized 89.5% of all PAD limbs. Conclusion The combined BOSO ABI and ecfPWV measurements may help select patients requiring further non-invasive diagnostic evaluation for PAD. The user-friendly feasibility may make it suitable for screening large populations.
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Affiliation(s)
- Krisztina Fendrik
- Division of Angiology, 1st Department of Medicine of the Clinical Centre University of Pécs, University of Pécs Medical School, Pécs, Hungary
| | - Katalin Biró
- Division of Angiology, 1st Department of Medicine of the Clinical Centre University of Pécs, University of Pécs Medical School, Pécs, Hungary
| | - Dóra Endrei
- Division of Angiology, 1st Department of Medicine of the Clinical Centre University of Pécs, University of Pécs Medical School, Pécs, Hungary
| | - Katalin Koltai
- Division of Angiology, 1st Department of Medicine of the Clinical Centre University of Pécs, University of Pécs Medical School, Pécs, Hungary
| | - Barbara Sándor
- Division of Cardiology, 1st Department of Medicine of the Clinical Centre University of Pécs, University of Pécs Medical School, Pécs, Hungary
| | - Kálmán Tóth
- Division of Cardiology, 1st Department of Medicine of the Clinical Centre University of Pécs, University of Pécs Medical School, Pécs, Hungary
| | - Gábor Késmárky
- Division of Angiology, 1st Department of Medicine of the Clinical Centre University of Pécs, University of Pécs Medical School, Pécs, Hungary
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Said M, Ghoneim B, Jones J, Tawfick W. The effects of sedentary behaviour on patients with peripheral arterial Disease: A systematic review. Prev Med Rep 2023; 36:102424. [PMID: 37810263 PMCID: PMC10556819 DOI: 10.1016/j.pmedr.2023.102424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/28/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Abstract
Sedentary behavior has recently emerged as a risk factor for cardiometabolic diseases. The objective of this review was to assess the relationship between sedentary behavior and peripheral arterial disease (PAD). Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we performed an electronic search across databases including Cochrane Central Register of Controlled Trials, Embase, MEDLINE (Ovid), CINHAL and PubMed to identify studies focusing on sedentary behavior and PAD. A total of 678 records fulfilled eligibility; 166 duplicates were removed, 487 were excluded at the title and abstract level and 15 studies were excluded at the full article level. Thus, our review comprised 10 studies of 20,064 patients with mean age 67.4 years. The average sedentary time was 544.9 min/day. The current review findings indicate that patients with PAD exhibited prolonged periods of sedentary behavior. Furthermore, sedentary behavior among patients with PAD was associated with lower survival rates. The included studies also reported varied outcomes regarding walking distance with some showing an association between reduced sedentary behavior and increased total walking distance. A randomized controlled trial in this review highlighted that reducing sedentary time among patients with PAD improved walking distance. Therefore, the connection between sedentary behavior and PAD seems to be bidirectional. Sedentary time could contribute to PAD development, and PAD-related symptoms may lead to prolonged sedentary behavior. A call for research investigating the link between PAD and sedentary time. Additionally, intervention studies are needed to target the reduction of sedentary time in patients with PAD.
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Affiliation(s)
- Marwa Said
- School of Medicine, University of Galway, Ireland
| | | | - Jennifer Jones
- School of Medicine, University of Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Ireland
| | - Wael Tawfick
- School of Medicine, University of Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Ireland
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Anghel R, Adam CA, Marcu DTM, Mitu O, Roca M, Tinica G, Mitu F. Cardiac Rehabilitation in Peripheral Artery Disease in a Tertiary Center-Impact on Arterial Stiffness and Functional Status after 6 Months. Life (Basel) 2022; 12:life12040601. [PMID: 35455092 PMCID: PMC9024562 DOI: 10.3390/life12040601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/07/2022] [Accepted: 04/15/2022] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives: Cardiac rehabilitation (CR) plays an essential role in peripheral artery disease (PAD), leading to improved functional status, increased quality of life, and reduced arterial stiffness. We aimed to assess factors associated with clinical improvement 6 months after enrolment in a rehabilitation program at an academic medical center in north-eastern Europe. Materials and Methods: We conducted a prospective cohort study on 97 patients with PAD admitted to a single tertiary referral center. At the 6-months follow-up, 75 patients (77.3%) showed improved clinical status. We analyzed demographics and clinical and paraclinical parameters in order to explore factors associated with a favorable outcome. Results: Hypertension (p = 0.002), diabetes mellitus (p = 0.002), dyslipidemia (p = 0.045), and obesity (p = 0.564) were associated with no clinical improvement. Smoking cessation (p < 0.001), changing sedentary lifestyle (p = 0.032), and improvement of lipid and carbohydrate profile as well as functional status parameters and ambulatory arterial stiffness index (p = 0.008) were factors associated with clinical improvement at the 6-months follow-up. Conclusions: PAD patients require an integrative, multidisciplinary management to maintain functional status and increase quality of life. Improving carbohydrate and lipid profile, adopting a healthy lifestyle, quitting smoking and increasing exercise capacity are predictors for clinical improvement 6 months after enrolment in a CR program.
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Affiliation(s)
- Razvan Anghel
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iași, Romania; (R.A.); (C.A.A.); (M.R.); (F.M.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iași, Romania;
| | - Cristina Andreea Adam
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iași, Romania; (R.A.); (C.A.A.); (M.R.); (F.M.)
| | - Dragos Traian Marius Marcu
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iași, Romania;
| | - Ovidiu Mitu
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iași, Romania;
- “Sf. Spiridon” Clinical Emergency Hospital, Independence Boulevard nr 1, 700111 Iași, Romania
- Correspondence:
| | - Mihai Roca
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iași, Romania; (R.A.); (C.A.A.); (M.R.); (F.M.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iași, Romania;
| | - Grigore Tinica
- Department of Cardiovascular Surgery, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iași, Romania;
- Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iași, Romania
| | - Florin Mitu
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iași, Romania; (R.A.); (C.A.A.); (M.R.); (F.M.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iași, Romania;
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da Silva GO, Correia MDA, de Oliveira PLM, Farah BQ, Vianna LC, Puech-Leão P, Wolosker N, Cucato GG, Ritti-Dias RM. Are Vascular Parameters Associated with Walking Impairment in Patients with Claudication? Ann Vasc Surg 2021; 77:31-37. [PMID: 34455045 DOI: 10.1016/j.avsg.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/30/2021] [Accepted: 06/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The mechanisms underlying functional impairments in symptomatic PAD patients are controversial and poorly understood. Endothelial dysfunction and arterial stiffness have been proposed as potential mechanisms related to functional impairment in symptomatic PAD patients, however, more studies are needed to confirm these associations. OBJECTIVE To analyze the association between vascular function and walking impairment in patients with peripheral arterial disease (PAD) and symptoms of claudication. METHODS This was a cross-sectional study that included 68 patients with symptomatic PAD. All patients underwent an objective (Six-minute walk test [6MWT], 4-meter walk test) and a subjective (Walking Impairment Questionnaire [WIQ]) measurement of walking impairment. Vascular parameters measured were pulse-wave velocity (PWV) and flow-mediated dilation (FMD). Multiple linear regression was performed to investigate the association among walking impairment variables with vascular function parameters. RESULTS No significant associations between the claudication onset distance (PWV: b=.060, P = 0.842; FMD: b=-.192, P = 0.456), 6MWT (PWV: b=.007, P = 0..975; FMD: b=.090, P = 0.725), WIQ distance (PWV: b=.337, P = 0.117; FMD: b=-.025, P = 0.895) WIQ speed (PWV: b=.320, P = 0.181; FMD: b=-.028, P = 0.497), WIQ stairs (PWV: b=.256, P = 0.204; FMD: b=-.228, P = 0.230), 4-meter usual walk (PWV: b=-.421, P = 0.107; FMD: b=-.338, P = 0.112), 4-meter fast walk (PWV: b=-.496, P = 0.063; FMD: b=-.371, P = 0.086) and vascular function were found. CONCLUSIONS In symptomatic PAD patients, vascular function is not associated to walking impairment, even when adjusting for comorbid conditions and diabetes.
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Affiliation(s)
| | | | | | - Breno Quintella Farah
- Physical Education Department, Rural Federal University of Pernambuco, Recife-PE, Brazil.; Graduate Program in Physical Education, Federal University of Pernambuco (UFPE), Recife, Brazil
| | - Lauro C Vianna
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasilia, Brasilia-DF, Brazil
| | - Pedro Puech-Leão
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brazil
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Longano P, Kanegusuku H, Correia MA, Puech-Leao P, Wolosker N, Cucato GG, Ritti-Dias RM. Are cardiovascular function and habitual physical activity levels similar in patients with classic and atypical claudication symptoms? A cross-sectional study. Vascular 2020; 28:360-367. [DOI: 10.1177/1708538120911292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective To analyze the impact of the different types of exertional leg pain on cardiovascular function, functional capacity, and habitual physical activity levels in patients with peripheral arterial disease. Methods In this cross-sectional study, 124 patients with symptomatic peripheral arterial disease were included. Exertional leg pain was evaluated using the San Diego Claudication Questionnaire. Subsequently, patients were categorized into two groups according to their exertional leg pain: atypical leg pain (non-calf pain and atypical calf pain, n = 31) and intermittent claudication (classic intermittent claudication symptoms, n = 93). Cardiovascular function (blood pressure, heart rate, arterial stiffness, and heart rate variability), functional capacity (6-min walk distance, handgrip strength, and short physical performance battery), and habitual physical activity levels were measured. Results Functional capacity and physical activity levels were similar between patients with atypical leg pain and symptoms of intermittent claudication. However, patients with classic intermittent claudication symptoms presented higher central systolic blood pressure ( P = 0.028) and arterial stiffness (augmentation index and pulse pressure; P ≤ 0.001 and 0.019, respectively) compared to patients with atypical leg pain. Conclusion The type of exertional leg pain does not influence functional capacity and habitual physical activity levels in patients with peripheral arterial disease. However, patients with classic intermittent claudication symptoms present impaired cardiovascular function compared to patients with atypical leg pain.
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Affiliation(s)
- Paulo Longano
- Graduated Program in Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, Brazil
| | - Hélcio Kanegusuku
- Graduated Program in Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, Brazil
| | - Marilia A. Correia
- Graduated Program in Medicine, Universidade Nove de Julho, São Paulo, Brazil
| | - Pedro Puech-Leao
- Ambulatory of Vascular Surgery, Hospital das Clínicas, University of São Paulo, Brazil
| | - Nelson Wolosker
- Ambulatory of Vascular Surgery, Hospital das Clínicas, University of São Paulo, Brazil
- Ambulatory of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Gabriel G Cucato
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle Upon Tyne, UK
| | - Raphael M. Ritti-Dias
- Graduated Program in Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, Brazil
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Mendes-Pinto D, Rodrigues-Machado MDG, Navarro TP, Dardik A. Association Between Critical Limb Ischemia, the Society for Vascular Surgery Wound, Ischemia and Foot Infection (WIfI) Classification System and Arterial Stiffness. Ann Vasc Surg 2020; 63:250-258.e2. [DOI: 10.1016/j.avsg.2019.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 12/17/2022]
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Kuusik K, Kepler T, Zilmer M, Eha J, Vähi M, Kals J. Effects of Remote Ischaemic Preconditioning on Arterial Stiffness in Patients Undergoing Lower Limb Angiographic Procedures: A Randomised Clinical Trial. Eur J Vasc Endovasc Surg 2019; 58:875-882. [PMID: 31648881 DOI: 10.1016/j.ejvs.2019.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/09/2019] [Accepted: 06/09/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Remote ischaemic preconditioning (RIPC) is a phenomenon that promotes protection of tissues and organs against ischaemia reperfusion injury. RIPC has been shown to reduce myocardial and renal injury but its effect on arterial stiffness in patients undergoing lower limb digital subtraction angiography (DSA) is unknown. The aim of this study was to evaluate the effect of RIPC on arterial stiffness in patients with peripheral arterial disease (PAD) undergoing lower limb DSA. METHODS In the RIPC intervention, the blood pressure cuff on the arm was inflated to 200 mmHg or to 20 mmHg above systolic pressure, and in the sham intervention to 20 mmHg. For both, the procedure was repeated for four five minute cycles at five minute intervals between the cycles. Changes in heart rate corrected augmentation index (AIx@75), augmentation index (AIx), carotid femoral pulse wave velocity (PWV), and haemodynamic parameters were measured before and 24 h after DSA. RESULTS 111 (RIPC 54, sham 57) patients with symptomatic lower limb PAD scheduled for DSA were randomised. 102 patients (RIPC 47, sham 55) were included in final analysis. RIPC significantly improved AIx (-5.46% in RIPC and -1.45% in sham group; p = .05), but not AIx@75 (-4.88% in RIPC and -1.38% in sham group; p = .07) or PWV (-0.41 m/s in RIPC and -0.27 m/s in sham group; p = .74). In the RIPC group a significant reduction in AIx (p = .002) and AIx@75 (p = .003) was noted after stenting when compared with the sham intervention. AIx (p = .001), AIx@75 (p = .002), mean arterial (p = .01), peripheral (p = .02), and central systolic blood pressure (p = .006) were significantly reduced only in the RIPC group 24 h after DSA. CONCLUSION This study evaluates for the first time the effects of RIPC on arterial stiffness parameters in patients with symptomatic PAD following DSA. RIPC may modulate arterial stiffness following a DSA procedure and is more pronounced in patients after stent placement.
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Affiliation(s)
- Karl Kuusik
- Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Heart Clinic, Tartu University Hospital, Tartu, Estonia; Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia.
| | - Teele Kepler
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Mihkel Zilmer
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Jaan Eha
- Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Heart Clinic, Tartu University Hospital, Tartu, Estonia
| | - Mare Vähi
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
| | - Jaak Kals
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Department of Vascular Surgery, Surgery Clinic, Tartu University Hospital, Tartu, Estonia
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10
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Park SY, Kwak YS, Pekas EJ. Impacts of aquatic walking on arterial stiffness, exercise tolerance, and physical function in patients with peripheral artery disease: a randomized clinical trial. J Appl Physiol (1985) 2019; 127:940-949. [PMID: 31369328 DOI: 10.1152/japplphysiol.00209.2019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Peripheral artery disease (PAD) is an atherosclerotic disease that is associated with attenuated vascular function, cardiorespiratory capacity, physical function, and muscular strength. It is essential to combat these negative effects on health by incorporating lifestyle interventions to slow disease progression, such as exercise. We sought to examine the effects of aquatic walking exercise on cardiovascular function, cardiorespiratory capacity [maximal volume of oxygen consumption (V̇o2max)], exercise tolerance [6-min walking distance (6MWD)], physical function, muscular strength, and body composition in patients with PAD. Patients with PAD (n = 72) were recruited and randomly assigned to a 12-wk aquatic walking training group (AQ, n = 35) or a control group (CON, n = 37). The AQ group performed walking and leg exercises in waist-to-chest-deep water. Leg arterial stiffness [femoral-to-ankle pulse wave velocity (legPWV)], heart rate (HR), blood pressure (BP), ankle-to-brachial index (ABI), V̇o2max, 6MWD, physical function, muscular strength, body composition, resting metabolic rate (RMR), and flexibility were measured before and after 12 wk. There were significant group × time interactions (P < 0.05) after 12 wk for legPWV and HR, which significantly decreased (P < 0.05) in AQ, and V̇o2max, 6MWD, physical function, and muscular strength, which significantly increased (P < 0.05) in AQ, compared with no changes in CON. There were no significant differences (P > 0.05) for BP, ABI, RMR, or flexibility after 12 wk. Interestingly, there was relatively high adherence (84%) to the aquatic walking exercise program in this population. These results suggest that aquatic walking exercise is an effective therapy to reduce arterial stiffness and resting HR and improve cardiorespiratory capacity, exercise tolerance, physical function, and muscular strength in patients with PAD.NEW & NOTEWORTHY The results of this study reveal for the first time that aquatic walking exercise can decrease arterial stiffness and improve exercise tolerance, cardiorespiratory capacity, and muscular strength in patients with peripheral artery disease (PAD). Aquatic walking exercise training demonstrates relatively high exercise adherence in this population. Aquatic walking exercise training may be a useful therapeutic intervention for improving physical function in patients with PAD.
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Affiliation(s)
- Song-Young Park
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska.,Department of Physical Education, Dong-Eui University, Busan, South Korea
| | - Yi-Sub Kwak
- Department of Physical Education, Dong-Eui University, Busan, South Korea
| | - Elizabeth J Pekas
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska
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11
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LASLOVICH STEVE, ALVAR BRENTA, ALLISON MATTHEW, RAUH MITCHELLJ. Effects of Lifestyle Physical Activity on Vascular Function in Asymptomatic Peripheral Arterial Disease. Med Sci Sports Exerc 2019; 52:8-15. [DOI: 10.1249/mss.0000000000002109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Factors Associated to Arterial Stiffness in Patients With Symptomatic Peripheral Artery Disease. Ann Vasc Surg 2019; 61:78-82. [PMID: 31352085 DOI: 10.1016/j.avsg.2019.04.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 04/21/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND The aim of this study was to identify the clinical factors associated with arterial stiffness in patients with symptomatic peripheral artery disease. METHODS In this cross-sectional study, 181 patients (67% men; mean aged 66 ± 9 years) were recruited and had their central arterial stiffness assessed by carotid-femoral pulse wave velocity (cf-PWV). Clinical characteristics are sociodemographic data, body mass index, comorbid conditions, and walking capacity. RESULTS Multiple linear regression analysis showed that age (b = 0.182, P = 0.032), body mass index (b = 0.254, P = 0.002), and mean blood pressure (b = 0.249, P = 0.021) were positively associated with cf-PWV. CONCLUSIONS Our results showed that the aging, elevated body mass index, and higher blood pressure are clinical factors associated with increased arterial stiffness in patients with peripheral artery disease.
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13
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Nattero-Chávez L, Redondo López S, Alonso Díaz S, Garnica Ureña M, Fernández-Durán E, Escobar-Morreale HF, Luque-Ramírez M. Association of Cardiovascular Autonomic Dysfunction With Peripheral Arterial Stiffness in Patients With Type 1 Diabetes. J Clin Endocrinol Metab 2019; 104:2675-2684. [PMID: 30786000 DOI: 10.1210/jc.2018-02729] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/15/2019] [Indexed: 12/12/2022]
Abstract
CONTEXT Cardiovascular autonomic neuropathy (CAN) appears to contribute to peripheral arterial stiffness (AS) in type 1 diabetes. Whether CAN in patients with AS is associated with concomitant asymptomatic peripheral arterial disease (aPAD) remains unclear. OBJECTIVE To assess the risk of CAN in patients with type 1 diabetes and AS and its potential association with atherosclerosis. DESIGN Cross-sectional study. SETTING Type 1 diabetes clinic in an academic hospital. PATIENTS Two hundred sixty-four patients with type 1 diabetes. INTERVENTION AS was defined as an ankle-brachial index (ABI) >1.2, aPAD by the toe-brachial index and Doppler sonography, and CAN by blood pressure and heart rate responses to active standing and Ewing and Clarke tests. MAIN OUTCOME MEASURES Odds of having CAN among patients with AS. Odds for CAN were also calculated as a function of the presence of AS and concomitant aPAD. RESULTS The study population's mean age was 35 ± 11 years, with a duration of disease of 19 ± 10 years and mean hemoglobin A1c of 7.5% ± 1.3%. Seventy-three patients (28%) had peripheral AS, of whom 28 showed aPAD. The prevalence of CAN among patients with AS was 48% but it was only 23% in subjects with normal ABI (OR: 3.1 [1.7; 5.4]). Concomitant aPAD increased the OR for CAN (OR: 4.5 [2.0; 10.1]). After adjustments for aPAD and relevant cardiovascular risk factors, AS remained associated with parasympathetic dysfunction. CONCLUSIONS In type 1 diabetes, both peripheral AS and atherosclerosis were associated with CAN. A simple method, such as the ABI, may identify a subset of patients with undiagnosed dysautonomia.
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Affiliation(s)
- Lía Nattero-Chávez
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria, CIBER Diabetes y Enfermedades Metabólicas Asociadas, Madrid, Spain
| | - Sandra Redondo López
- Department of Vascular Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Sara Alonso Díaz
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marta Garnica Ureña
- Department of Vascular Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Elena Fernández-Durán
- Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria, CIBER Diabetes y Enfermedades Metabólicas Asociadas, Madrid, Spain
| | - Héctor F Escobar-Morreale
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria, CIBER Diabetes y Enfermedades Metabólicas Asociadas, Madrid, Spain
- Department of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain
| | - Manuel Luque-Ramírez
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria, CIBER Diabetes y Enfermedades Metabólicas Asociadas, Madrid, Spain
- Department of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain
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14
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Mendes-Pinto D, Rodrigues-Machado MDG. Applications of arterial stiffness markers in peripheral arterial disease. J Vasc Bras 2019; 18:e20180093. [PMID: 31236104 PMCID: PMC6579524 DOI: 10.1590/1677-5449.009318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 01/04/2019] [Indexed: 11/21/2022] Open
Abstract
Arterial stiffness has been analyzed in many different population groups with the objective of identifying cardiovascular risk early and performing specific therapeutic interventions. Increased arterial stiffness affects the capacity of the aorta and elastic arteries to adapt to pressure variations during the cardiac cycle. The main markers of arterial stiffness are pulse wave velocity (PWV), augmentation index (AIx) and central aortic pressure. They can be measured noninvasively. Patients with coronary disease or on hemodialysis who have elevated PWV or AIx have increased mortality. The association with peripheral arterial disease has been studied little. The objective of this review is to demonstrate the applicability and utility of assessing measures of arterial stiffness in patients with peripheral arterial disease.
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Affiliation(s)
- Daniel Mendes-Pinto
- Departamento de Cirurgia Vascular, Hospital Felício Rocho, Belo Horizonte, MG, Brasil.,Faculdade Ciências Médicas de Minas Gerais - FCMMG, Belo Horizonte, MG, Brasil
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15
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Ramirez JL, Spaulding KA, Zahner GJ, Khetani SA, Schaller MS, Gasper WJ, Hills NK, Marlene Grenon S. Radial Artery Tonometry is Associated With Major Adverse Cardiac Events in Patients With Peripheral Artery Disease. J Surg Res 2019; 235:250-257. [PMID: 30691803 PMCID: PMC6355158 DOI: 10.1016/j.jss.2018.09.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/09/2018] [Accepted: 09/28/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is associated with increased arterial stiffness, as measured by an increasing radial artery augmentation index (AIX). However, it has not yet been clearly demonstrated whether AIX is associated with adverse cardiovascular outcomes in a PAD population. MATERIALS AND METHODS Seventy-two patients with PAD were recruited between 2011 and 2016. Radial artery applanation tonometry was performed at a baseline visit, and the central AIX, normalized to 75 beats/min, and the peripheral AIX were calculated using pulse wave analysis. Incident major adverse cardiac events (MACEs) were identified by subsequent chart review. RESULTS Study subjects had comorbidities commonly associated with PAD including a high prevalence of hypertension (93%), hyperlipidemia (85%), coronary artery disease (39%), and diabetes mellitus (39%). During a median follow-up period of 34 mo (interquartile range 29-38), 14 patients experienced a MACE. In a univariate Cox proportional hazards model, a 10-unit increase in the peripheral AIX was significantly associated with a 54% increased rate of MACE (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.06-2.22, P = 0.02), but central AIX, normalized to 75 beats/min, was not (HR 1.33, 95% CI 0.71-2.47, P = 0.37). In a multivariable model adjusted for coronary artery disease, age, and Rutherford category the peripheral AIX remained significantly associated with MACE (HR 1.70, 95% CI 1.10-2.62, P = 0.02). CONCLUSIONS Increased arterial stiffness, as measured by the peripheral AIX, was independently associated with an increased rate of MACE in patients with PAD. The use of radial artery tonometry should be contemplated as a tool for risk stratification in patients with PAD.
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Affiliation(s)
- Joel L Ramirez
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Kimberly A Spaulding
- Department of Surgery, University of California, San Francisco, San Francisco, California; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, California
| | - Greg J Zahner
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Sukaynah A Khetani
- Department of Surgery, University of California, San Francisco, San Francisco, California; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, California
| | - Melinda S Schaller
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Warren J Gasper
- Department of Surgery, University of California, San Francisco, San Francisco, California; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, California
| | - Nancy K Hills
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - S Marlene Grenon
- Department of Surgery, University of California, San Francisco, San Francisco, California; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, California.
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16
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Kaczmarczyk P, Maga P, Niżankowski R, Januszek R, Frołow M, Maga M, Kościelniak J, Belowski A. The relationship between pulse waveform analysis indices, endothelial function and clinical outcomes in patients with peripheral artery disease treated using percutaneous transluminal angioplasty during a one-year follow-up period. Cardiol J 2018; 27:142-151. [PMID: 29611173 DOI: 10.5603/cj.a2018.0026] [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] [Received: 11/01/2017] [Revised: 03/26/2018] [Accepted: 02/28/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Several predictors of clinical outcomes after percutaneous transluminal angioplasty (PTA) interventions in patients with peripheral arterial disease (PAD) have been investigated. Indices of endothelial function, arterial pulse waveform analysis (aPWA) and markers of peripheral artery ischemia were among the most commonly examined. The aim of the current study was to assess the relationship between potential predictors of clinical outcomes after peripheral artery PTA during a 1-year follow-up period. METHODS The study included 72 individuals with PAD at a mean age of 66.3 ± 7.2 (79.1% males). All patients underwent PTA of the peripheral arteries. Among them, 42.8% presented critical limb ischemia (CLI). During the first visit and at 1 month and 6 months after PTA, endothelial function and aPWA measurements were taken. Ankle-brachial index (ABI), toe-brachial index (TBI) and physical evalu-ation of the limbs took place during the first visit and at 1, 6 and 12 months after the PTA. The study endpoints included myocardial infarction, amputation, death, stroke and reintervention. All subjects included in the study were observed for 386 days after the PTA. RESULTS A significant improvement was noted in walking distance after PTA at the following time points, as well as transient improvement of ABI and flow-mediated dilatation (FMD) and no significant change in aPWA indices and reactive-hyperaemia index (RHI). The mean ABI, TBI, FMD and RHI values did not correlate with each other at baseline. There were 25 study endpoints which occurred in 16 patients during the follow-up period (22.2%). Patients with CLI, hypercholesterolemia, lower dias-tolic blood pressure, higher subendocardial viability ratio, a greater number of pack-years and lower TBI at baseline presented significantly poorer clinical outcomes in terms of endpoint events. CONCLUSIONS Endothelial function assessed as FMD and reactive hyperemia-peripheral arterial tonometry (RH-PAT) before PTA in patients with advanced PAD do not predict clinical outcomes during the 1-year follow-up.
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Affiliation(s)
| | - Paweł Maga
- Angio-Medicus Treatment Facility, Krakow, Poland.,Department of Angiology, Jagiellonian University Medical College, Krakow, Poland
| | - Rafał Niżankowski
- Department of Angiology, Jagiellonian University Medical College, Krakow, Poland
| | - Rafał Januszek
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,Department of Clinical Rehabilitation, University of Physical Education, Krakow, Poland
| | - Marzena Frołow
- Department of Angiology, Jagiellonian University Medical College, Krakow, Poland
| | - Mikołaj Maga
- Department of Angiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jolanta Kościelniak
- Angio-Medicus Treatment Facility, Krakow, Poland.,Department of Angiology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Belowski
- Angio-Medicus Treatment Facility, Krakow, Poland.,Department of Angiology, Jagiellonian University Medical College, Krakow, Poland
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17
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Zahner GJ, Gruendl MA, Spaulding KA, Schaller MS, Hills NK, Gasper WJ, Grenon SM. Association between arterial stiffness and peripheral artery disease as measured by radial artery tonometry. J Vasc Surg 2017; 66:1518-1526. [PMID: 28756044 DOI: 10.1016/j.jvs.2017.06.068] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/15/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Arterial stiffness and peripheral artery disease (PAD) are both associated with an elevated risk of major adverse cardiac events; however, the association between arterial stiffness and PAD is less well characterized. The goal of this study was to examine the association between parameters of radial artery tonometry, a noninvasive measure of arterial stiffness, and PAD. METHODS We conducted a cross-sectional study of 134 vascular surgery outpatients (controls, 33; PAD, 101) using arterial applanation tonometry. Central augmentation index (AIX) normalized to 75 beats/min and peripheral AIX were measured using radial artery pulse wave analysis. Pulse wave velocity was recorded at the carotid and femoral arteries. PAD was defined as symptomatic claudication with an ankle-brachial index of <0.9 or a history of peripheral revascularization. Controls had no history of atherosclerotic vascular disease and an ankle-brachial index ≥0.9. RESULTS Among the 126 participants with high-quality tonometry data, compared with controls (n = 33), patients with PAD (n = 93) were older, with higher rates of hypertension, hyperlipidemia, diabetes, and smoking (P < .05). Patients with PAD also had greater arterial stiffness as measured by central AIX, peripheral AIX, and pulse wave velocity (P < .05). In a multivariable model, a significantly increased odds of PAD was associated with each 10-unit increase in central AIX (odds ratio, 2.1; 95% confidence interval, 1.1-3.9; P = .03) and peripheral AIX (odds ratio, 1.9; 95% confidence interval, 1.2-3.2; P = .01). In addition, central and peripheral AIX were highly correlated (r120 = 0.76; P < .001). CONCLUSIONS In a cross-sectional analysis, arterial stiffness as measured by the AIX is independently associated with PAD, even when adjusting for several atherosclerotic risk factors. Further prospective data are needed to establish whether radial artery tonometry could be a tool for risk stratification in the PAD population.
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Affiliation(s)
- Greg J Zahner
- Department of Surgery, University of California, San Francisco, Calif
| | | | - Kimberly A Spaulding
- Department of Surgery, University of California, San Francisco, Calif; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, Calif
| | | | - Nancy K Hills
- Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif
| | - Warren J Gasper
- Department of Surgery, University of California, San Francisco, Calif; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, Calif
| | - S Marlene Grenon
- Department of Surgery, University of California, San Francisco, Calif; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, Calif.
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18
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Rontoyanni VG, Nunez Lopez O, Fankhauser GT, Cheema ZF, Rasmussen BB, Porter C. Mitochondrial Bioenergetics in the Metabolic Myopathy Accompanying Peripheral Artery Disease. Front Physiol 2017; 8:141. [PMID: 28348531 PMCID: PMC5346567 DOI: 10.3389/fphys.2017.00141] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/23/2017] [Indexed: 11/14/2022] Open
Abstract
Peripheral artery disease (PAD) is a serious but relatively underdiagnosed and undertreated clinical condition associated with a marked reduction in functional capacity and a heightened risk of morbidity and mortality. The pathophysiology of lower extremity PAD is complex, and extends beyond the atherosclerotic arterial occlusion and subsequent mismatch between oxygen demand and delivery to skeletal muscle mitochondria. In this review, we evaluate and summarize the available evidence implicating mitochondria in the metabolic myopathy that accompanies PAD. Following a short discussion of the available in vivo and in vitro methodologies to quantitate indices of muscle mitochondrial function, we review the current evidence implicating skeletal muscle mitochondrial dysfunction in the pathophysiology of PAD myopathy, while attempting to highlight questions that remain unanswered. Given the rising prevalence of PAD, the detriment in quality of life for patients, and the associated significant healthcare resource utilization, new alternate therapies that ameliorate lower limb symptoms and the functional impairment associated with PAD are needed. A clear understanding of the role of mitochondria in the pathophysiology of PAD may contribute to the development of novel therapeutic interventions.
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Affiliation(s)
- Victoria G. Rontoyanni
- Metabolism Unit, Shriners Hospitals for ChildrenGalveston, TX, USA
- Department of Surgery, University of Texas Medical BranchGalveston, TX, USA
| | - Omar Nunez Lopez
- Metabolism Unit, Shriners Hospitals for ChildrenGalveston, TX, USA
- Department of Surgery, University of Texas Medical BranchGalveston, TX, USA
| | | | - Zulfiqar F. Cheema
- Department of Surgery, University of Texas Medical BranchGalveston, TX, USA
| | - Blake B. Rasmussen
- Department of Nutrition and Metabolism, University of Texas Medical BranchGalveston, TX, USA
| | - Craig Porter
- Metabolism Unit, Shriners Hospitals for ChildrenGalveston, TX, USA
- Department of Surgery, University of Texas Medical BranchGalveston, TX, USA
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19
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Shin H, Min SD. Feasibility study for the non-invasive blood pressure estimation based on ppg morphology: normotensive subject study. Biomed Eng Online 2017; 16:10. [PMID: 28086939 PMCID: PMC5234121 DOI: 10.1186/s12938-016-0302-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 12/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background Blood pressure is a critical bio-signal and its importance has been increased with the aged society and the growth of cardiovascular disease population. However, most of hypertensive patients have been suffered the inconvenience in monitoring blood pressure in daily life because the measurement of the blood pressure depends on the cuff-based technique. Nowadays there are many trials to measure blood pressure without cuff, especially, photoplethysmography (PPG) based research is carried out in various ways. Methods Our research is designed to hypothesis the relationship between vessel wall movement and pressure-flow relationship of PPG and to validate its appropriateness by experimental methods. PPG waveform is simplified by approximate model, and then it is analyzed as the velocity and the acceleration of blood flow using the derivatives of PPG. Finally, we develop pressure index (PI) as an estimation factor of blood pressure by combining of statistically significant segments of photoplethysmographic waveform. Results Twenty-five subjects were participated in the experiment. As a result of simulation, correlation coefficients between developed PI and blood pressure were represented with R = 0.818, R = 0.827 and R = 0.615 in systolic blood pressure, pulse pressure and mean arterial pressure, respectively, and both of result showed the meaningful statistically significance (P < 0.05). Conclusions Current study can estimate only the relative variation of blood pressure but could not find the absolute pressure value. Moreover, proposed index has the limitation of diastolic pressure tracing. However, the result shows that the proposed PI is statistically significantly correlated with blood pressures, and it suggests that the proposed PI as a promising additional parameter for the cuff less blood pressure monitoring.
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Affiliation(s)
- Hangsik Shin
- Healthcare Solution Laboratory, Department of Biomedical Engineering, Chonnam National University, 502, 3rd Eng. Bldg., 50 Daehak-ro, Yeosu, South Korea
| | - Se Dong Min
- Department of Medical IT Engineering, College of Medical Science, Soonchunhyang University, 22, Soonchunhyang-ro, Eumnae-ri, Sinchang-myeon, Asan-si, Chungcheongnam-do, Republic of Korea.
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20
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Affiliation(s)
- Naomi M. Hamburg
- Whitaker Cardiovascular Institute, Boston University School of Medicine
- the Section of Vascular Biology, Department of Medicine, Boston Medical Center
| | - Mark A. Creager
- Dartmouth-Hitchcock Heart and Vascular Center and the Geisel School of Medicine at Dartmouth
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21
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Walking Capacity Is Positively Related with Heart Rate Variability in Symptomatic Peripheral Artery Disease. Eur J Vasc Endovasc Surg 2016; 52:82-9. [DOI: 10.1016/j.ejvs.2016.03.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/30/2016] [Indexed: 01/16/2023]
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22
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Dantas FFO, da Silva Santana F, da Silva TSR, Cucato GG, Farah BQ, Ritti-Dias RM. Acute Effects of T'ai Chi Chuan Exercise on Blood Pressure and Heart Rate in Peripheral Artery Disease Patients. J Altern Complement Med 2016; 22:375-9. [PMID: 27058396 DOI: 10.1089/acm.2015.0230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the acute effect of a t'ai chi chuan session on blood pressure and heart rate in patients with peripheral artery disease (PAD). DESIGN Randomized crossover intervention study. SETTING Outpatient therapy center. PARTICIPANTS Seven patients with PAD, aged 50-79 years, not using β-blockers, calcium-channel blockers, or nondihidropiridinic vasodilators. INTERVENTION T'ai chi chuan and control session (both sessions lasted 40 minutes). OUTCOME MEASURES Systolic and diastolic blood pressure and heart rate, which were evaluated before and after the intervention (10, 30, and 50 minutes). RESULTS T'ai chi chuan exercise acutely decreased systolic blood pressure at 30 minutes after exercise (p = 0.042) and increased diastolic blood pressure at 50 minutes after exercise (p = 0.041). Heart rate did not change after t'ai chi chuan exercise. CONCLUSION T'ai chi chuan acutely decreases systolic blood pressure in patients with PAD.
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Affiliation(s)
| | | | | | | | - Breno Quintella Farah
- 4 Associate Graduate Program in Physical Education, University of Pernambuco , Recife, Brazil .,5 Group Research in Health and Sport, ASCES College , Caruaru, Brazil
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23
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Beckmann M, Jacomella V, Kohler M, Lachat M, Salem A, Amann-Vesti B, Husmann M. Risk Stratification of Patients with Peripheral Arterial Disease and Abdominal Aortic Aneurysm Using Aortic Augmentation Index. PLoS One 2015; 10:e0139887. [PMID: 26452151 PMCID: PMC4599890 DOI: 10.1371/journal.pone.0139887] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/19/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Central augmentation index (cAIx) is an indicator for vascular stiffness. Obstructive and aneurysmatic vascular disease can affect pulse wave propagation and reflection, causing changes in central aortic pressures. AIM To assess and compare cAIx in patients with peripheral arterial disease (PAD) and / or abdominal aortic aneurysm (AAA). METHODS cAIx was assessed by radial applanation tonometry (Sphygmocor) in a total of 184 patients at a tertiary referral centre. Patients were grouped as having PAD only, AAA only, or both AAA and PAD. Differences in cAIx measurements between the three patient groups were tested by non-parametric tests and stepwise multivariate linear regression analysis to investigate associations with obstructive or aneurysmatic patterns of vascular disease. RESULTS In the study sample of 184 patients, 130 had PAD only, 20 had AAA only, and 34 patients had both AAA and PAD. Mean cAIx (%) was 30.5 ± 8.2 across all patients. It was significantly higher in females (35.2 ± 6.1, n = 55) than males (28.4 ± 8.2, n = 129), and significantly higher in patients over 80 years of age (34.4 ± 6.9, n = 22) than in those under 80 years (30.0 ± 8.2, n = 162). Intergroup comparison revealed a significant difference in cAIx between the three patient groups (AAA: 27.3 ± 9.5; PAD: 31.4 ± 7.8; AAA & PAD: 28.8 ± 8.5). cAIx was significantly lower in patients with AAA, higher in patients with both AAA and PAD, and highest in patients with PAD only (beta = 0.21, p = 0.006). CONCLUSION Non-invasive assessment of arterial stiffness in high-risk patients indicates that cAIx differs according to the pattern of vascular disease. Measurements revealed significantly higher cAIx values for patients with obstructive peripheral arterial disease than for patients with aneurysmatic disease.
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Affiliation(s)
- Marianne Beckmann
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Angiology Division, Department of Internal Medicine, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - Vincenzo Jacomella
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Malcom Kohler
- Clinic for Pneumology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Mario Lachat
- Clinic for Cardiovascular Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Amr Salem
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Beatrice Amann-Vesti
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Marc Husmann
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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24
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Kawamoto R, Kohara K, Katoh T, Kusunoki T, Ohtsuka N, Abe M, Kumagi T, Miki T. Brachial-ankle pulse wave velocity is a predictor of walking distance in community-dwelling adults. Aging Clin Exp Res 2015; 27:187-93. [PMID: 25037107 DOI: 10.1007/s40520-014-0262-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/01/2014] [Indexed: 10/25/2022]
Abstract
Arterial stiffness represents the cumulative effects of cardiovascular risk factors, including aging, on the arterial wall, and has been found to be a surrogate marker of cardiovascular disease. However, it remains unknown whether baseline arterial stiffness is independently associated with improvement in functional abilities after exercise training. The subjects were 72 adults (9 men and 63 women) aged 67 ± 7 years from a rural village. Before and at the end of a 12-week Nordic walking program, 6-min walk distance (6MWD) as functional abilities, metabolic characteristics, and the mean of the right and left brachial-ankle pulse wave velocity (baPWV) as a marker of arterial stiffness were measured. Higher baseline mean baPWV levels correlated significantly with shorter baseline 6MWD (P < 0.001), and also with the follow-up 6MWD (P < 0.001) and change rate (P = 0.019) in 6MWD after the 12-week training program. Multivariate linear regression analysis was employed to evaluate the contribution of baseline mean baPWV for 6MWD parameters showing that baseline mean baPWV values were significantly and independently associated with follow-up 6MWD (β = -0.523, P < 0.001) and change rate in 6MWD (β = -0.399, P < 0.001) as well as baseline 6MWD (β = -0.522, P < 0.001), but was not associated with change after the 12-week training program. Higher baPWV, a measurement of arterial stiffness, might be a predictor of functional abilities after exercise training, independent of confounding factors, in the general population.
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Catalano M, Scandale G, Carzaniga G, Cinquini M, Minola M, Antoniazzi V, Dimitrov G, Carotta M. Aortic augmentation index in patients with peripheral arterial disease. J Clin Hypertens (Greenwich) 2014; 16:782-7. [PMID: 25228305 PMCID: PMC8031844 DOI: 10.1111/jch.12406] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 01/09/2023]
Abstract
Aortic augmentation index (AIx) is used to investigate arterial stiffness. The authors tested the hypothesis that patients with peripheral arterial disease (PAD) demonstrate a higher AIx and also evaluated several related factors. In 97 patients with PAD, identified by ankle-brachial pressure index (ABPI ≤ 0.9), and 97 controls (ABPI ≥ 0.91< 1.4), AIx (%) was determined using tonometry of the radial artery. There was no significant difference between patients and controls in characteristics of age, sex, height, diastolic blood pressure, mean blood pressure, and heart rate. AIx was higher in patients with PAD (32 ± 9 vs 28 ± 9; P = .001). In multivariate regression analysis, AIx was independently associated with heart rate (β = -0.40, P = .0005). This study showed that AIx increased in patients with PAD and that heart rate is a determinant of AIx. Further studies are necessary to assess the pathophysiological and clinical importance of AIx in patients with PAD.
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Affiliation(s)
- Mariella Catalano
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Giovanni Scandale
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Gianni Carzaniga
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Michela Cinquini
- Laboratory for the Development of New Pharmacological StrategiesDepartment of OncologyMario Negri Institute for Pharmacological ResearchMilanItaly
| | - Marzio Minola
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Valeria Antoniazzi
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Gabriel Dimitrov
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Maria Carotta
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
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Chrysant GS. Peripheral vascular disease is associated with increased pulse wave velocity and augmentation index: clinical implications. J Clin Hypertens (Greenwich) 2014; 16:788-9. [PMID: 25243631 DOI: 10.1111/jch.12407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lilly SM, Jacobs DR, Kronmal R, Bluemke DA, Criqui M, Lima J, Allison M, Duprez D, Segers P, Chirinos JA. Arterial compliance across the spectrum of ankle-brachial index: the Multiethnic Study of Atherosclerosis. Atherosclerosis 2014; 233:691-696. [PMID: 24583417 DOI: 10.1016/j.atherosclerosis.2014.01.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/06/2013] [Accepted: 01/08/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE A low ankle-brachial index is associated with cardiovascular disease and reduced arterial compliance. A high ankle-brachial index is also associated with an increased risk of cardiovascular events. We tested the hypothesis that subjects with a high ankle-brachial index demonstrate a lower arterial compliance. In addition, we assessed whether pulse pressure amplification is increased among subjects with a high ankle-brachial index. METHODS We studied 6814 adults enrolled in the Multiethnic Study of Atherosclerosis who were, by definition, free of clinical cardiovascular disease at baseline. Differences in total arterial compliance (ratio of stroke volume to pulse pressure), aortic and carotid distensibility (measured with magnetic resonance imaging and duplex ultrasound, respectively) were compared across ankle-brachial index subclasses (≤0.90, 0.91-1.29; ≥1.30) with analyses adjusted for cardiovascular risk factors and subclinical atherosclerosis. RESULTS Peripheral arterial disease was detected in 230 (3.4%) and high ABI in 648 (9.6%) of subjects. Those with high ankle-brachial index demonstrated greater aortic/radial pulse pressure amplification than those with a normal ankle-brachial index. In adjusted models aortic and carotid distensibility as well as total arterial compliance, were lowest among those with ankle-brachial index≤0.9 (p<0.01 vs. all), but were not reduced in subjects with an ankle-brachial index≥1.3. CONCLUSION Lower aortic, carotid and total arterial compliance is not present in subjects free of overt cardiovascular disease and with a high ankle-brachial index. However, increased pulse pressure amplification contributes to a greater ankle-brachial index in the general population and may allow better characterization of individuals with this phenotype.
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Affiliation(s)
- Scott M Lilly
- Division of Cardiovascular Medicine, Ohio State University Heart and Vascular Center, Columbus, OH, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - Richard Kronmal
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - David A Bluemke
- Departments of Radiology and Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Criqui
- Division of Preventive Medicine, University of California, San Diego, San Diego, CA, USA
| | - Joao Lima
- Departments of Radiology and Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew Allison
- Division of Preventive Medicine, University of California, San Diego, San Diego, CA, USA
| | - Daniel Duprez
- Cardiovascular Division, University of Minnesota, University of Minnesota, MN, USA
| | - Patrick Segers
- Institute Biomedical Technology, Ghent University, Gent, Belgium
| | - Julio A Chirinos
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA; Philadelphia VA Medical Center, Philadelphia, PA, USA.
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Grenon SM, Chong K, Alley H, Nosova E, Gasper W, Hiramoto J, Boscardin WJ, Owens CD. Walking disability in patients with peripheral artery disease is associated with arterial endothelial function. J Vasc Surg 2014; 59:1025-34. [PMID: 24423479 DOI: 10.1016/j.jvs.2013.10.084] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 10/17/2013] [Accepted: 10/17/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Patients with peripheral artery disease (PAD) have varying degrees of walking disability that do not completely correlate with ankle-brachial index (ABI) or angiographic anatomy. We hypothesized that endothelial function (EF) is an independent predictor of symptom severity in PAD patients. METHODS This was a cross-sectional study of 100 PAD patients presenting to a vascular surgery clinic. All patients received ABI testing and brachial artery flow-mediated, endothelium-dependent vasodilation (FMD) to assess arterial EF. Symptom severity and walking disability reported by Rutherford category was based on the patient's self-report during the clinic visit and recorded by the investigator-vascular surgeons. Demographic, biochemical, and physiologic parameters were entered into regression equations to determine association with symptom severity. RESULTS Patients were a mean age of 66 ± 8 years, and 43% had diabetes. Mean FMD was 7.4%, indicating impaired EF. EF progressively declined as Rutherford category increased (P = .01). Brachial artery FMD, ABI, systolic blood pressure, C-reactive protein, low-density lipoprotein, high-density lipoprotein, β-blocker use, and a history of diabetes or coronary artery disease were all associated with Rutherford category (all P < .05). Multivariable regression showed EF (P < .02) and ABI (P < .0001) were independently associated with walking disability. When the cohort was restricted to claudicant patients (n = 73), EF remained associated with walking disability after adjustment for other covariates (P = .0001). CONCLUSIONS Symptom severity in PAD is multifactorial, reflecting impaired hemodynamics and vascular dysfunction. This is the first report demonstrating that walking disability in PAD is associated with arterial EF. The mechanistic link underlying these observations remains to be defined.
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Affiliation(s)
- S Marlene Grenon
- Department of Surgery, University of California San Francisco, San Francisco, Calif; Department of Surgery, Veterans Affairs Medical Center, San Francisco, Calif; VIPERx Laboratory, San Francisco, Calif.
| | - Karen Chong
- Department of Surgery, University of California San Francisco, San Francisco, Calif; VIPERx Laboratory, San Francisco, Calif
| | - Hugh Alley
- Department of Surgery, University of California San Francisco, San Francisco, Calif; VIPERx Laboratory, San Francisco, Calif
| | - Emily Nosova
- Department of Surgery, University of California San Francisco, San Francisco, Calif; VIPERx Laboratory, San Francisco, Calif
| | - Warren Gasper
- Department of Surgery, University of California San Francisco, San Francisco, Calif; Department of Surgery, Veterans Affairs Medical Center, San Francisco, Calif; VIPERx Laboratory, San Francisco, Calif
| | - Jade Hiramoto
- Department of Surgery, University of California San Francisco, San Francisco, Calif
| | - W John Boscardin
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, Calif; Department of Medicine, University of California San Francisco, San Francisco, Calif
| | - Christopher D Owens
- Department of Surgery, University of California San Francisco, San Francisco, Calif; Department of Surgery, Veterans Affairs Medical Center, San Francisco, Calif; VIPERx Laboratory, San Francisco, Calif
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Catalano M, Scandale G, Carzaniga G, Cinquini M, Minola M, Dimitrov G, Carotta M. Increased Aortic Stiffness and Related Factors in Patients With Peripheral Arterial Disease. J Clin Hypertens (Greenwich) 2013; 15:712-6. [DOI: 10.1111/jch.12167] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/04/2013] [Accepted: 06/09/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Mariella Catalano
- Research Center on Vascular Diseases and Angiology Unit; University of Milan; Milan Italy
| | - Giovanni Scandale
- Research Center on Vascular Diseases and Angiology Unit; University of Milan; Milan Italy
| | - Gianni Carzaniga
- Research Center on Vascular Diseases and Angiology Unit; University of Milan; Milan Italy
| | - Michela Cinquini
- Laboratory for the Development of New Pharmacological Strategies Department of Oncology; Mario Negri Institute for Pharmacological Research; Milan Italy
| | - Marzio Minola
- Research Center on Vascular Diseases and Angiology Unit; University of Milan; Milan Italy
| | - Gabriel Dimitrov
- Research Center on Vascular Diseases and Angiology Unit; University of Milan; Milan Italy
| | - Maria Carotta
- Research Center on Vascular Diseases and Angiology Unit; University of Milan; Milan Italy
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Lane AD, Wu PT, Kistler B, Fitschen P, Tomayko E, Jeong JH, Chung HR, Yan H, Ranadive SM, Phillips S, Fernhall B, Wilund K. Arterial stiffness and walk time in patients with end-stage renal disease. Kidney Blood Press Res 2013; 37:142-50. [PMID: 23653111 PMCID: PMC3711576 DOI: 10.1159/000350068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND End-stage renal disease patients experience increased prevalence of cardiovascular disease. Heart-artery interaction may be shifted, impacting blood pressure lability, and exercise tolerance. The coupling ratio consists of the ratio of indexed arterial elastance (EaI, arterial load) to ElvI, a measure of cardiac contractility or stiffness. Our purpose was to explore the relationship between elastances and functional capacity. We hypothesized that arterial stiffness (central pulse wave velocity, PWV) and elastances would be correlated to shuttle walk time. METHODS We used applanation tonometry, ultrasonography, and a shuttle walk test to evaluate our hypothesis. Spearman's correlations were used to assess relationships between variables. Block regression was also performed. RESULTS Forty-two subjects on maintenance hemodialysis participated. Average age=44±5 years, body surface area=2.01 kg/m(2). Mean EaI=4.45 and mean ElvI=6.89; the coupling ratio=0.82. Mean aortic pulse pressure=51 mmHg and PWV=9.6 m/s. PWV(r=-0.385) and EaI (r=-0.424) were significantly and inversely related to walking time while stroke volume index (SVI) was positively correlated to shuttle walk time (r=0.337), p<0.05 for all. CONCLUSIONS We conclude that, like other clinical populations, both arterial and heart function predict walking ability and represent potential targets for intervention; arterial stiffness and SVI are strongly related to shuttle walk time in patients with ESRD.
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Affiliation(s)
- Abbi D Lane
- University of Illinois at Chicago, Chicago, IL, USA.
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Athyros VG, Katsiki N, Karagiannis A. Nonalcoholic Fatty Liver Disease and Severity of Cardiovascular Disease Manifestations. Angiology 2013; 64:572-5. [DOI: 10.1177/0003319713481101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Vasilios G. Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
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The impact of endovascular lower-limb revascularisation on the aortic augmentation index in patients with peripheral arterial disease. Eur J Vasc Endovasc Surg 2013; 45:497-501. [PMID: 23453515 DOI: 10.1016/j.ejvs.2013.01.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 01/15/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aortic augmentation index (AIx), a marker of arterial stiffness, and peripheral arterial disease (PAD) are associated with an increased cardiovascular risk. In claudicants, the effect of balloon angioplasty (percutaneous transluminal angioplasty, PTA) on AIx has not been determined so far. METHODS Measurements of the ankle-brachial pressure index (ABI) and AIx were performed before and 3 months after PTA and compared to age- and sex-matched PAD patients under best medical treatment. RESULTS The data of 61 patients (44% female, mean age 68 years) who underwent lower-limb PTA was compared to 48 conservatively treated patients (38% female, mean age 68 years). ABI significantly improved after PTA from 0.73 ± 0.02 to 0.85 ± 0.03 (p = 0.001), but remained unchanged in the control group (0.85 ± 0.23 and 0.80 ± 0.21; p = 0.16). Revascularisation was associated with a significant reduction of AIx from 31.5 ± 1.1% to 28.8 ± 1.1% after 3 months (p = 0.01). In the conservatively treated group, AIx did not change during follow-up (29.9 ± 1.1% to 29.9 ± 1.1%; p = 0.83). CONCLUSION Lower-limb revascularisation in PAD Rutherford stage II-III is associated with an improvement of markers for arterial stiffness.
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Heffernan KS, Manini TM, Hsu FC, Blair SN, Nicklas BJ, Kritchevsky SB, Newman AB, Sutton-Tyrrell K, Church TS, Haskell WL, Fielding RA. Relation of pulse pressure to long-distance gait speed in community-dwelling older adults: findings from the LIFE-P study. PLoS One 2012. [PMID: 23185357 PMCID: PMC3503986 DOI: 10.1371/journal.pone.0049544] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Reduced gait speed is associated with falls, late-life disability, hospitalization/institutionalization and cardiovascular morbidity and mortality. Aging is also accompanied by a widening of pulse pressure (PP) that contributes to ventricular-vascular uncoupling. The purpose of this study was to test the hypothesis that PP is associated with long-distance gait speed in community-dwelling older adults in the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study. Methods Brachial blood pressure and 400-meter gait speed (average speed maintained over a 400-meter walk at “usual” pace) were assessed in 424 older adults between the ages of 70–89 yrs at risk for mobility disability (mean age = 77 yrs; 31% male). PP was calculated as systolic blood pressure (BP) – diastolic BP. Results Patients with a history of heart failure and stroke (n = 42) were excluded leaving 382 participants for final analysis. When categorized into tertiles of PP, participants within the highest PP tertile had significantly slower gait speed than those within the lowest PP tertile (p<0.05). Following stepwise multiple regression, PP was significantly and inversely associated with 400-meter gait speed (p<0.05). Other significant predictors of gait speed included: handgrip strength, body weight, age and history of diabetes mellitus (p<0.05). Mean arterial pressure, systolic BP and diastolic BP were not predictors of gait speed. Conclusions Pulse pressure is associated long-distance gait speed in community-dwelling older adults. Vascular senescence and altered ventricular-vascular coupling may be associated with the deterioration of mobility and physical function in older adults.
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Affiliation(s)
- Kevin S Heffernan
- Department of Exercise Science, Human Performance Laboratory, Syracuse University, Syracuse, New York, United States of America.
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Mosimann K, Jacomella V, Thalhammer C, Meier TO, Kohler M, Amann-Vesti B, Husmann M. Severity of Peripheral Arterial Disease is Associated With Aortic Pressure Augmentation and Subendocardial Viability Ratio. J Clin Hypertens (Greenwich) 2012. [DOI: 10.1111/j.1751-7176.2012.00702.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fan J, Jouni H, Khaleghi M, Bailey KR, Kullo IJ. Serum N-terminal pro-B-type natriuretic peptide levels are associated with functional capacity in patients with peripheral arterial disease. Angiology 2011; 63:435-42. [PMID: 22096207 DOI: 10.1177/0003319711423095] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We hypothesized that higher serum levels of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) are associated with lower functional capacity in patients with peripheral arterial disease ([PAD] n = 481, mean age 67, 68% men). Functional capacity was quantified as distance walked on a treadmill for 5 minutes. Patients were divided into 3 groups according to the distance walked: >144 yards (group 1, n = 254); 60 to 144 yards (group 2, n = 80); <60 yards or did not walk (group 3, n = 147). The association between NT-pro-BNP levels and the ordinal 3-level walking distance was assessed using multivariable ordinal logistic regression analyses that adjusted for several possible confounding variables. Higher levels of NT-pro-BNP were associated with a lower ordinal walking category independent of possible confounders (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.28-1.77; P < .001). In conclusion, higher levels of NT-pro-BNP are independently associated with lower functional capacity in patients with PAD and may be a marker of hemodynamic stress in these patients.
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Affiliation(s)
- Jin Fan
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Heffernan KS, Ranadive S, Weikert M, Lane A, Yan H, Fernhall B, Motl RW. Pulse pressure is associated with walking impairment in multiple sclerosis. J Neurol Sci 2011; 309:105-9. [PMID: 21821264 DOI: 10.1016/j.jns.2011.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 06/30/2011] [Accepted: 07/05/2011] [Indexed: 10/17/2022]
Abstract
Persons with multiple sclerosis (MS) have reduced gait performance and this is associated with disability and disease progression. The current study sought to test the hypothesis that higher central (aortic and carotid) and peripheral (brachial) pulse pressure (PP), manifestations of ventricular-vascular uncoupling related to increased arterial stiffness and pressure from wave reflections, would be associated with reduced gait performance in persons with MS. Participants consisted of 33 individuals with MS and 33 age/sex matched controls. Central blood pressure (BP) was assessed via applanation tonometry. Brachial BP was measured using an automated oscillometric cuff. PP was defined as systolic BP--diastolic BP. Gait performance was measured as 6-minute walk (6 MW) distance. Within the sample with MS, the 6 MW distance was significantly associated with brachial (r = -.49, p<.005), aortic (r = -.52, p<.001), and carotid (r = -.57, p<.001) pulse pressure. There was no association between any PP measure and 6 MW distance in controls (p>0.05 for all). In conclusion, PP is a predictor of gait performance in persons with MS. These findings suggest that vascular senescence and altered ventricular-vascular coupling may contribute, in part, to the deterioration of physical function in persons with MS.
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Affiliation(s)
- Kevin S Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
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Coutinho T, Rooke TW, Kullo IJ. Arterial dysfunction and functional performance in patients with peripheral artery disease: A review. Vasc Med 2011; 16:203-11. [DOI: 10.1177/1358863x11400935] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Functional performance influences quality of life in individuals with peripheral artery disease (PAD) and is also a powerful prognostic marker in these patients. The pathophysiology of impaired functional performance in patients with PAD is incompletely understood. The severity of atherosclerotic burden, non-invasively assessed by the ankle—brachial index (ABI), does not reliably predict the degree of functional impairment observed in PAD patients. We review associations of measures of arterial function (arterial stiffness and endothelial dysfunction) with functional performance in PAD patients, and also review potential therapies for arterial stiffness and endothelial dysfunction that could improve functional performance in PAD. Recent studies suggest that measures of arterial function, such as arterial stiffness and endothelial function, are associated with exercise performance in the setting of PAD. These studies have provided new insights into (1) the pathophysiology of functional impairment in PAD, (2) mechanisms of strategies known to be effective such as walking programs, and (3) potential new therapeutic interventions for improving functional performance. Thus, therapies aimed at arterial ‘de-stiffening’ and improving endothelial function (such as aerobic exercise, statins and angiotensin-converting enzyme inhibitors) may improve functional performance in patients with PAD; however, further investigations are needed.
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Affiliation(s)
- Thais Coutinho
- Department of Internal Medicine, Division of Cardiovascular Diseases and Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Thom W Rooke
- Department of Internal Medicine, Division of Cardiovascular Diseases and Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Iftikhar J Kullo
- Department of Internal Medicine, Division of Cardiovascular Diseases and Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA,
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Kals J, Zagura M, Serg M, Kampus P, Zilmer K, Unt E, Lieberg J, Eha J, Peetsalu A, Zilmer M. β2-microglobulin, a novel biomarker of peripheral arterial disease, independently predicts aortic stiffness in these patients. Scandinavian Journal of Clinical and Laboratory Investigation 2011; 71:257-63. [PMID: 21314441 DOI: 10.3109/00365513.2011.558108] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Arterial stiffness is a prominent feature of vascular ageing and strongly predicts cardiovascular and total mortality. The β2-microglobulin, (β2M) a newly identified biomarker of peripheral arterial disease (PAD), is related to renal insufficiency, inflammatory and neoplastic diseases, but may also play a role in vascular dysfunction. However, the relationship between arterial stiffness and β2M has not been previously studied in patients with atherosclerosis. In the present study we examined a possible association between β2M and arterial stiffness in patients with PAD and in healthy subjects. Plasma β2M levels and parameters of arterial stiffness such as aortic pulse wave velocity (aPWV) and augmentation index (AIx) were measured in 66 patients with PAD and in 66 apparently healthy subjects. Plasma levels of β2M, aPWV and AIx were significantly increased in patients with PAD compared with controls (1858.1 ± 472.8 vs 1554.5 ± 277.9 μg/L, p < 0.001; 9.9 ± 2.2 m/s vs 7.6 ± 1.6 m/s, p < 0.001; 28 ± 8 vs 14 ± 11%, p < 0.001; respectively). There existed significant correlation between aPWV and β2M for the patient group (R = 0.47; p < 0.001), but not for the controls (R = 0.14; p = 0.26). In multivariate analysis, β2M remained independently associated with aPWV, fetuin-A, age and glomerular filtration rate in patients (R(2) = 0.5, p < 0.001). We found no relationship between β2M and AIx in either group. We demonstrated that among patients with PAD elevated plasma β2M levels were associated with higher aortic stiffness irrespective of cardiovascular disease risk factors. These data suggest that β2M may influence the pathogenesis of aortic stiffness in atherosclerosis.
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Affiliation(s)
- Jaak Kals
- Department of Biochemistry, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia.
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Hamburg NM, Balady GJ. Exercise rehabilitation in peripheral artery disease: functional impact and mechanisms of benefits. Circulation 2011; 123:87-97. [PMID: 21200015 DOI: 10.1161/circulationaha.109.881888] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Naomi M Hamburg
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA
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Urbina EM, Wadwa RP, Davis C, Snively BM, Dolan LM, Daniels SR, Hamman RF, Dabelea D. Prevalence of increased arterial stiffness in children with type 1 diabetes mellitus differs by measurement site and sex: the SEARCH for Diabetes in Youth Study. J Pediatr 2010; 156:731-7, 737.e1. [PMID: 20097360 DOI: 10.1016/j.jpeds.2009.11.011] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 10/01/2009] [Accepted: 11/09/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To discuss vascular stiffness commonly encountered in children with type 1 diabetes mellitus (T1DM). STUDY DESIGN We examined 535 subjects with T1DM (14.6 years; 53% male, 88% non-Hispanic white) and 241 healthy control subjects (17.8 years; 42% male, 39% non-Hispanic white). Abnormalities in brachial distensibility (BrachD), pulse wave velocity, and augmentation index corrected to a HR of 75 (AIx-75) were examined. RESULTS Subjects with T1DM had higher body mass index, LDL-cholesterol, fasting glucose, and blood pressure than control subjects. Diabetic subjects had lower BrachD and higher AIx-75 indicating increased stiffness. Age-adjusted pulse wave velocity-trunk (aorto-femoral) was higher in cases (all P <or= < .05). Increased peripheral stiffness was more common than central stiffness in subjects with T1DM (low BrachD in 33% vs high PWV-trunk in 9.9%). Male subjects with type 1 diabetes had a higher prevalence of VS abnormalities than females. Presence of T1DM, male sex, and increased mean arterial pressure were the most consistent independent determinants of vascular stiffness. CONCLUSIONS Increased vascular stiffness is present in youth with T1DM with peripheral abnormalities predominating especially in males. Traditional risk factors are important correlates. Identifying early vascular abnormalities in youth with T1DM will allow for implementation of more aggressive risk factor management.
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Affiliation(s)
- Elaine M Urbina
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, College of Medicine, Cincinnati, OH, USA
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Brachial-ankle pulse wave velocity is associated with walking distance in patients referred for peripheral arterial disease evaluation. Atherosclerosis 2009; 206:173-8. [PMID: 19278681 DOI: 10.1016/j.atherosclerosis.2009.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 01/14/2009] [Accepted: 02/01/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Impaired functional capacity predicts morbidity and increased mortality in patients with PAD. We hypothesized that brachial-ankle pulse wave velocity (baPWV), a measure of arterial stiffness, is associated with functional capacity in patients undergoing noninvasive evaluation for peripheral arterial disease (PAD). METHODS We studied 114 patients (age 68+/-10 years) referred to Mayo Clinic's noninvasive vascular laboratory. Functional capacity was estimated in terms of distance walked in 5 min on a treadmill at a speed of 1.0-2.0 mph. Ankle-brachial index (ABI) was obtained with Doppler method before and 1 min after exercise. baPWV was estimated noninvasively using an oscillometric device. The association of baPWV with walking distance was assessed using accelerated failure time and Cox proportional-hazards models. RESULTS The mean baPWV was higher in patients who were unable to complete the walk test compared to those who successfully completed the test (P=0.008). Higher baPWV was associated with a lower walking distance after adjustment for heart rate, mean arterial pressure, and cardiovascular risk factors (P=0.017) and after additional adjustment for pulse pressure (P=0.034) and ABI (P=0.030). Higher baPWV was associated with failure to complete the treadmill walk test, after adjustment for heart rate, mean arterial pressure, and cardiovascular risk factors (P=0.025) and after additional adjustment for pulse pressure (P=0.041) and ABI (P=0.039). CONCLUSION Increased baPWV, a measure of arterial stiffness, is associated with impaired functional capacity in patients undergoing evaluation for PAD.
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Safar ME, Priollet P, Luizy F, Mourad JJ, Cacoub P, Levesque H, Benelbaz J, Michon P, Herrmann MA, Blacher J. Peripheral arterial disease and isolated systolic hypertension: the ATTEST study. J Hum Hypertens 2008; 23:182-7. [PMID: 18830251 DOI: 10.1038/jhh.2008.121] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hypertension is a risk factor for cardiovascular (CV) diseases, either coronary artery disease (CAD), peripheral artery disease (PAD) or cerebrovascular disease (CVD). The relationships between those different localizations of CV disease and the haemodynamic features of hypertension have been poorly evaluated in the past. In the ATTEST study, a geographically representative panel of 3020 general practitioners recruited 8316 consecutive patients with CV diseases (PAD, CAD or CVD, alone or in association). Blood pressure, which was not an inclusion criterion, was then measured and related to the different forms of CV diseases. Blood pressure classification involved 20% normotensive subjects, 24% subjects with controlled hypertension, 42% subjects with isolated systolic hypertension and 14% subjects with systolic-diastolic hypertension, all hypertensives with or without antihypertensive therapy. From multiple regression analysis, it appeared that subjects with systolic hypertension were characterized by the presence of PAD, with little or no presence of CAD and/or CVD. Subjects with systolic-diastolic hypertension were characterized by the presence of CAD and/or CVD, but without PAD. Although the former was only influenced by age, dyslipidaemia and diabetes mellitus influenced the latter. This study confirms the high prevalence of hypertension (80%) in a large population of patients with CV diseases selected in primary care. Analysis of different features of hypertension revealed that isolated systolic hypertension was the most prevalent form of hypertension in this treated population. Finally, one of the predominant goals of secondary prevention in subjects with PAD should be the treatment of isolated systolic hypertension.
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Affiliation(s)
- M E Safar
- Faculté de Médecine, Hôtel-Dieu hospital, Université Paris Descartes, Paris, France
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Reduced arterial stiffness may contribute to angiotensin-converting enzyme inhibitor induced improvements in walking time in peripheral arterial disease patients. J Hypertens 2008; 26:1037-42. [DOI: 10.1097/hjh.0b013e3282f8e3b6] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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