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Co-Vu JG, Jacobs JP. Hit That Snooze Button?: Hidden Link Between Sleep Patterns, Genetic Risk, and Abdominal Aortic Aneurysm. JACC. ADVANCES 2024; 3:100970. [PMID: 38938866 PMCID: PMC11198652 DOI: 10.1016/j.jacadv.2024.100970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Jennifer G. Co-Vu
- University of Florida Congenital Heart Center, Gainesville, Florida USA
| | - Jeffrey P. Jacobs
- University of Florida Congenital Heart Center, Gainesville, Florida USA
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ, Faxon DP, Upchurch GR, Aday AW, Azizzadeh A, Boisen M, Hawkins B, Kramer CM, Luc JGY, MacGillivray TE, Malaisrie SC, Osteen K, Patel HJ, Patel PJ, Popescu WM, Rodriguez E, Sorber R, Tsao PS, Santos Volgman A, Beckman JA, Otto CM, O'Gara PT, Armbruster A, Birtcher KK, de Las Fuentes L, Deswal A, Dixon DL, Gorenek B, Haynes N, Hernandez AF, Joglar JA, Jones WS, Mark D, Mukherjee D, Palaniappan L, Piano MR, Rab T, Spatz ES, Tamis-Holland JE, Woo YJ. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2023; 166:e182-e331. [PMID: 37389507 PMCID: PMC10784847 DOI: 10.1016/j.jtcvs.2023.04.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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Isselbacher EM, Preventza O, Hamilton Black Iii J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Jones WS, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Times SS, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 80:e223-e393. [PMID: 36334952 PMCID: PMC9860464 DOI: 10.1016/j.jacc.2022.08.004] [Citation(s) in RCA: 138] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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Martinez-De Jesús FR, Hernandez-Luevano E, Rodriguez-Ramírez N, Cendejas-Alatorre R, Muñoa Prado JA, Carrera Maigua F, Zambrano-Loaiza E. Validation of the Ischaemia Severity Scale (ISS) Based on Non-Invasive Vascular Assessments (SEWSS) for Predicting Outcomes of Diabetic Foot Attack. J Clin Med 2022; 11:jcm11237195. [PMID: 36498772 PMCID: PMC9738640 DOI: 10.3390/jcm11237195] [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: 10/27/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Assessment of ischaemia severity includes a variety of measures, such as pedal pulse palpation, the ankle/brachial index (ABI), and the toe/brachial index (TBI), but there is a lack of consensus regarding which ischaemia scale is the most effective for determining outcome prognosis. The purpose of this study is to validate the application of the ischaemia severity scale (ISS) in the effective prediction of wound healing, amputations, and mortality for diabetic foot wounds (DFW). This prospective study included 235 consecutive patients graded according to the Saint Elian Wound Score System (SEWSS). The ISS is part of this system, with patients being scored as non-ischaemic (0) or having mild (1), moderate (2), or severe (3) ischaemia. Age, diabetes duration in years, and ulcer size were found to be associated with a longer mean ischaemia of increasing severity. A trend of reduction in the pulse palpation rates (70.4%, 50%, 8.5% to 0%; p < 0.01), ABI (1.1 ± 0.1, 0.86 ± 0.3, 0.68 ± 0.2, 0.47 ± 0.2, p < 0.01), TBI average values (0.90 ± 0.35, 0.62 ± 0.52, 0.50 ± 0.33, 0.10 ± 0.42, p < 0.01), wound healing success (88.7%, 57.7%, 40.7%, 12.9%; p < 0.01), and delay in weeks (Kaplan−Meier: log-rank 44.2, p < 0.01) was observed with increasing values of the ISS (0, 1, 2, and 3). The odds ratio for adverse outcomes increased for each additional level of ischaemia severity. Thus, we demonstrate that the ISS is useful in effectively predicting adverse outcomes for DFW.
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Affiliation(s)
- Fermín Rafael Martinez-De Jesús
- The Diabetic Foot Latinamerican Society Research Group 1, Diabetic Foot Salvage and Prevention Center Saint Elian, Veracruz 91900, Mexico
- Correspondence: ; Tel.: +52-12-9173-5819
| | - Emmanuel Hernandez-Luevano
- The Diabetic Foot Latinamerican Society Research Group 2, Diabetic Foot Salvage and Prevention Center Saint Elian, Veracruz 91900, Mexico
| | - Neftalí Rodriguez-Ramírez
- The Diabetic Foot Latinamerican Society Research Group 2, Diabetic Foot Salvage and Prevention Center Saint Elian, Veracruz 91900, Mexico
| | - Rafael Cendejas-Alatorre
- The Diabetic Foot Latinamerican Society Research Group 2, Diabetic Foot Salvage and Prevention Center Saint Elian, Veracruz 91900, Mexico
| | - José Antonio Muñoa Prado
- The Diabetic Foot Latinamerican Society Research Group 2, Diabetic Foot Salvage and Prevention Center Saint Elian, Veracruz 91900, Mexico
| | - Favio Carrera Maigua
- The Diabetic Foot Latinamerican Society Research Group 2, Diabetic Foot Salvage and Prevention Center Saint Elian, Veracruz 91900, Mexico
| | - Elízabeth Zambrano-Loaiza
- The Diabetic Foot Latinamerican Society Research Group 1, Diabetic Foot Salvage and Prevention Center Saint Elian, Veracruz 91900, Mexico
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Verma S, Graham MM, Lecamwasam A, Romanovsky A, Duggan S, Bagshaw S, Senaratne JM. Cardiorenal Interactions: A Review. CJC Open 2022; 4:873-885. [PMID: 36254331 PMCID: PMC9568715 DOI: 10.1016/j.cjco.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/24/2022] [Indexed: 10/29/2022] Open
Abstract
A complex interaction occurs between cardiac and renal function. They are intricately tied together, and a range of disorders in both the heart and kidneys can alter the function of the other. The pathophysiology is complex, and these conditions are termed cardiorenal syndromes. They can be acute and/or chronic in nature, they result in and from hemodynamic consequences, systemic congestion, and metabolic abnormalities, and they lead to dysfunction of both the heart and kidneys. The aim of this article is to provide a review for cardiologists and intensivists who are treating patients for whom cardiac and renal interactions may complicate their picture. We review acute kidney injuries, management of the complications of renal dysfunction, renal replacement therapy, and cardiorenal syndromes.
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Affiliation(s)
- Sanam Verma
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle M. Graham
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Ashani Lecamwasam
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Department of Nephrology, Northern Health, Epping, Victoria, Australia
- Epworth UroRenal and Vascular Clinical Institute, Internal Medicine Clinical Institute, Victoria, Australia
| | - Adam Romanovsky
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Shelley Duggan
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sean Bagshaw
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Janek Manoj Senaratne
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
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Brahmbhatt A, Bryce Y, Hasan M, Pena C. Arterial Evaluation. Tech Vasc Interv Radiol 2022; 25:100866. [DOI: 10.1016/j.tvir.2022.100866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bonham PA, Brunette G, Crestodina L, Droste LR, González A, Kelechi TJ, Ratliff CR, Varnado MF. 2021 Guideline for Management of Patients With Lower-Extremity Wounds Due to Diabetes Mellitus and/or Neuropathic Disease: An Executive Summary. J Wound Ostomy Continence Nurs 2022; 49:267-285. [PMID: 35523243 DOI: 10.1097/won.0000000000000860] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article provides an executive summary of the Wound, Ostomy, and Continence Nurses Society's (WOCN) "2021 Guideline for Management of Patients With Lower-Extremity wounds Due to Diabetes Mellitus and/or Neuropathic Disease." This executive summary presents an overview of the systematic process used to update and develop the guideline and recommendations from the guideline for screening and diagnosis, assessment, and management and education of patients with lower-extremity wounds due to diabetes mellitus and/or neuropathic disease. In addition, the executive summary provides suggestions for implementing recommendations from the guideline. The guideline is a resource for WOC nurse specialists and other nurses and health care professionals who work with adults who have/or are at risk for lower-extremity wounds due to diabetes mellitus/neuropathic disease. The complete guideline includes the evidence and references supporting the recommendations, and it is available in print and electronically from the Wound, Ostomy, and Continence Nurses Society, 1120 Rt 73, Suite 200, Mount Laurel, New Jersey, 08054; Web site: www.wocn.org.
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Affiliation(s)
- Phyllis A Bonham
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
| | - Glenda Brunette
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
| | - Lea Crestodina
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
| | - Linda R Droste
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
| | - Arturo González
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
| | - Teresa J Kelechi
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
| | - Catherine R Ratliff
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
| | - Myra F Varnado
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
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Marples R, Binks M, Spina R, Wright M, Huilgol R. Prophylactic paclitaxel-eluting stent placement does not improve covered femoropopliteal stent patency. Surg Open Sci 2022; 7:18-21. [PMID: 34805818 PMCID: PMC8590064 DOI: 10.1016/j.sopen.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/25/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Covered stents are an important tool in managing femoropopliteal peripheral arterial disease. However, their performance is impaired by edge neointimal hyperplasia and restenosis. We examined the effectiveness of prophylactic deployment of paclitaxel-eluting stents to prevent edge restenosis. METHODS A retrospective case-control study was performed. Patients with femoropopliteal peripheral arterial disease who were treated with Viabahn stent placement were compared to patients treated with Viabahn stents deployed in conjunction with paclitaxel-eluting stents (PTX). The primary outcome was time to loss of stent primary patency. The Kaplan-Meier method was used. RESULTS A total of 36 Viabahn and 25 Viabahn + paclitaxel-eluting stent procedures were evaluated, with mean follow-up periods of 27 and 18 months, respectively. The Viabahn + paclitaxel-eluting stent group had a longer length of vessel stented (P = .0023). Twelve-month primary patency was 74% in the Viabahn group and 75% in the Viabahn + paclitaxel-eluting stent group. Pre-existing dyslipidemia correlated with earlier loss of primary patency across the combined cohort (P = .0193). CONCLUSION Viabahn stent primary patency is unaffected by the addition of paclitaxel-eluting stents.
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Affiliation(s)
- Rory Marples
- University of New South Wales, Sydney, Australia
- University of Notre Dame, Australia
| | - Matthew Binks
- Wagga Wagga Rural Referral Hospital, Wagga Wagga, New South Wales
- University of New South Wales, Sydney, Australia
| | | | | | - Ravi Huilgol
- Wagga Wagga Rural Referral Hospital, Wagga Wagga, New South Wales
- University of Notre Dame, Australia
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Chiu LYC, Syed MH, Zamzam A, Rotstein OD, Abdin R, Laraya N, Qadura M. Perceived Challenges to Routine Uptake of the Ankle Brachial Index within Primary Care Practice. J Clin Med 2021; 10:4371. [PMID: 34640389 PMCID: PMC8509610 DOI: 10.3390/jcm10194371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/08/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Introduction: The ankle-brachial index (ABI) is the most widely used method of diagnosing peripheral arterial disease (PAD). However, the uptake of ABIs has been reported to be low in primary care settings across different various healthcare settings; however, this is yet to be investigated within the Canadian context. (2) Objective: Therefore, we sought to assess the rates of ABI usage as well as perceived barriers among primary care practitioners (PCPs) in Toronto, Canada. (3) Methods: A modified questionnaire was electronically sent to 257 PCPs in the Greater Toronto Area (GTA). Questions pertained to frequency, feasibility, utility, and barriers associated with ABI usage in clinical practice. Responses were collected and tallied. (4) Results: A total of 52 PCPs completed the questionnaire. 79% of PCPs did not routinely perform ABIs within their clinical practice, and 56% deemed ABI usage as unfeasible. Constraints in time and staff personnel, as well as complexity of ABI result interpretation, were cited as the major perceived barriers to ABI usage. The overwhelming majority of PCPs viewed alternative forms of diagnosis, such as a blood test for PAD, as being preferable to ABI, as such an approach would enhance diagnostic simplicity and efficiency. (5) Conclusion: ABI usage rates are poor within primary care practices in Toronto, Canada. Alternative approaches for diagnosing PAD may result in greater adoption rates among PCPs and therefore improve the identification of patients with PAD.
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Affiliation(s)
- Lily Y. C. Chiu
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; (L.Y.C.C.); (M.H.S.); (A.Z.)
| | - Muzammil H. Syed
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; (L.Y.C.C.); (M.H.S.); (A.Z.)
| | - Abdelrahman Zamzam
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; (L.Y.C.C.); (M.H.S.); (A.Z.)
| | - Ori D. Rotstein
- Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada;
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
| | - Rawand Abdin
- Department of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada;
| | - Nadine Laraya
- Family Medicine Department, St. Joseph’s Health Centre, Toronto, ON M6R 1B5, Canada;
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Mohammad Qadura
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; (L.Y.C.C.); (M.H.S.); (A.Z.)
- Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada;
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
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10
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Ahden S, Ngo V, Hoskin J, Mach V, Magharious S, Tambar A, Brooks D, Hébert AA, Marzolini S. Inclusion of People With Peripheral Artery Disease in Cardiac Rehabilitation Programs: A Pan-Canadian Survey. Heart Lung Circ 2021; 30:1031-1043. [DOI: 10.1016/j.hlc.2020.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/04/2020] [Accepted: 12/30/2020] [Indexed: 01/01/2023]
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11
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Yuan Z, Huang X, Wan P, Zhao C, Zhang Y, Zhang B, Wang J, Zhang H, Sang S. A cost-effective smartphone-based device for ankle-brachial index (ABI) detection. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 198:105790. [PMID: 33069974 DOI: 10.1016/j.cmpb.2020.105790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Detectors of ankle-brachial index (ABI) are commonly used in cardiovascular patients who have high-risk levels of arteriosclerosis. Increased evidences suggest that patients with arteriosclerosis possess many risks of geriatric and chronic diseases. Meanwhile, new chronic treatments trend from the hospitals toward family and community health centers, but for arteriosclerosis cases have delivered benefits far below instrument costs. Compared to traditional devices based on cuff pressure, cuffless and non-invasive measures have wider application potential in home health care, especially in the case of physically-restricted or severely symptomatic patients. METHODS In this study, we developed a simple smartphone-based device for non-invasive ABI monitoring, which consists of four wireless cuffless limbs blood sensors. By identifying and tracking blood flow waveform, a multiparameter fusion (MPF) algorithm is used to estimate blood pressure and generate ABI value. An ARM-based chip STM32 has been adopted as the microcontroller. The ABI calculating program is embedded in C++ and executed by the processor. After generating data, ABI information can be delivered to the smartphone by using Bluetooth. Relying on mobile apps to visualize the data and display on the screen, doctors can monitor cardiovascular patients in real time and analyze the risk levels of arteriosclerosis online. RESULTS In this paper, the detection conducted by the classical Doppler equipment and prototype were recorded respectively. A statistical evaluation of the verification results obtained from 29 patients and 7 sub-health volunteers is given, which shows that our device can achieve 91.80% and 93.84% accuracy for patients and sub-health volunteers, respectively. In addition, the prototype can be performed stably for a continuous long time monitoring. CONCLUSIONS According to our studies, the accuracy of our device is sufficient for home medical and chronic disease monitoring within a certain time interval. The smartphone-based ABI device has several apparent advantages over traditional devices, such as portability, cost-effectiveness and energy-efficiency.
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Affiliation(s)
- Zhongyun Yuan
- MicroNano System Research Center, College of Information & Computer Engineering, Key Laboratory of Advanced Transducers and Intelligent Control System of Ministry of Education and Shanxi Province, Taiyuan University of Technology, Taiyuan 030024, China
| | - Xinru Huang
- MicroNano System Research Center, College of Information & Computer Engineering, Key Laboratory of Advanced Transducers and Intelligent Control System of Ministry of Education and Shanxi Province, Taiyuan University of Technology, Taiyuan 030024, China
| | - Pei Wan
- MicroNano System Research Center, College of Information & Computer Engineering, Key Laboratory of Advanced Transducers and Intelligent Control System of Ministry of Education and Shanxi Province, Taiyuan University of Technology, Taiyuan 030024, China
| | - Chun Zhao
- College of Information and Communication Engineering, Sungkyunkwan University, Suwon 440-746, Korea
| | - Yixia Zhang
- MicroNano System Research Center, College of Information & Computer Engineering, Key Laboratory of Advanced Transducers and Intelligent Control System of Ministry of Education and Shanxi Province, Taiyuan University of Technology, Taiyuan 030024, China
| | - Bo Zhang
- MicroNano System Research Center, College of Information & Computer Engineering, Key Laboratory of Advanced Transducers and Intelligent Control System of Ministry of Education and Shanxi Province, Taiyuan University of Technology, Taiyuan 030024, China
| | - Jianming Wang
- General Hospital of TISCO, North Street, Xinghualing District, Taiyuan 030024, China
| | - Hongpeng Zhang
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing 100853, China.
| | - Shengbo Sang
- MicroNano System Research Center, College of Information & Computer Engineering, Key Laboratory of Advanced Transducers and Intelligent Control System of Ministry of Education and Shanxi Province, Taiyuan University of Technology, Taiyuan 030024, China.
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Chanan EL, Bingham N, Smith DE, Nunnally ME. Early Detection, Prevention, and Management of Acute Limb Ischemia in Adults Supported With Venoarterial Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2020; 34:3125-3132. [DOI: 10.1053/j.jvca.2020.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/01/2020] [Accepted: 02/12/2020] [Indexed: 12/25/2022]
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13
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2019 Guideline for Management of Wounds in Patients With Lower-Extremity Venous Disease (LEVD): An Executive Summary. J Wound Ostomy Continence Nurs 2020; 47:97-110. [PMID: 32150136 DOI: 10.1097/won.0000000000000622] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article provides an executive summary of the 2019 Guideline for Management of Wounds in Patients with Lower-Extremity Venous Disease (LEVD) published by the Wound, Ostomy and Continence Nurses Society (WOCN). The executive summary presents an overview of the systematic process used to update and develop the guideline. It also lists the specific recommendations from the guideline for assessment, prevention, and management of LEVD and venous leg ulcers (VLUs). In addition, the guideline includes a new section regarding implementation of clinical practice guidelines. The LEVD guideline is a resource for WOC nurse specialists and other nurses, physicians, therapists, and health care professionals who work with adults who have or who are at risk for VLU.
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14
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AbuRahma AF, Adams E, AbuRahma J, Mata LA, Dean LS, Caron C, Sloan J. Critical analysis and limitations of resting ankle-brachial index in the diagnosis of symptomatic peripheral arterial disease patients and the role of diabetes mellitus and chronic kidney disease. J Vasc Surg 2020; 71:937-945. [PMID: 31471230 PMCID: PMC7203622 DOI: 10.1016/j.jvs.2019.05.050] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/15/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The ankle-brachial index (ABI) may underestimate the severity of peripheral arterial disease (PAD) in patients with noncompressible vessels. This study analyzed limitations of the ABI and toe-brachial index (TBI), if done alone, in patients with symptomatic PAD, diagnosed by duplex ultrasound (DUS) examination, particularly in patients with diabetes and chronic kidney disease (CKD). METHODS This is a retrospective review of prospectively collected data. All patients underwent resting ABIs, TBI, and/or DUS. An ABIs of 0.90 or less in either leg was considered abnormal, and the term inconclusive ABIs (noncompressibility) was used if the ABI was 1.3 or greater. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy (OA) of ABIs in detecting 50% or greater stenosis of any arterial segment based on DUS were determined. A TBI of less than 0.7 was considered abnormal. RESULTS We included 2226 ABIs and 1383 DUS examinations: 46% of patients had diabetes, 16% had CKD, and 39% had coronary artery disease. Fifty-three percent of the ABIs were normal, 34% were abnormal, and 13% were inconclusive. For patients with limb-threatening ischemia, 40% had normal ABIs, 40% abnormal ABIs, and 20% were inconclusive. The sensitivity and OA for ABIs in detecting 50% or greater stenosis in the whole series were 57% (95% confidence interval [CI], 53.7-61.2) and 74% (95% CI, 71.9-76.6); for diabetics 51% (95% CI, 46.1-56.3) and 66% (95% CI, 62.3-69.8); nondiabetics 66% (95% CI, 59.9-70.9) and 81% (95% CI, 78.2-83.9). For patients with CKD, the sensitivity and OA for ABIs in detecting 50% or greater stenosis was 43% (95% CI, 34.3-52.7) and 67% (95% CI, 60.2-73.0) versus patients with no CKD 60% (95% CI, 56.3-64.6) and 76% (95% CI, 73.1-78.1). If patients with inconclusive ABIs were excluded, these values were 69% (95% CI, 65.2-72.9) and 80% (95% CI, 77.2-81.9) in the whole series; 67% (95% CI, 61.6-72.7) and 75% (95% CI, 70.5-78.4) for diabetics; and 63% (95% CI, 51.3-73.0) and 78% (95% CI, 70.6-83.9) for patients with CKD. Thirty-three percent of TBIs were normal and 67% were abnormal. The sensitivity and OA for abnormal TBI in detecting 50% or greater stenosis were 85% (95% CI, 78.9-90.0) and 75% (95% CI, 70.1-80.2) in the whole series; 84% (95% CI, 76.0-90.3) and 74% (95% CI, 67.1-80.2) for diabetics; and 77% (95% CI, 61.4-88.2) and 72% (95% CI, 59.9-82.3) for patients with CKD. For those with inconclusive ABIs, these values for TBI were 75% and 69%. CONCLUSIONS Of symptomatic patients with PAD with 50% or greater stenosis on DUS examination, 43% had normal/inconclusive resting ABIs (49% in diabetics and 57% in CKD). TBI may help in patients with inconclusive ABIs. These patients should undergo further imaging to determine proper treatment.
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Affiliation(s)
- Ali F AbuRahma
- Department of Surgery, West Virginia University, Charleston, WV.
| | - Elliot Adams
- Department of Surgery, West Virginia University, Charleston, WV
| | - Joseph AbuRahma
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Fla
| | - Luis A Mata
- Department of Surgery, West Virginia University, Charleston, WV
| | - L Scott Dean
- CAMC Health Education and Research Institute, Charleston, WV
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Acuna A, Berman AG, Damen FW, Meyers BA, Adelsperger AR, Bayer KC, Brindise MC, Bungart B, Kiel AM, Morrison RA, Muskat JC, Wasilczuk KM, Wen Y, Zhang J, Zito P, Goergen CJ. Computational Fluid Dynamics of Vascular Disease in Animal Models. J Biomech Eng 2019; 140:2676341. [PMID: 29570754 DOI: 10.1115/1.4039678] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Indexed: 12/19/2022]
Abstract
Recent applications of computational fluid dynamics (CFD) applied to the cardiovascular system have demonstrated its power in investigating the impact of hemodynamics on disease initiation, progression, and treatment outcomes. Flow metrics such as pressure distributions, wall shear stresses (WSS), and blood velocity profiles can be quantified to provide insight into observed pathologies, assist with surgical planning, or even predict disease progression. While numerous studies have performed simulations on clinical human patient data, it often lacks prediagnosis information and can be subject to large intersubject variability, limiting the generalizability of findings. Thus, animal models are often used to identify and manipulate specific factors contributing to vascular disease because they provide a more controlled environment. In this review, we explore the use of CFD in animal models in recent studies to investigate the initiating mechanisms, progression, and intervention effects of various vascular diseases. The first section provides a brief overview of the CFD theory and tools that are commonly used to study blood flow. The following sections are separated by anatomical region, with the abdominal, thoracic, and cerebral areas specifically highlighted. We discuss the associated benefits and obstacles to performing CFD modeling in each location. Finally, we highlight animal CFD studies focusing on common surgical treatments, including arteriovenous fistulas (AVF) and pulmonary artery grafts. The studies included in this review demonstrate the value of combining CFD with animal imaging and should encourage further research to optimize and expand upon these techniques for the study of vascular disease.
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Affiliation(s)
- Andrea Acuna
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907 e-mail:
| | - Alycia G Berman
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907 e-mail:
| | - Frederick W Damen
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907 e-mail:
| | - Brett A Meyers
- School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN 47907 e-mail:
| | - Amelia R Adelsperger
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907 e-mail:
| | - Kelsey C Bayer
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907 e-mail:
| | - Melissa C Brindise
- School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN 47907 e-mail:
| | - Brittani Bungart
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907 e-mail:
| | - Alexander M Kiel
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907 e-mail:
| | - Rachel A Morrison
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907 e-mail:
| | - Joseph C Muskat
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907 e-mail:
| | - Kelsey M Wasilczuk
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907 e-mail:
| | - Yi Wen
- Department of Agricultural and Biological Engineering, Purdue University, 225 South University Street, West Lafayette, IN 47907 e-mail:
| | - Jiacheng Zhang
- School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN 47907 e-mail:
| | - Patrick Zito
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907 e-mail:
| | - Craig J Goergen
- ASME Membership Bioengineering Division, Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907 e-mail:
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Green D, Vassallo D, Handley K, Ives N, Wheatley K, Chrysochou C, Hegarty J, Wright J, Moss J, Patel RK, Deighan C, Webster J, Rowe P, Carr S, Cross J, O'Driscoll J, Sharma R, Mark P, Kalra PA. Cardiac structure and function after revascularization versus medical therapy for renal artery stenosis: the ASTRAL heart echocardiographic sub-study. BMC Nephrol 2019; 20:220. [PMID: 31200662 PMCID: PMC6570952 DOI: 10.1186/s12882-019-1406-y] [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: 12/19/2017] [Accepted: 05/30/2019] [Indexed: 01/20/2023] Open
Abstract
Background The ASTRAL trial showed no difference in clinical outcomes between medical therapy and revascularization for atherosclerotic renal vascular disease (ARVD). Here we report a sub-study using echocardiography to assess differences in cardiac structure and function at 12 months. Methods ASTRAL patients from 7 participating centres underwent echocardiography at baseline and 12 months after randomisation. Changes in left ventricular ejection fraction (LVEF), left ventricular mass (LVM), left atrial diameter (LAD), aortic root diameter (AoRD), E:A, and E deceleration time (EDT) were compared between study arms. Analyses were performed using t-tests and multivariate linear regression. Results Ninety two patients were included (50 medical versus 42 revascularization). There was no difference between arms in any baseline echocardiographic parameter. Comparisons of longitudinal changes in echocardiographic measurements were: δLVEF medical 0.8 ± 8.7% versus revascularization − 2.8 ± 6.8% (p = 0.05), δLVM − 2.9 ± 33 versus − 1.7 ± 39 g (p = 0.9), δLAD 0.1 ± 0.4 versus 0.01 ± 0.5 cm (p = 0.3), δAoRD 0.002 ± 0.3 versus 0.06 ± 0.3 cm (p = 0.4), δE:A − 0.0005 ± 0.6 versus 0.03 ± 0.7 (p = 0.8), δEDT − 1.1 ± 55.5 versus − 9.0 ± 70.2 ms (p = 0.6). In multivariate models, there were no differences between treatment groups for any parameter at 12 months. Likewise, change in blood pressure did not differ between arms (mean δsystolic blood pressure medical 0 mmHg [range − 56 to + 54], revascularization − 3 mmHg [− 61 to + 59], p = 0.60). Conclusions This sub-study did not show any significant differences in cardiac structure and function accompanying renal revascularization in ASTRAL. Limitations include the small sample size, the relative insensitivity of echocardiography, and the fact that a large proportion of ASTRAL patient population had only modest renal artery stenosis as described in the main study.
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Affiliation(s)
- Darren Green
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.
| | - Diana Vassallo
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | | | | | | | - Constantina Chrysochou
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Janet Hegarty
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | | | | | | | | | | | | | - Sue Carr
- University Hospitals of Leicester, Leicester, UK
| | | | | | | | - Patrick Mark
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
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Mostaza JM, Lahoz C, Salinero-Fort MA, de Dios O, Castillo E, González-Alegre T, García-Iglesias F, Estirado E, Laguna F, Sabín C, López S, Cornejo V, de Burgos C, Sanchez V, Garcés C, Puntero BF, Montesano L, Aguilera Linde PP, Fernandez-Garcia PJ, Linde CA, Aguirre De Carcer Escolano ÁR, Sacristán PA, Álvarez Otero MJ, Arribas Pérez P, Asensio Ruiz ML, Astorga Díaz P, Berriatua Ena B, Bezos Varela AI, Calatrava Triguero MJ, García CC, Llorente ÁC, Diaz Laso C, García EE, Dueñas OE, Ferrer Zapata MI, Antuña F, García Lazaro MI, Gómez Rodríguez MT, Lucena ÁG, Hernández FH, Viñals RJ, Ruiz Ogarrio GL, Manzano MDCL, López SPL, Cabrera Peláez AM, Candenas MN, Carrera MAR, Rodríguez ÁC, Castellanos AL, García MV, Pacheco MR. R46L polymorphism in the PCSK9 gene: Relationship to lipid levels, subclinical vascular disease, and erectile dysfunction. J Clin Lipidol 2018; 12:1039-1046.e3. [DOI: 10.1016/j.jacl.2018.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/30/2018] [Accepted: 04/11/2018] [Indexed: 01/05/2023]
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19
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Arri SS, Patterson T, Williams RP, Moschonas K, Young CP, Redwood SR. Myocardial revascularisation in high-risk subjects. Heart 2017; 104:166-179. [PMID: 29180542 DOI: 10.1136/heartjnl-2016-310487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Satpal S Arri
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tiffany Patterson
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rupert P Williams
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Christopher P Young
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Simon R Redwood
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
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20
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Salisbury DL, Whipple MO, Burt M, Brown RJL, Hirsch A, Foley C, Treat-Jacobson D. Translation of an evidence-based therapeutic exercise program for patients with peripheral artery disease. JOURNAL OF VASCULAR NURSING 2017; 36:23-33. [PMID: 29452626 DOI: 10.1016/j.jvn.2017.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to implement and evaluate quality outcomes including referral, enrollment, and completion rates of a new peripheral artery disease (PAD)-specific supervised exercise therapy (SET) program within a preexisting clinical exercise wellness program and to evaluate the clinical effectiveness and patient-centered outcomes derived from 12 weeks of PAD-specific SET. Recruited participants completed an individualized, minimally supervised, PAD-specific SET program based on the AHA-ACC guidelines. Exercise workloads (metabolic equivalents of task [METs]) were tracked and evaluated throughout the program. Short Physical Performance Battery, 6-minute walk test (6MWT) Walking Impairment Questionnaire, Short-Form 36 (SF-36), and Peripheral Artery Disease Quality of Life Questionnaire (PADQOL) were assessed before and after the program. Paired t-tests were used to examine differences between baseline and follow-up outcome variables. On average, participants (n = 46) attended 23 (standard deviation [SD] 12.9) out of the possible 36 training sessions, for a 64% attendance rate. Among participants who used treadmill walking as the primary mode of exercise (n = 40), the overall mean MET level just prior to program completion was 3.79 (SD 1.49), which represented an increase of 0.92 (34%) METs compared to baseline (P < .001). Total distance on the 6MWT increased 115 (11%) feet (P = .011), which is considered a clinically meaningful improvement. Significant improvements were noted in the PADQOL: symptoms and limitations in physical functioning (P = .007). This study demonstrates that a minimally staffed PAD-specific SET program can improve functional performance in patients with claudication due to PAD and serves as a foundation to help build a clinically effective, Centers for Medicare and Medicaid reimbursed PAD-specific rehabilitation program.
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Affiliation(s)
| | - Mary O Whipple
- School of Nursing, University of Minnesota, Minneapolis, MN
| | - Marsha Burt
- Fairview Health System, University of Minnesota, Minneapolis, MN
| | | | - Alan Hirsch
- School of Medicine, University of Minnesota, Minneapolis, MN
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21
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Arhuidese I, Wang S, Locham S, Faateh M, Nejim B, Malas M. Racial disparities after infrainguinal bypass surgery in hemodialysis patients. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.04.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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22
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Younes JA, El-Sayed ND, Kamel AI. Prevalence of Subclinical Peripheral Vascular Disease in Obese Egyptian Patients. Indian J Nucl Med 2017; 32:271-278. [PMID: 29142342 PMCID: PMC5672746 DOI: 10.4103/0972-3919.216545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To detect subclinical peripheral vascular disease in obese Egyptian patients and establish relations between obesity, metabolic risk factors, and PVD. METHODS This was a prospective case-control study including 100 obese patients (BMI >30) (G1). In addition, 100 age and sex matched non-obese healthy subjects as a control group (G2). Both groups were subjected to duplex ultrasound, Radionuclide muscle scan. Angiography was done for 17 patients. RESULTS The image pattern of 99mTc-MIBI muscles uptake was studied and perfusion reserve (PR%) was calculated in (G1) and (G2). Comparison between the two groups showed statistically significant difference (P < 0.001) as regarding laboratory findings. Patients were categorized according to PR% into +ve for ischemia (mean PR% was 28.4 ± 20.3) and -ve for ischemia (mean PR% was 65.0 ± 11.4). Among (G1) 64 patients positive for ischemia by both PR% and Doppler, 36 patients were negative by Doppler and 22 of them were positive for ischemia by PR%. Angiography was done for 17 of them and proved ischemia in all of them. CONCLUSION The Tc-99m sestamibi muscle scan can be used as a screening and diagnostic tool of preclinical atherosclerosis in obese patients.
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Ungerleider JL, Kammeyer JK, Braden RL, Christman KL, Gianneschi NC. Enzyme-Targeted Nanoparticles for Delivery to Ischemic Skeletal Muscle. Polym Chem 2017; 8:5212-5219. [PMID: 29098018 PMCID: PMC5662209 DOI: 10.1039/c7py00568g] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The targeted delivery of enzyme-responsive nanoparticles to specific tissues can be a valuable, minimally invasive approach for imaging or drug delivery applications. In this study, we show for the first time enzyme-directed assembly of intravenously (IV) delivered nanoparticles in ischemic skeletal muscle, which has applications for drug delivery to damaged muscle of the type prevalent in peripheral artery disease (PAD). Specifically, micellar nanoparticles are cleavable by matrix metalloproteinases (MMPs), causing them to undergo a morphological switch and thus aggregate in tissues where these enzymes are upregulated, like ischemic muscle. Here, we demonstrated noninvasive in vivo imaging of these IV-injected nanoparticles through near-infrared dye labeling and in vivo imaging (IVIS) particle tracking in a rat hindlimb ischemia model. Polymer peptide amphiphilic nanoparticles were synthesized and optimized for both MMP cleavage efficiency and near-IR fluorescence. Nanoparticles were injected 4 days after unilateral hindlimb ischemia and were monitored over 28 days using IVIS imaging. Nanoparticles targeted to ischemic muscle over healthy muscle, and ex vivo biodistribution analysis at 7 and 28 days post-injection confirmed targeting to the ischemic muscle as well as off target accumulation in the liver and spleen. Ex vivo histology confirmed particle localization in ischemic but not healthy muscle. Altering the surface charge of the nanoparticles through addition of zwitterionic dye species resulted in improved targeting to the ischemic muscle. To our knowledge, this is the first study to demonstrate the targeted delivery and long term retention of nanoparticles using an enzyme-directed morphology switch. This has implications for noninvasive drug delivery vehicles for treating ischemic muscle, as no minimally invasive, non-surgical options currently exist.
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Affiliation(s)
- J L Ungerleider
- Department of Bioengineering, Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA, USA 92037
| | - J K Kammeyer
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, USA 92093
| | - R L Braden
- Department of Bioengineering, Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA, USA 92037
| | - K L Christman
- Department of Bioengineering, Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA, USA 92037
| | - N C Gianneschi
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, USA 92093
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Afzal N, Sohn S, Abram S, Scott CG, Chaudhry R, Liu H, Kullo IJ, Arruda-Olson AM. Mining peripheral arterial disease cases from narrative clinical notes using natural language processing. J Vasc Surg 2017; 65:1753-1761. [PMID: 28189359 PMCID: PMC5438905 DOI: 10.1016/j.jvs.2016.11.031] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Lower extremity peripheral arterial disease (PAD) is highly prevalent and affects millions of individuals worldwide. We developed a natural language processing (NLP) system for automated ascertainment of PAD cases from clinical narrative notes and compared the performance of the NLP algorithm with billing code algorithms, using ankle-brachial index test results as the gold standard. METHODS We compared the performance of the NLP algorithm to (1) results of gold standard ankle-brachial index; (2) previously validated algorithms based on relevant International Classification of Diseases, Ninth Revision diagnostic codes (simple model); and (3) a combination of International Classification of Diseases, Ninth Revision codes with procedural codes (full model). A dataset of 1569 patients with PAD and controls was randomly divided into training (n = 935) and testing (n = 634) subsets. RESULTS We iteratively refined the NLP algorithm in the training set including narrative note sections, note types, and service types, to maximize its accuracy. In the testing dataset, when compared with both simple and full models, the NLP algorithm had better accuracy (NLP, 91.8%; full model, 81.8%; simple model, 83%; P < .001), positive predictive value (NLP, 92.9%; full model, 74.3%; simple model, 79.9%; P < .001), and specificity (NLP, 92.5%; full model, 64.2%; simple model, 75.9%; P < .001). CONCLUSIONS A knowledge-driven NLP algorithm for automatic ascertainment of PAD cases from clinical notes had greater accuracy than billing code algorithms. Our findings highlight the potential of NLP tools for rapid and efficient ascertainment of PAD cases from electronic health records to facilitate clinical investigation and eventually improve care by clinical decision support.
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Affiliation(s)
- Naveed Afzal
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Sunghwan Sohn
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Sara Abram
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | | | - Rajeev Chaudhry
- Division of Primary Care Medicine, Knowledge Delivery Center and Center for Innovation, Mayo Clinic, Rochester, Minn
| | - Hongfang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Iftikhar J Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
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WOCN 2016 Guideline for Prevention and Management of Pressure Injuries (Ulcers). J Wound Ostomy Continence Nurs 2017; 44:241-246. [DOI: 10.1097/won.0000000000000321] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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López Espada C, Barreiro Veiguela J, Bellmunt Montoya S, Blanco Cañibano E, Florit López S, Morata Barrado C. Indicadores de calidad en patología vascular: estudio piloto multicéntrico nacional. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2015.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rich MW, Chyun DA, Skolnick AH, Alexander KP, Forman DE, Kitzman DW, Maurer MS, McClurken JB, Resnick BM, Shen WK, Tirschwell DL. Knowledge Gaps in Cardiovascular Care of the Older Adult Population: A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society. J Am Coll Cardiol 2016; 67:2419-2440. [PMID: 27079335 PMCID: PMC7733163 DOI: 10.1016/j.jacc.2016.03.004] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease is the leading cause of death and major disability in adults ≥75 years of age; however, despite the large impact of cardiovascular disease on quality of life, morbidity, and mortality in older adults, patients aged ≥75 years have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older patients with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in a nursing home or assisted living facility. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older patients typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence-based decision making, and recommend future research to close existing knowledge gaps. To achieve these objectives, we conducted a detailed review of current American College of Cardiology/American Heart Association and American Stroke Association guidelines to identify content and recommendations that explicitly targeted older patients. We found that there is a pervasive lack of evidence to guide clinical decision making in older patients with cardiovascular disease, as well as a paucity of data on the impact of diagnostic and therapeutic interventions on key outcomes that are particularly important to older patients, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population-based studies and clinical trials that include a broad spectrum of older patients representative of those seen in clinical practice and that incorporate relevant outcomes important to older patients in the study design. The results of these studies will provide the foundation for future evidence-based guidelines applicable to older patients, thereby enhancing patient-centered evidence-based care of older people with cardiovascular disease in the United States and around the world.
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Barriocanal AM, López A, Monreal M, Montané E. Quality assessment of peripheral artery disease clinical guidelines. J Vasc Surg 2016; 63:1091-8. [DOI: 10.1016/j.jvs.2015.12.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
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Peripheral arterial disease (PAD) assessed by ankle-brachial index in patients with established cardiovascular disease or at least one risk factor for atherosclerosis. Indian J Thorac Cardiovasc Surg 2016. [DOI: 10.1007/s12055-015-0415-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Abstract
Number of patients with peripheral arterial disease, despite various national public health programs, remains high and has no steady downward trend over the past few decades. Despite recent advances in drug therapy, сonservative approach in the management of peripheral arterial disease is often neglected by vascular surgeons. However, vast majority of patients with intermittent claudication, who receive comprehensive conservative treatment, including risk factor modification, exercise and drug therapy, may get significant improvement in quality of life by partial or complete relief of symptoms related to the disease. Patients strictly adhering to medical recommendations has favorable prognosis and progression of disease to the stage of critical limb ischemia is very unlikely. Noncompliant patients and those who continue smoking in particular, often experience progression of symptoms related to the disease. That may result in the need for surgical intervention aiming to prevent or delay the onset of critical limb ischemia.
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Affiliation(s)
- T H Gamzatov
- Sokolov's Hospital #122 of the Federal Medical and Biological Agency
| | - A V Svetlikov
- Sokolov's Hospital #122 of the Federal Medical and Biological Agency
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Cooke JP, Losordo DW. Modulating the vascular response to limb ischemia: angiogenic and cell therapies. Circ Res 2015; 116:1561-78. [PMID: 25908729 PMCID: PMC4869986 DOI: 10.1161/circresaha.115.303565] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/31/2015] [Indexed: 12/29/2022]
Abstract
The age-adjusted prevalence of peripheral arterial disease in the US population has been estimated to approach 12%. The clinical consequences of occlusive peripheral arterial disease include pain on walking (claudication), pain at rest, and loss of tissue integrity in the distal limbs; the latter may ultimately lead to amputation of a portion of the lower extremity. Surgical bypass techniques and percutaneous catheter-based interventions may successfully reperfuse the limbs of certain patients with peripheral arterial disease. In many patients, however, the anatomic extent and distribution of arterial occlusion is too severe to permit relief of pain and healing of ischemic ulcers. No effective medical therapy is available for the treatment of such patients, for many of whom amputation represents the only hope for alleviation of symptoms. The ultimate failure of medical treatment and procedural revascularization in significant numbers of patients has led to attempts to develop alternative therapies for ischemic disease. These strategies include administration of angiogenic cytokines, either as recombinant protein or as gene therapy, and more recently, to investigations of stem/progenitor cell therapy. The purpose of this review is to provide an outline of the preclinical basis for angiogenic and stem cell therapies, review the clinical research that has been done, summarize the lessons learned, identify gaps in knowledge, and suggest a course toward successfully addressing an unmet medical need in a large and growing patient population.
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Affiliation(s)
- John P Cooke
- From the Department of Cardiovascular Sciences, Houston Methodist Research Institute, TX (J.P.C.); and NeoStem Inc, New York, NY (D.W.L.).
| | - Douglas W Losordo
- From the Department of Cardiovascular Sciences, Houston Methodist Research Institute, TX (J.P.C.); and NeoStem Inc, New York, NY (D.W.L.).
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Murphy TP, Cutlip DE, Regensteiner JG, Mohler ER, Cohen DJ, Reynolds MR, Massaro JM, Lewis BA, Cerezo J, Oldenburg NC, Thum CC, Jaff MR, Comerota AJ, Steffes MW, Abrahamsen IH, Goldberg S, Hirsch AT. Supervised exercise, stent revascularization, or medical therapy for claudication due to aortoiliac peripheral artery disease: the CLEVER study. J Am Coll Cardiol 2015; 65:999-1009. [PMID: 25766947 PMCID: PMC5278564 DOI: 10.1016/j.jacc.2014.12.043] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 12/10/2014] [Accepted: 12/16/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Treatment for claudication that is due to aortoiliac peripheral artery disease (PAD) often relies on stent revascularization (ST). However, supervised exercise (SE) is known to provide comparable short-term (6-month) improvements in functional status and quality of life. Longer-term outcomes are not known. OBJECTIVES The goal of this study was to report the longer-term (18-month) efficacy of SE compared with ST and optimal medical care (OMC). METHODS Of 111 patients with aortoiliac PAD randomly assigned to receive OMC, OMC plus SE, or OMC plus ST, 79 completed the 18-month clinical and treadmill follow-up assessment. SE consisted of 6 months of SE and an additional year of telephone-based exercise counseling. Primary clinical outcomes included objective treadmill-based walking performance and subjective quality of life. RESULTS Peak walking time improved from baseline to 18 months for both SE (5.0 ± 5.4 min) and ST (3.2 ± 4.7 min) significantly more than for OMC (0.2 ± 2.1 min; p < 0.001 and p = 0.04, respectively). The difference between SE and ST was not significant (p = 0.16). Improvement in claudication onset time was greater for SE compared with OMC, but not for ST compared with OMC. Many disease-specific quality-of-life scales demonstrated durable improvements that were greater for ST compared with SE or OMC. CONCLUSIONS Both SE and ST had better 18-month outcomes than OMC. SE and ST provided comparable durable improvement in functional status and in quality of life up to 18 months. The durability of claudication exercise interventions merits its consideration as a primary PAD claudication treatment.
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Affiliation(s)
- Timothy P Murphy
- Department of Diagnostic Imaging, Vascular Disease Research Center, Rhode Island Hospital, Providence, Rhode Island.
| | - Donald E Cutlip
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Clinical Research Institute, Boston, Massachusetts
| | - Judith G Regensteiner
- University of Colorado School of Medicine-Aurora, Center for Women's Health Research, Aurora, Colorado
| | - Emile R Mohler
- Section of Vascular Medicine, Cardiovascular Division at Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Cohen
- Division of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Joseph M Massaro
- Harvard Clinical Research Institute, Boston, Massachusetts; Department of Biostatistics, Boston University, Boston, Massachusetts
| | - Beth A Lewis
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Joselyn Cerezo
- Department of Diagnostic Imaging, Vascular Disease Research Center, Rhode Island Hospital, Providence, Rhode Island
| | - Niki C Oldenburg
- Lillehei Heart Institute, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Claudia C Thum
- Harvard Clinical Research Institute, Boston, Massachusetts
| | - Michael R Jaff
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Michael W Steffes
- Lillehei Heart Institute, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | | | - Alan T Hirsch
- Lillehei Heart Institute, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
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Reynolds MR, Apruzzese P, Galper BZ, Murphy TP, Hirsch AT, Cutlip DE, Mohler ER, Regensteiner JG, Cohen DJ. Cost-effectiveness of supervised exercise, stenting, and optimal medical care for claudication: results from the Claudication: Exercise Versus Endoluminal Revascularization (CLEVER) trial. J Am Heart Assoc 2014; 3:e001233. [PMID: 25389284 PMCID: PMC4338709 DOI: 10.1161/jaha.114.001233] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/08/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Both supervised exercise (SE) and stenting (ST) improve functional status, symptoms, and quality of life compared with optimal medical care (OMC) in patients with claudication. The relative cost-effectiveness of these strategies is not well defined. METHODS AND RESULTS The Claudication: Exercise Versus Endoluminal Revascularization (CLEVER) study randomized patients with claudication due to aortoiliac stenosis to a 6-month SE program, to ST, or to OMC. Participants who completed 6-month follow-up (n=98) were included in a health economic analysis through 18 months. Costs were assessed using resource-based methods and hospital billing data. Quality-adjusted life-years were estimated using the EQ-5D. Markov modeling based on the in-trial results was used to explore the impact of assumptions about the longer term durability of observed differences in quality of life. Through 18 months, mean healthcare costs were $5178, $9804, and $14 590 per patient for OMC, SE, and ST, respectively. Measured quality-adjusted life-years through 18 months were 1.04, 1.16, and 1.20. In our base case analysis, which assumed that observed differences in quality of life would dissipate after 5 years, the incremental cost-effectiveness ratios were $24 070 per quality-adjusted life-year gained for SE versus OMC, $41 376 for ST versus OMC, and $122 600 for ST versus SE. If the treatment effect of ST was assumed to be more durable than that of SE, the incremental cost-effectiveness ratio for ST versus SE became more favorable. CONCLUSIONS Both SE and ST are economically attractive by US standards relative to OMC for the treatment of claudication in patients with aortoiliac disease. ST is more expensive than SE, with uncertain incremental benefit. CLINICAL TRIAL REGISTRATION URL www.clinicaltrials.gov, Unique identifier: NCT00132743.
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Affiliation(s)
| | | | | | | | | | | | - Emile R. Mohler
- Division of Cardiovascular Disease, Section of Vascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (E.R.M.)
| | | | - David J. Cohen
- Saint‐Luke's Mid America Heart Institute, University of Missouri‐Kansas City School of Medicine, Kansas City, MO (D.J.C.)
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Association of the thickness of carotid intima-media complex and ancle brachial index with coronary disease severity. Open Med (Wars) 2014. [DOI: 10.2478/s11536-013-0309-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
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35
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Implementation of a “real-world” learning health care system: Washington state's Comparative Effectiveness Research Translation Network (CERTAIN). Surgery 2014; 155:860-6. [DOI: 10.1016/j.surg.2014.01.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 01/27/2014] [Indexed: 12/31/2022]
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Feuerstein JD, Akbari M, Gifford AE, Hurley CM, Leffler DA, Sheth SG, Cheifetz AS. Systematic analysis underlying the quality of the scientific evidence and conflicts of interest in interventional medicine subspecialty guidelines. Mayo Clin Proc 2014; 89:16-24. [PMID: 24388018 DOI: 10.1016/j.mayocp.2013.09.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 08/06/2013] [Accepted: 09/03/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the validity of guidelines published by interventional medical societies. METHODS We reviewed the interventional medicine subspecialty society websites of the American Association for Bronchology and Interventional Pulmonology (AABIP), American Society of Diagnostic and Interventional Nephrology (ASDIN), American Society for Gastrointestinal Endoscopy (ASGE), and Society for Cardiovascular Angiography and Interventions (SCAI) as of November 15, 2012, for published interventional guidelines. The study was performed between November 15, 2012, and January 1, 2013. The AABIP did not publish guidelines, so American Thoracic Society and American College of Chest Physicians guidelines were reviewed. All the guidelines were reviewed for graded levels of evidence, methods used to grade the evidence, and disclosures of conflicts of interest (COIs). RESULTS Of 153 interventional guidelines evaluated, 4 were duplicates. Forty-six percent of guidelines (69 of 149) graded the quality of evidence using 7 different methods. The ASGE graded 71% of guidelines (46 of 65) compared with 29% (23 of 78) by the SCAI and 0 by the ASDIN (n=4) and the pulmonary societies (n=2). Of the 3425 recommendations reviewed, 11% (n=364) were supported by level A, 42% (n=1432) by level B, and 48% (n=1629) by level C. The mean age of the guidelines was 5.2 years. Additionally, 62% of the guidelines (92 of 149) failed to comment on COIs; when disclosed, 91% of guidelines (52 of 57) reported COIs. In total, 1827 COIs were reported by 45% of the authors (317 of 697), averaging 5.8 COIs per author. CONCLUSION Most of the interventional guidelines failed to grade the evidence. When present, most guidelines used lower-quality evidence. Furthermore, most guidelines failed to disclose COIs. When commented on, numerous COIs were present. Future guidelines should clearly state the quality of evidence, use a standard grading system, be transparent regarding potential biases, and provide frequent updates.
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Affiliation(s)
- Joseph D Feuerstein
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Mona Akbari
- Department of Medicine and Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Anne E Gifford
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Christine M Hurley
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Daniel A Leffler
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sunil G Sheth
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Adam S Cheifetz
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Takada K, Ishikawa S, Yokoyama N, Hosogoe N, Isshiki T. Effects of Eicosapentaenoic Acid on Platelet Function in Patients Taking Long-Term Aspirin Following Coronary Stent Implantation. Int Heart J 2014; 55:228-33. [DOI: 10.1536/ihj.13-295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kaoru Takada
- Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine
| | - Shuichi Ishikawa
- Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine
| | - Naoyuki Yokoyama
- Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine
| | - Naoyoshi Hosogoe
- Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine
| | - Takaaki Isshiki
- Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine
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Missed Opportunities. TOPICS IN GERIATRIC REHABILITATION 2013. [DOI: 10.1097/tgr.0b013e31828aa360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rocha-Singh KJ, Jaff M, Joye J, Laird J, Ansel G, Schneider P. Major adverse limb events and wound healing following infrapopliteal artery stent implantation in patients with critical limb ischemia: The XCELL trial. Catheter Cardiovasc Interv 2012; 80:1042-51. [DOI: 10.1002/ccd.24485] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 04/11/2012] [Accepted: 05/12/2012] [Indexed: 11/12/2022]
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Structural and biochemical characteristics of arterial stiffness in patients with atherosclerosis and in healthy subjects. Hypertens Res 2012; 35:1032-7. [PMID: 22739422 DOI: 10.1038/hr.2012.88] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Arterial stiffness is an independent predictor of vascular morbidity and mortality in patients with atherosclerosis. Angiographic score (ASc) reflects severity of atherosclerosis in patients with peripheral arterial disease (PAD). Osteopontin (OPN) and oxidized low-density lipoprotein (oxLDL) are involved in the pathogenesis of atherosclerosis. The aim of the present study was to evaluate the association between arterial stiffness, ASc, serum OPN and oxLDL in patients with symptomatic PAD, and in clinically healthy subjects. We studied 79 men with symptomatic PAD (mean age 64±7 years) and 84 healthy men (mean age 63±8 years). Calculation of the ASc was based on severity and location of atherosclerotic lesions in the arteries of the lower extremities. Aortic pulse wave velocity (aPWV) was evaluated by applanation tonometry using the Sphygmocor device. Serum OPN and oxLDL levels were determined by enzyme-linked immunosorbent assay. The aPWV (10±2.4 vs. 8.4±1.7 (m s(-1)); P<0.001), OPN (75 (62.3-85.8) vs. 54.8 (47.7-67.9) (ng ml(-1)); P<0.001) and oxLDL (67 (52.5-93.5) vs. 47.5 (37-65.5); P<0.001) were different for the patients and for the controls. In multiple regression models, aPWV was independently determined by ASc, log-OPN, log-oxLDL and estimated glomerular filtration rate in the patients (R2=0.44; P<0.001) and by log-OPN, log-oxLDL, age and heart rate in the controls (R2=0.38; P<0.001). The independent relationship of a PWV with serum levels of OPN and oxLDL in the patients with PAD and in the controls indicates that OPN and oxLDL might influence arterial stiffening in patients with atherosclerosis and in clinically healthy subjects.
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Eraso LH, Fukaya E, Mohler ER, Xie D, Sha D, Berger JS. Peripheral arterial disease, prevalence and cumulative risk factor profile analysis. Eur J Prev Cardiol 2012; 21:704-11. [PMID: 22739687 DOI: 10.1177/2047487312452968] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The primary aim of the present study was to determine the cumulative effect of a set of peripheral artery disease (PAD) risk factors among age, gender and race/ethnicity groups in the United States. METHODS We examined data from a nationally representative sample of the US population (National Health and Nutrition Examination Survey [NHANES], 1999-2004). A total of 7058 subjects 40 years or older that completed the interview, medical examination and had ankle-brachial index (ABI) measurements were included in this study. RESULTS The age- and sex-standardized prevalence of PAD was 4.6 % (standard error [SE] 0.3%).The highest prevalence of PAD was observed among elderly, non-Hispanic Blacks and women. In a multivariable age-, gender- and race/ethnicity-adjusted model hypertension, diabetes, chronic kidney disease, and smoking were retained as PAD risk factors (p ≤ 0.05 for each). The odds of PAD increased with each additional risk factor present from a non-significant 1.5-fold increase (O.R 1.5, 95% confidence interval [CI] 0.9-2.6) in the presence of one risk factor, to more than ten-fold (OR 10.2, 95% CI 6.4-16.3) in the presence of three or more risk factors. In stratified analysis, non-Hispanic Blacks (OR 14.7, 95% CI 2.1-104.1) and women (OR 18.6, 95% CI 7.1-48.7) were particularly sensitive to this cumulative effect. CONCLUSION In a large nationally representative sample, an aggregate set of risk factors that included diabetes mellitus, chronic kidney disease, hypertension and smoking significantly increase the likelihood of prevalent PAD. A cumulative risk factor analysis highlights important susceptibility differences among different population groups and provides additional evidence to redefine screening strategies in PAD.
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Affiliation(s)
- Luis H Eraso
- Jefferson Vascular Center, Departments of Medicine and Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eri Fukaya
- Cardiovascular Division, Vascular Medicine Section, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Emile R Mohler
- Cardiovascular Division, Vascular Medicine Section, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Dawei Xie
- Departments of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Daohang Sha
- Departments of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Jeffrey S Berger
- Cardiology, Hematology and Vascular Surgery, New York University School of Medicine, New York, NY, USA
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Félix-Redondo FJ, Fernández-Bergés D, Grau M, Baena-Diez JM, Mostaza JM, Vila J. Prevalence and clinical characteristics of peripheral arterial disease in the study population Hermex. Rev Esp Cardiol 2012; 65:726-33. [PMID: 22727799 DOI: 10.1016/j.recesp.2012.03.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 03/05/2012] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES To estimate the prevalence of peripheral arterial disease as measured on ankle-brachial index and evaluate the associated risk, clinical, and diagnostic factors. METHODS Cross-sectional study conducted in a random population-based sample of 2833 individuals aged 25 to 79 years from Don Benito health area (Badajoz). Peripheral arterial disease was considered for ankle-brachial index<0.90. To identify symptomatic disease we used the Edinburgh questionnaire. The current screening recommendations, changes to other categories of estimated coronary risk associated with index measurements, and the association with risk factors were assessed. RESULTS The prevalence of peripheral arterial disease was 3.7% (95% confidence interval, 3.0%-4.5%), 5.0% (3.9%-6.3%) in men and 2.6% (1.8%-3.5%) in women (P=.001). The cumulative prevalence in those aged 50, 60 and 70 years were 6.2%, 9.1%, and 13.1% respectively. The disease was symptomatic in 13.3% (6.8%-19.8%) of cases and 29.6% of asymptomatic patients were not detected as recommended for high-risk groups. The use of ankle-brachial index increased the number of individuals with high coronary risk by 32.7%. Peripheral arterial disease was positively associated with age, smoking, hypercholesterolemia, sedentary lifestyle, microalbuminuria and history of cardiovascular disease, and negatively with alcohol consumption. CONCLUSIONS The use of ankle-brachial index for peripheral arterial disease diagnosis is advisable because of the low prevalence of symptomatic cases and the associated change in estimated coronary risk. Screening groups should be adapted to the Spanish population. Smoking and hypercholesterolemia are major associated risk factors.
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Affiliation(s)
- Francisco J Félix-Redondo
- Centro de Salud Villanueva Norte, Servicio Extremeño de Salud, Villanueva de la Serena, Badajoz, Spain.
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Chesbro SB, Asongwed ET, Brown J, John EB. Reliability of Doppler and stethoscope methods of determining systolic blood pressures: considerations for calculating an ankle-brachial index. J Natl Med Assoc 2012; 103:863-9. [PMID: 22364054 DOI: 10.1016/s0027-9684(15)30441-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The purposes of this study were to: (1) identify the interrater and intrarater reliability of systolic blood pressures using a stethoscope and Doppler to determine an ankle-brachial index (ABI), and (2) to determine the correlation between the 2 methods. BACKGROUND Peripheral arterial disease (PAD) affects approximately 8 to 12 million people in the United States, and nearly half of those with this disease are asymptomatic. Early detection and prompt treatment of PAD will improve health outcomes. It is important that clinicians perform tests that determine the presence of PAD. METHOD Two individual raters trained in ABI procedure measured the systolic blood pressures of 20 individuals' upper and lower extremities. Standard ABI measurement protocols were observed. Raters individually recorded the systolic blood pressures of each extremity using a stethoscope and a Doppler, for a total of 640 independent measures. RESULTS Interrater reliability of Doppler measurements to determine SBP at the ankle was very strong (intraclass correlation coefficient [ICC], 0.93-0.99) compared to moderate to strong reliability using a stethoscope (ICC, 0.64-0.87). Agreement between the 2 devices to determine SBP was moderate to very weak (ICC, 0.13-0.61). Comparisons of the use of Doppler and stethoscope to determine ABI showed weak to very weak intrarater correlation (ICC, 0.17-0.35). Linear regression analysis of the 2 methods to determine ABI showed positive but weak to very weak correlations (r2 = .013, P = .184). CONCLUSIONS A Doppler ultrasound is recommended over a stethoscope for accuracy in systolic pressure readings for ABI measurements.
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Affiliation(s)
- Steven B Chesbro
- Alabama State University, Department of Physical Therapy, 915 S Jackson St, Montgomery, AL 36101, USA.
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Dogan MI, Tasci I, Bulucu F, Aydogdu A, Acar R, Ceyhan T, Koc B, Demir O, Gezer M, Sağlam K. Abdominal Obesity is Associated With a Lower Ankle–Brachial Index in Women With Polycystic Ovary Syndrome. Angiology 2012; 64:105-11. [DOI: 10.1177/0003319711436248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ilker Tasci
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Fatih Bulucu
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Aydogan Aydogdu
- Department of Endocrinology and Metabolism, Gulhane School of Medicine, Ankara, Turkey
| | - Ramazan Acar
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Temel Ceyhan
- Department of Obstetrics and Gynecology, Gulhane School of Medicine, Ankara, Turkey
| | - Bayram Koc
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Orhan Demir
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Mustafa Gezer
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Kenan Sağlam
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
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Schwarcz AI, Quijano A, Olin JW, Ostfeld RJ. Internal Medicine Interns Have a Poor Knowledge of Peripheral Artery Disease. Angiology 2012; 63:597-602. [DOI: 10.1177/0003319711435148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Peripheral arterial disease (PAD) is common and carries an increased risk of morbidity and mortality. The level of knowledge among incoming medical trainees about PAD is unknown. During orientation to a single internal medicine residency program, incoming medical interns were given a 19-question multiple-choice questionnaire. The questions fell into 1 of 4 categories about PAD: (1) prevalence, (2) screening, (3) treatment, and (4) outcome. Sixty-two incoming interns were queried. The percentage of questions answered correctly overall was 41.7% (10.5%-73.7%). The percentage of questions answered correctly in the prevalence, screening, treatment, and outcome groups were 48.9% (0 to 100%), 33.8% (0 to 80%), 45.0% (0 to 87.5%), and 42.5% (0 to 100%), respectively. Internal medicine interns have poor knowledge about PAD including its prevalence, screening, treatment, and outcomes. Increased education during medical school is encouraged.
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Affiliation(s)
- Aron I. Schwarcz
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Aimee Quijano
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Jeffrey W. Olin
- Zena and Michael A. Wiener Cardiovascular Institute & Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY, USA
| | - Robert J. Ostfeld
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
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Murabito JM, White CC, Kavousi M, Sun YV, Feitosa MF, Nambi V, Lamina C, Schillert A, Coassin S, Bis JC, Broer L, Crawford DC, Franceschini N, Frikke-Schmidt R, Haun M, Holewijn S, Huffman JE, Hwang SJ, Kiechl S, Kollerits B, Montasser ME, Nolte IM, Rudock ME, Senft A, Teumer A, van der Harst P, Vitart V, Waite LL, Wood AR, Wassel CL, Absher DM, Allison MA, Amin N, Arnold A, Asselbergs FW, Aulchenko Y, Bandinelli S, Barbalic M, Boban M, Brown-Gentry K, Couper DJ, Criqui MH, Dehghan A, Heijer MD, Dieplinger B, Ding J, Dörr M, Espinola-Klein C, Felix SB, Ferrucci L, Folsom AR, Fraedrich G, Gibson Q, Goodloe R, Gunjaca G, Haltmayer M, Heiss G, Hofman A, Kieback A, Kiemeney LA, Kolcic I, Kullo IJ, Kritchevsky SB, Lackner KJ, Li X, Lieb W, Lohman K, Meisinger C, Melzer D, Mohler ER, Mudnic I, Mueller T, Navis G, Oberhollenzer F, Olin JW, O’Connell J, O’Donnell CJ, Palmas W, Penninx BW, Petersmann A, Polasek O, Psaty BM, Rantner B, Rice K, Rivadeneira F, Rotter JI, Seldenrijk A, Stadler M, Summerer M, Tanaka T, Tybjaerg-Hansen A, Uitterlinden AG, van Gilst WH, Vermeulen SH, Wild SH, Wild PS, Willeit J, Zeller T, Zemunik T, Zgaga L, Assimes TL, Blankenberg S, Boerwinkle E, Campbell H, Cooke JP, de Graaf J, Herrington D, Kardia SLR, Mitchell BD, Murray A, Münzel T, Newman A, Oostra BA, Rudan I, Shuldiner AR, Snieder H, van Duijn CM, Völker U, Wright AF, Wichmann HE, Wilson JF, Witteman JC, Liu Y, Hayward C, Borecki IB, Ziegler A, North KE, Cupples LA, Kronenberg F. Association between chromosome 9p21 variants and the ankle-brachial index identified by a meta-analysis of 21 genome-wide association studies. CIRCULATION. CARDIOVASCULAR GENETICS 2012; 5:100-12. [PMID: 22199011 PMCID: PMC3303225 DOI: 10.1161/circgenetics.111.961292] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Genetic determinants of peripheral arterial disease (PAD) remain largely unknown. To identify genetic variants associated with the ankle-brachial index (ABI), a noninvasive measure of PAD, we conducted a meta-analysis of genome-wide association study data from 21 population-based cohorts. METHODS AND RESULTS Continuous ABI and PAD (ABI ≤0.9) phenotypes adjusted for age and sex were examined. Each study conducted genotyping and imputed data to the ≈2.5 million single nucleotide polymorphisms (SNPs) in HapMap. Linear and logistic regression models were used to test each SNP for association with ABI and PAD using additive genetic models. Study-specific data were combined using fixed effects inverse variance weighted meta-analyses. There were a total of 41 692 participants of European ancestry (≈60% women, mean ABI 1.02 to 1.19), including 3409 participants with PAD and with genome-wide association study data available. In the discovery meta-analysis, rs10757269 on chromosome 9 near CDKN2B had the strongest association with ABI (β=-0.006, P=2.46×10(-8)). We sought replication of the 6 strongest SNP associations in 5 population-based studies and 3 clinical samples (n=16 717). The association for rs10757269 strengthened in the combined discovery and replication analysis (P=2.65×10(-9)). No other SNP associations for ABI or PAD achieved genome-wide significance. However, 2 previously reported candidate genes for PAD and 1 SNP associated with coronary artery disease were associated with ABI: DAB21P (rs13290547, P=3.6×10(-5)), CYBA (rs3794624, P=6.3×10(-5)), and rs1122608 (LDLR, P=0.0026). CONCLUSIONS Genome-wide association studies in more than 40 000 individuals identified 1 genome wide significant association on chromosome 9p21 with ABI. Two candidate genes for PAD and 1 SNP for coronary artery disease are associated with ABI.
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Affiliation(s)
- Joanne M. Murabito
- NHLBI’s Framingham Heart Study, Framingham
- Dept of Med, Section of Gen Internal Med, BU School of Med
| | | | - Maryam Kavousi
- Dept of Epidemiology, Erasmus Univ Med Ctr
- Netherlands Genomics Initiative (NGI)-Sponsored Netherlands Consortium for Hlthy Aging (NCHA) & Ctr for Med Systems Biology, Rotterdam, the Netherlands
| | - Yan V. Sun
- Dept of Epidemiology, Emory Univ School of Public Hlth, Atlanta, GA
| | - Mary F. Feitosa
- Statistical Genomics, Dept of Genetics, Washington Univ School of Med, St. Louis, MO
| | - Vijay Nambi
- Dept of Atherosclerosis & Vascular Med, BCM, Houston, TX
| | - Claudia Lamina
- Genetic Epidemiology, Dept of Med Genetics, Molecular & Clin Pharmacology, Innsbruck Med Univ, Innsbruck, Austria
| | | | - Stefan Coassin
- Genetic Epidemiology, Dept of Med Genetics, Molecular & Clin Pharmacology, Innsbruck Med Univ, Innsbruck, Austria
| | - Joshua C. Bis
- Cardiovascular Hlth Rsrch Unit, Dept of Med, Univ of Washington, Seattle, WA
| | - Linda Broer
- Dept of Epidemiology, Erasmus Univ Med Ctr
- Netherlands Genomics Initiative (NGI)-Sponsored Netherlands Consortium for Hlthy Aging (NCHA) & Ctr for Med Systems Biology, Rotterdam, the Netherlands
| | - Dana C. Crawford
- Dept of Molecular Physiology & Biophysics, The Ctr for Human Genetics Rsrch, Vanderbilt Univ, Nashville, TN
| | - Nora Franceschini
- Dept of Epidemiology, UNC Gillings School of Global Public Hlth, The Univ of North Carolina, Chapel Hill, NC
| | - Ruth Frikke-Schmidt
- Dept of Clin Biochemistry, Rigshospitalet, Copenhagen Univ Hosp, Copenhagen, Denmark
| | - Margot Haun
- Genetic Epidemiology, Dept of Med Genetics, Molecular & Clin Pharmacology, Innsbruck Med Univ, Innsbruck, Austria
| | - Suzanne Holewijn
- Dept of Gen Internal Med, Vascular Med, Radboud Univ Nijmegen Med Ctr, Nijmegen, The Netherlands
| | - Jennifer E. Huffman
- MRC Human Genetics Unit, Inst of Genetics & Molecular Med, Western Gen Hosp, Edinburgh, Scotland, UK
| | | | - Stefan Kiechl
- Dept of Neurology, Innsbruck Med Univ, Innsbruck, Austria
| | - Barbara Kollerits
- Genetic Epidemiology, Dept of Med Genetics, Molecular & Clin Pharmacology, Innsbruck Med Univ, Innsbruck, Austria
| | - May E. Montasser
- Endocrinology, Dept of Med, Univ of Maryland School of Med, Baltimore, MD
| | - Ilja M. Nolte
- Unit of Gen Epidemiology & Bioinformatics, Dept of Epidemiology, Univ Med Ctr Groningen, Univ of Groningen, Groningen, The Netherlands
| | - Megan E. Rudock
- Dept of Epidemiology & Prevention, Wake Forest Univ School of Med, Winston-Salem, NC
| | - Andrea Senft
- Institut für Med Biometrie & Statistik, Univ zu Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Alexander Teumer
- Interfaculty Inst for Genetics & Functional Genomics, Ernst-Moritz-Arndt-Univ Greifswald, Greifswald, Germany
| | - Pim van der Harst
- Dept of Cardiology, Univ Med Ctr Groningen, Univ of Groningen, Groningen, The Netherlands
- Dept of Genetics, Univ Med Ctr Groningen, Univ of Groningen, Groningen, The Netherlands
| | - Veronique Vitart
- MRC Human Genetics Unit, Inst of Genetics & Molecular Med, Western Gen Hosp, Edinburgh, Scotland, UK
| | | | - Andrew R. Wood
- Genetics of Complex Traits, Peninsula College of Med & Dentistry, Univ of Exeter, UK
| | | | | | - Matthew A. Allison
- Dept of Family & Preventive Med, UC San Diego, Preventive Med, La Jolla, CA
| | - Najaf Amin
- Dept of Epidemiology, Erasmus Univ Med Ctr
| | - Alice Arnold
- Dept of Biostatistics, Univ of Washington, Seattle, WA
| | - Folkert W. Asselbergs
- Dept of Cardiology, Heart & Lungs, Univ Med Ctr Utrecht, Utrecht, The Netherlands
- Julius Ctr for Hlth Sciences & Primary Care, Univ Med Ctr, Utrecht, The Netherlands
- Dept of Med Genetics, Biomedical Genetics, Univ Med Ctr, Utrecht, The Netherlands
| | | | - Stefania Bandinelli
- Geriatric Rehabilitation Unit, Azienda Sanitaria di Firenze, Florence, Italy
| | - Maja Barbalic
- Univ of Texas Hlth Science Ctr at Houston, Dept of Epidemiology, Human Genetics & Environmental Sciences, Houston, TX
| | | | | | | | - Michael H. Criqui
- Dept of Family & Preventive Med, UC San Diego, Preventive Med, La Jolla, CA
| | - Abbas Dehghan
- Dept of Epidemiology, Erasmus Univ Med Ctr
- Netherlands Genomics Initiative (NGI)-Sponsored Netherlands Consortium for Hlthy Aging (NCHA) & Ctr for Med Systems Biology, Rotterdam, the Netherlands
| | - Martin den Heijer
- Dept of Endocrinology & Epidemiology, Biostatistics & HTA, Radboud Univ Nijmegen Med Ctr, Nijmegen, The Netherlands
| | | | - Jingzhong Ding
- Sticht Ctr on Aging, Wake Forest School of Med, Winston-Salem, NC
| | - Marcus Dörr
- Dept of Internal Med B- Cardiology, Angiology & Pneumology & Intensive Care Med, Univ Med, Greifswald
| | | | - Stephan B. Felix
- Dept of Internal Med B- Cardiology, Angiology & Pneumology & Intensive Care Med, Univ Med, Greifswald
| | - Luigi Ferrucci
- Longitudinal Studies Section, Clinical Rsrch Branch, Nat Inst on Aging, NIH, Baltimore, MD
| | - Aaron R. Folsom
- Epidemiology & Community Hlth, School of Public Hlth, Univ of Minnesota, Minneapolis, MN
| | - Gustav Fraedrich
- Dept of Vascular Surgery, Innsbruck Med Univ, Innsbruck, Austria
| | - Quince Gibson
- Endocrinology, Dept of Med, Univ of Maryland School of Med, Baltimore, MD
| | - Robert Goodloe
- The Ctr for Human Genetics Rsrch, Vanderbilt Univ, Nashville, TN
| | | | - Meinhard Haltmayer
- Dept of Lab Med, Konventhospital Barmherzige Brueder Linz, Linz, Austria
| | - Gerardo Heiss
- Dept of Epidemiology, UNC Gillings School of Global Public Hlth, The Univ of North Carolina, Chapel Hill, NC
| | - Albert Hofman
- Dept of Epidemiology, Erasmus Univ Med Ctr
- Netherlands Genomics Initiative (NGI)-Sponsored Netherlands Consortium for Hlthy Aging (NCHA) & Ctr for Med Systems Biology, Rotterdam, the Netherlands
| | - Arne Kieback
- Dept of Internal Med B- Cardiology, Angiology & Pneumology & Intensive Care Med, Univ Med, Greifswald
| | - Lambertus A. Kiemeney
- Dept of Epidemiology, Biostatistics & HTA, Radboud Univ Nijmegen Med Ctr, Nijmegen, The Netherlands
| | - Ivana Kolcic
- Dept of Public Hlth, University of Split School of Med, Croatia
| | - Iftikhar J. Kullo
- Cardiovascular Diseases & the Gonda Vascular Ctr, Mayo Clinic, Rochester, MN
| | | | - Karl J. Lackner
- Dept of Med 2, Univ Med Ctr Mainz, Johannes Gutenberg-Univ Mainz, Germany
| | - Xiaohui Li
- Med Genetics Inst, Cedars-Sinai Med Ctr, Los Angeles, CA
| | - Wolfgang Lieb
- Inst for Community Med, Univ Med Greifswald, Germany
| | - Kurt Lohman
- Dept of Biostatistics, Wake Forest Univ School of Med, Winston-Salem, NC
| | - Christa Meisinger
- Inst of Epidemiology II, Helmholtz Zentrum München, German Rsrch Ctr for Environmental Hlth (GmbH), Neuherberg, Germany
| | - David Melzer
- Dept of Epidemiology & Public Hlth, Peninsula College of Med & Dentistry, Univ of Exeter, UK
| | - Emile R Mohler
- Perelman School of Med at the Univ of Pennsylvania, Cardiovascular Division, Vascular Med Section, Philadelphia, PA
| | | | - Thomas Mueller
- Dept of Lab Med, Konventhospital Barmherzige Brueder Linz, Linz, Austria
| | - Gerjan Navis
- Dept of Internal Med, Univ Med Ctr Groningen, Univ of Groningen, Groningen, Netherlands
| | | | | | - Jeff O’Connell
- Endocrinology, Dept of Med, Univ of Maryland School of Med, Baltimore, MD
| | - Christopher J. O’Donnell
- NHLBI’s Framingham Heart Study, Framingham
- Nat Heart, Lung, & Blood Inst, Intramural Rsrch, Bethesda, MD
| | | | - Brenda W. Penninx
- Dept of Psychiatry/EMGO Inst, VU Univ Med Ctr, Amsterdam
- Dept of Psychiatry, Univ Med Ctr Groningen, Univ of Groningen, Groningen
- Dept of Psychiatry, Leiden Univ Med Ctr, Leiden, The Netherlands
| | | | - Ozren Polasek
- Dept of Public Hlth, University of Split School of Med, Croatia
| | - Bruce M. Psaty
- Cardiovascular Hlth Rsrch Unit, Depts of Med, Epidemiology & Hlth Services, Univ of Washington
- Group Hlth Rsrch Inst, Group Hlth Cooperative, Seattle, WA
| | - Barbara Rantner
- Genetic Epidemiology, Dept of Med Genetics, Molecular & Clin Pharmacology, Innsbruck Med Univ, Innsbruck, Austria
- Dept of Vascular Surgery, Innsbruck Med Univ, Innsbruck, Austria
| | - Ken Rice
- Dept of Biostatistics, Univ of Washington, Seattle, WA
| | - Fernando Rivadeneira
- Dept of Epidemiology, Erasmus Univ Med Ctr
- Netherlands Genomics Initiative (NGI)-Sponsored Netherlands Consortium for Hlthy Aging (NCHA) & Ctr for Med Systems Biology, Rotterdam, the Netherlands
- Dept of Internal Med, Erasmus Univ Med Ctr, Rotterdam, The Netherlands
| | | | | | - Marietta Stadler
- Hietzing Hosp, 3rd Med Dept of Metabolic Diseases & Nephrology, Vienna, Austria
| | - Monika Summerer
- Genetic Epidemiology, Dept of Med Genetics, Molecular & Clin Pharmacology, Innsbruck Med Univ, Innsbruck, Austria
| | | | - Anne Tybjaerg-Hansen
- Dept of Clin Biochemistry, Rigshospitalet, Copenhagen Univ Hosp, Copenhagen, Denmark
| | - Andre G. Uitterlinden
- Dept of Epidemiology, Erasmus Univ Med Ctr
- Netherlands Genomics Initiative (NGI)-Sponsored Netherlands Consortium for Hlthy Aging (NCHA) & Ctr for Med Systems Biology, Rotterdam, the Netherlands
- Dept of Internal Med, Erasmus Univ Med Ctr, Rotterdam, The Netherlands
| | - Wiek H. van Gilst
- Dept of Cardiology, Univ Med Ctr Groningen, Univ of Groningen, Groningen, The Netherlands
| | - Sita H. Vermeulen
- Dept of Epidemiology, Biostatistics & HTA, Radboud Univ Nijmegen Med Ctr, Nijmegen, The Netherlands
| | - Sarah H. Wild
- Ctr for Pop Hlth Sciences, Univ of Edinburgh, Edinburgh, Scotland
| | - Philipp S. Wild
- Dept of Med 2, Univ Med Ctr Mainz, Johannes Gutenberg-Univ Mainz, Germany
- Ctr for Thrombosis & Hemostasis, Univ Med Ctr Mainz, Johannes Gutenberg-Univ Mainz
| | - Johann Willeit
- Dept of Neurology, Innsbruck Med Univ, Innsbruck, Austria
| | - Tanja Zeller
- Clinic for General & Interventional Cardiology, Univ Heart Ctr Hamburg, Hamburg, Germany
| | | | - Lina Zgaga
- Ctr for Pop Hlth Sciences, Univ of Edinburgh, Edinburgh, Scotland
- Andrija Stampar School of Public Health, Med School, Univ of Zagreb, Croatia
| | | | - Stefan Blankenberg
- Clinic for General & Interventional Cardiology, Univ Heart Ctr Hamburg, Hamburg, Germany
| | - Eric Boerwinkle
- Univ of Texas Hlth Science Ctr at Houston, Dept of Epidemiology, Human Genetics & Environmental Sciences, Houston, TX
| | - Harry Campbell
- Ctr for Pop Hlth Sciences, Univ of Edinburgh, Edinburgh, Scotland
| | - John P. Cooke
- Dept of Med, Stanford Univ School of Med, Stanford, CA
| | - Jacqueline de Graaf
- Dept of Gen Internal Med, Vascular Med, Radboud Univ Nijmegen Med Ctr, Nijmegen, The Netherlands
| | - David Herrington
- Dept of Internal Med, Wake Forest Univ School of Med, Winston-Salem, NC
| | | | | | - Anna Murray
- Genetics of Complex Traits, Peninsula College of Med & Dentistry, Univ of Exeter, UK
| | - Thomas Münzel
- Dept of Med 2, Univ Med Ctr Mainz, Johannes Gutenberg-Univ Mainz, Germany
| | - Anne Newman
- Dept of Epidemiology, Graduate School of Public Hlth, Univ of Pittsburgh, PA
| | - Ben A. Oostra
- Dept of Clinical Genetics, Erasmus Med Ctr, Rotterdam, The Netherlands
| | - Igor Rudan
- Ctr for Pop Hlth Sciences, Univ of Edinburgh, Edinburgh, Scotland
- Andrija Stampar School of Public Health, Med School, Univ of Zagreb, Croatia
| | - Alan R. Shuldiner
- Endocrinology, Dept of Med, Univ of Maryland School of Med, Baltimore, MD
- Geriatric Rsrch & Edu Clinical Ctr, VA Med Ctr, Baltimore, MD
| | - Harold Snieder
- Unit of Gen Epidemiology & Bioinformatics, Dept of Epidemiology, Univ Med Ctr Groningen, Univ of Groningen, Groningen, The Netherlands
| | - Cornelia M. van Duijn
- Dept of Epidemiology, Erasmus Univ Med Ctr
- Netherlands Genomics Initiative (NGI)-Sponsored Netherlands Consortium for Hlthy Aging (NCHA) & Ctr for Med Systems Biology, Rotterdam, the Netherlands
| | - Uwe Völker
- Interfaculty Inst for Genetics & Functional Genomics, Ernst-Moritz-Arndt-Univ Greifswald, Greifswald, Germany
| | - Alan F. Wright
- MRC Human Genetics Unit, Inst of Genetics & Molecular Med, Western Gen Hosp, Edinburgh, Scotland, UK
| | - H.-Erich Wichmann
- Inst of Epidemiology I, Helmholtz Zentrum München, German Rsrch Ctr for Environmental Hlth (GmbH), Neuherberg, Germany
| | - James F. Wilson
- Ctr for Pop Hlth Sciences, Univ of Edinburgh, Edinburgh, Scotland
| | - Jacqueline C.M. Witteman
- Dept of Epidemiology, Erasmus Univ Med Ctr
- Netherlands Genomics Initiative (NGI)-Sponsored Netherlands Consortium for Hlthy Aging (NCHA) & Ctr for Med Systems Biology, Rotterdam, the Netherlands
| | - Yongmei Liu
- Dept of Epidemiology & Prevention, Wake Forest Univ School of Med, Winston-Salem, NC
| | - Caroline Hayward
- MRC Human Genetics Unit, Inst of Genetics & Molecular Med, Western Gen Hosp, Edinburgh, Scotland, UK
| | - Ingrid B. Borecki
- Statistical Genomics, Dept of Genetics, Washington Univ School of Med, St. Louis, MO
| | - Andreas Ziegler
- Institut für Med Biometrie & Statistik, Univ zu Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Kari E. North
- Dept of Epidemiology, UNC Gillings School of Global Public Hlth, The Univ of North Carolina, Chapel Hill, NC
- Carolina Ctr for Genome Sciences, School of Public Hlth, UNC-CH, Chapel Hill, NC
| | - L. Adrienne Cupples
- NHLBI’s Framingham Heart Study, Framingham
- Dept of Biostatistics, BU, Boston, MA
| | - Florian Kronenberg
- Genetic Epidemiology, Dept of Med Genetics, Molecular & Clin Pharmacology, Innsbruck Med Univ, Innsbruck, Austria
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Aortic Stiffness and Vitamin D are Independent Markers of Aortic Calcification in Patients with Peripheral Arterial Disease and in Healthy Subjects. Eur J Vasc Endovasc Surg 2011; 42:689-95. [DOI: 10.1016/j.ejvs.2011.07.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 07/22/2011] [Indexed: 11/21/2022]
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Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK, Golzarian J, Gornik HL, Halperin JL, Jaff MR, Moneta GL, Olin JW, Stanley JC, White CJ, White JV, Zierler RE. 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011; 58:2020-45. [PMID: 21963765 DOI: 10.1016/j.jacc.2011.08.023] [Citation(s) in RCA: 462] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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The Current Management of Aortic, Common Iliac, and External Iliac Artery Disease: Basic Data Underlying Clinical Decision Making. Ann Vasc Surg 2011; 25:990-1003. [DOI: 10.1016/j.avsg.2011.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 04/26/2011] [Accepted: 05/15/2011] [Indexed: 10/17/2022]
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