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Sempore WY, Ramondou P, Hersant J, Feuilloy M, Guilleron C, Henni S, Abraham P. Specific slow tests are not mandatory in patients with extremely short standard (3.2 km/hr 10% slope) test durations during exercise oximetry. Clin Physiol Funct Imaging 2020; 40:232-237. [DOI: 10.1111/cpf.12626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/10/2019] [Accepted: 02/23/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Wendsèndaté Yves Sempore
- Department of Vascular Medicine University Hospital Angers Angers France
- Centre Muraz National Institut of Public Health Bobo dioulaso Burkina Faso
| | - Pierre Ramondou
- Department of Vascular Medicine University Hospital Angers Angers France
| | - Jeanne Hersant
- Department of Vascular Medicine University Hospital Angers Angers France
| | | | - Celine Guilleron
- Department of Sports medicine University Hospital Angers Angers France
- Department of Sports Sciences University Le mans Le mans France
| | - Samir Henni
- Department of Vascular Medicine University Hospital Angers Angers France
- UMR Mitovasc CNRS6015‐INSERM 1083 University of Angers Angers France
| | - Pierre Abraham
- Department of Vascular Medicine University Hospital Angers Angers France
- Department of Sports medicine University Hospital Angers Angers France
- UMR Mitovasc CNRS6015‐INSERM 1083 University of Angers Angers France
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Kalinin RE, Suchkov IA, Mzhavanadze ND, Pshennikov AS, Ncheĭe AF. [Current aspects of performing treadmill test in patients with peripheral artery disease]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:25-33. [PMID: 31149988 DOI: 10.33529/angio2019209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The protocols of performing treadmill tests (TMT) in patients presenting with peripheral artery disease have over the last decades undergone significant changes, with the alterations concerning not only the speed and time values of the load, but also the parameters measured. Currently, there is no unified generally accepted method of TMT, hence the need for an optimal protocol for carrying out this type of examination, which would help obtain reliable results in assessment of everyday life functional activity of patients and efficacy of various methods of treatment for peripheral atherosclerosis. The choice of an optimal methodology of performing a TMT in patients with intermittent claudication is extremely important because studying the haemodynamic parameters alone not always clearly reflect functional peculiarities of the course of the disease, since they depend not only on the presence of arterial stenoses or occlusions, but also on the activity of oxidative enzymes, endothelial and mitochondrial dysfunction, taking therapeutic agents, concomitant pathology and a series of other factors. The article is a review of the related literature contained in such databases as the Medline, PubMed, Russian Science Citation Index (RSCI) and Scopus and concerning TMT in patients with peripheral artery disease. The authors summarized the information from a total of 63 literature sources over the period from the 1970s to 2018.
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Affiliation(s)
- R E Kalinin
- Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
| | - I A Suchkov
- Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
| | - N D Mzhavanadze
- Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
| | - A S Pshennikov
- Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
| | - A F Ncheĭe
- Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
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Henni S, Ammi M, Semporé Y, Hersant J, Zegar G, Gourdier AS, Picquet J, Abraham P. Treadmill Measured vs. Questionnaire Estimated Changes in Walking Ability in Patients With Peripheral Artery Disease. Eur J Vasc Endovasc Surg 2019; 57:676-684. [PMID: 30982731 DOI: 10.1016/j.ejvs.2018.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/22/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Determining the maximum walking time (MWT) using the treadmill test is the gold standard method for evaluating walking capacity and treatment effect in patients with peripheral arterial disease (PAD). However, self reported functional disability is important when assessing quality of life. Changes in the Walking Estimated Limitation Calculated by History (WELCH) questionnaire scores were compared with the MWT. METHODS A cross sectional study was performed in patients with intermittent claudication. The treadmill test (3.2 km/h; 10% gradient) and WELCH questionnaire were administered to all patients for objective evaluation of walking capacity. Given the log normal distribution of these parameters in patients with PAD, a log transformation was applied to the WELCH score (LnW) and maximum walking time (LnT). The responsiveness of the WELCH score was determined using mean changes and correlation coefficients of LnW and LnT changes. The effect of time on the "estimated minus real" (E - R) changes (LnW - change minus LnT - change) was assessed after categorisation of patients into various test-retest intervals. Patients who underwent lower limb revascularisation between the two tests and those who underwent medical treatment only were analysed. RESULTS Correlation coefficients between LnW and LnT for tests 1 and 2 were r = 0.514 and r = 0.503, respectively (p < .001, for both). Correlation for LnW change vs. LnT change was 0.384 (p < .001). E - R was positive only early after surgery. E - R was negative for all test-retest intervals >1 year in revascularised and non-revascularised patients. CONCLUSION Changes in WELCH scores correlated with changes observed on the treadmill in patients with intermittent claudication. For long test-retest intervals, WELCH changes tended to overestimate the worsening of walking impairment as compared with the measured difference observed in both revascularised and non-revascularised patients. A shortlived "honeymoon" (overestimation of the benefit for the shortest test-retest interval) was observed only in revascularised patients.
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Affiliation(s)
- Samir Henni
- Vascular Medicine Department, University Hospital Centre of Angers, Angers, France
| | - Myriam Ammi
- Vascular Surgery Department, University Hospital Centre of Angers, Angers, France
| | - Yves Semporé
- Laboratoire de Physiologie, Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Jeanne Hersant
- Vascular Medicine Department, University Hospital Centre of Angers, Angers, France
| | - Geoffrey Zegar
- Vascular Medicine Department, University Hospital Centre of Angers, Angers, France
| | - Anne-Sophie Gourdier
- Vascular Medicine Department, University Hospital Centre of Angers, Angers, France
| | - Jean Picquet
- Vascular Surgery Department, University Hospital Centre of Angers, Angers, France; UMR CNRS 6015, INSERM U1083, Mitovasc Institute, Angers, France
| | - Pierre Abraham
- Vascular Surgery Department, University Hospital Centre of Angers, Angers, France; UMR CNRS 6015, INSERM U1083, Mitovasc Institute, Angers, France.
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Audonnet M, Signolet I, Colas-Ribas C, Ammi M, Abraham P, Henni S. Exercise Transcutaneous Oximetry of the Buttocks ― External Validation With Computed Tomography Angiography ―. Circ J 2017; 81:1123-1128. [DOI: 10.1253/circj.cj-16-1316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Martin Audonnet
- Laboratory for Vascular Investigations, University Hospital of Angers
- Department of Cardiology, University Hospital of Angers
| | - Isabelle Signolet
- Laboratory for Vascular Investigations, University Hospital of Angers
- Biochemistry Laboratory, University Hospital of Angers
| | | | - Myriam Ammi
- Vascular and Cardiothoracic Surgery, University Hospital of Angers
| | - Pierre Abraham
- Laboratory for Vascular Investigations, University Hospital of Angers
- University Nantes Angers Le Mans, Joint Research Unit, National Center for Scientific Research U6015 and National Institute of Health and Medical Research U1083
| | - Samir Henni
- Laboratory for Vascular Investigations, University Hospital of Angers
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Mahe G, Kalra M, Abraham P, Liedl DA, Wennberg PW. Application of exercise transcutaneous oxygen pressure measurements for detection of proximal lower extremity arterial disease: a case report. Vasc Med 2015; 20:251-5. [PMID: 25750011 DOI: 10.1177/1358863x14567030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Proximal claudication is secondary to ischemia caused by peripheral artery disease (PAD), whereas proximal pseudo-claudication is secondary to other disease processes such as hip arthritis, spinal stenosis, neuropathy, and so forth. The differentiation between the two can be challenging. Exercise transcutaneous oxygen pressure measurement (exercise-TcPO2) allows noninvasive detection of flow-reducing lesions in the proximal arteries and tributaries of the lower extremity arterial tree. We present the first case report in the United States using an exercise-TcPO2 algorithm. A 71-year-old diabetic patient with proximal left-sided and right-calf claudication with indeterminate ankle-brachial indices underwent an exercise-TcPO2 study before and after endovascular intervention. Four TcPO2 probes were placed: one at chest level (reference probe), one on each buttock, and one on the symptomatic calf. The Delta from Resting Oxygen Pressure (DROP) index was calculated at each probe site using a previously validated protocol. Proximal left- and right-calf ischemia were confirmed by the initial exercise-TcPO2, and, after endovascular treatment of the left iliac artery lesion, improvements in proximal exercise-TcPO2 values were found. These data suggest that exercise-TcPO2 can be useful in PAD evaluation in patients with non-compressible arteries and/or proximal claudication.
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Affiliation(s)
- Guillaume Mahe
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA INSERM Clinical Investigation Center CIC 1414, Rennes, France
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Pierre Abraham
- Laboratory of Vascular Investigations, University Hospital, Angers, France; and Faculty of Medicine, LUNAM University, Angers, France
| | - David A Liedl
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
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Fouasson-Chailloux A, Abraham P, Vielle B, Laporte I, Omarjee L, Ouedraogo N. The correlation of the "Walking Estimated-Limitation Calculated by History" (WELCH) questionnaire with treadmill maximal walking time is not impaired by age, in patients with claudication. Qual Life Res 2015; 24:1857-64. [PMID: 25578404 DOI: 10.1007/s11136-015-0915-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The "Walking Estimated-Limitation Calculated by History" (WELCH) questionnaire is a short four-item questionnaire that estimates the walking capacity of a patient in comparison with relatives, friends or people the same age. As such, it should be relatively insensitive to age, yet this has never been tested. METHODS A prospective study was performed among 525 patients presenting vascular-type claudication. Patients were grouped into quintiles of age-from quintile 1 for the youngest patients to quintile 5 for the oldest ones. Patients completed a self-administered questionnaire and then had their maximal walking time (MWT) measured on a treadmill. We estimated the coefficient of correlation, the slope and the intercept of the relationship between the WELCH score and the MWT, then the accuracy of a WELCH score under 25 to predict the ability to walk for 5 min on a treadmill. RESULTS The slopes of the relationships and the correlation coefficients were not significantly different in each quintile, but a significant shift in the intercept of regressing lines was found with age. Nevertheless, the accuracy in predicting treadmill results from the WELCH score with a cut-off point of 25 was, respectively, 68.6, 72.4, 80.0, 72.4 and 73.3 % in quintiles 1, 2, 3, 4 and 5 (p = 0.45). CONCLUSIONS The relationship of MWT on a treadmill and the WELCH score is slightly influenced by age, but a score superior to 25 seems to be of equal discriminatory performance in different quintiles of age to predict the ability to walk for 5 min on a treadmill. This makes this cut-off limit of interest for routine use, regardless of age.
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Affiliation(s)
- Alban Fouasson-Chailloux
- CHU Angers, Laboratory for Vascular Investigations, University Hospital, 4 rue Larrey, 49933, Angers Cedex 09, France
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Gernigon M, Le Faucheur A, Noury-Desvaux B, Mahe G, Abraham P. Applicability of global positioning system for the assessment of walking ability in patients with arterial claudication. J Vasc Surg 2014; 60:973-81.e1. [PMID: 24930016 DOI: 10.1016/j.jvs.2014.04.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 04/16/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study determined for the first time the clinical applicability of a global positioning system (GPS)-monitored community-based walking ability assessment in a large cohort of patients with peripheral artery disease (PAD). METHODS A multicenter study was conducted among PAD patients who complained of intermittent claudication. Patients equipped with a GPS device performed a community-based outdoor walk. We determined the number of technically satisfactory GPS recordings (attempt No. 1). Patients with unsatisfactory GPS recordings were asked to perform a second attempt (attempt No. 2). From the satisfactory recordings obtained after attempts No. 1 and No. 2, we analyzed several GPS parameters to provide clinical information on the patients' walking ability. Results are reported as median (interquartile range). RESULTS A total of 218 patients performed an outdoor walk. GPS recordings were technically satisfactory in 185 patients (85%) and in 203 (93%) after attempts No. 1 and No. 2, respectively. The highest measured distance between two stops during community walking was 678 m (IQR, 381-1333 m), whereas self-reported maximal walking distance was 250 m (IQR, 150-400 m; P < .001). Walking speed was 3.6 km/h (IQR, 3.1-3.9 km/h), with few variations during the walk. Among the patients who had to stop during the walk, the stop durations were <10 minutes in all but one individual. CONCLUSIONS GPS is applicable for the nonsupervised multicenter recording of walking ability in the community. In the future, it may facilitate objective community-based assessment of walking ability, allow for the adequate monitoring of home-based walking programs, and for the study of new dimensions of walking in PAD patients with intermittent claudication.
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Affiliation(s)
- Marie Gernigon
- Laboratory for Vascular Investigations, University Hospital, Angers, France; Department of Integrated Neurovascular and Mitochondrial Biology, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR) 1083-Centre National de la Recherche Scientifique (CNRS) UMR 6214, Medical School, University of Angers, Angers, France; Research team "Activité Physique, Corps, Sport et Santé", Institute of Physical Education and Sports Sciences, Université Catholique de l'Ouest (UCO), Les Ponts de Cé, France
| | - Alexis Le Faucheur
- Department of Integrated Neurovascular and Mitochondrial Biology, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR) 1083-Centre National de la Recherche Scientifique (CNRS) UMR 6214, Medical School, University of Angers, Angers, France; Research team "Activité Physique, Corps, Sport et Santé", Institute of Physical Education and Sports Sciences, Université Catholique de l'Ouest (UCO), Les Ponts de Cé, France; Movement, Sport and Health Laboratory, EA 1274, Unité de Formation et de Recherche (UFR) Activités Physiques et Sportives, University of Rennes, Rennes, France; Department of Sport Sciences and Physical Education, École Normale Supérieure de Rennes, Bruz, France; INSERM, Centre d'investigation clinique (CIC) 1414, Rennes, France
| | - Bénédicte Noury-Desvaux
- Department of Integrated Neurovascular and Mitochondrial Biology, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR) 1083-Centre National de la Recherche Scientifique (CNRS) UMR 6214, Medical School, University of Angers, Angers, France; Research team "Activité Physique, Corps, Sport et Santé", Institute of Physical Education and Sports Sciences, Université Catholique de l'Ouest (UCO), Les Ponts de Cé, France
| | - Guillaume Mahe
- Laboratory for Vascular Investigations, University Hospital, Angers, France; Department of Integrated Neurovascular and Mitochondrial Biology, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR) 1083-Centre National de la Recherche Scientifique (CNRS) UMR 6214, Medical School, University of Angers, Angers, France; INSERM, Centre d'investigation clinique (CIC) 1414, Rennes, France; Centre Hospitalier Universitaire Rennes, Imagerie Coeur-Vaisseaux, Rennes, France
| | - Pierre Abraham
- Laboratory for Vascular Investigations, University Hospital, Angers, France; Department of Integrated Neurovascular and Mitochondrial Biology, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR) 1083-Centre National de la Recherche Scientifique (CNRS) UMR 6214, Medical School, University of Angers, Angers, France.
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Abraham P, Godet R, Harbonnier M, Laneelle D, Leftheriotis G, Ouedraogo N. External Validation of the “Walking Estimated Limitation Calculated by History” (WELCH) Questionnaire in Patients with Claudication. Eur J Vasc Endovasc Surg 2014; 47:319-25. [PMID: 24445082 DOI: 10.1016/j.ejvs.2013.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 11/22/2013] [Indexed: 10/26/2022]
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Ouedraogo N, Marchand J, Bondarenko M, Picquet J, Leftheriotis G, Abraham P. Estimation of Running Capacity can Likely be Removed from Questionnaires Estimating Walking Impairment in Patients with Claudication. Eur J Vasc Endovasc Surg 2012; 43:705-10. [DOI: 10.1016/j.ejvs.2012.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 02/08/2012] [Indexed: 11/16/2022]
Affiliation(s)
- N Ouedraogo
- Laboratory for Vascular Investigations, University Hospital, 4 rue Larrey, Angers Cedex 09, France
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Self-reported estimation of usual walking speed improves the performance of questionnaires estimating walking capacity in patients with vascular-type claudication. J Vasc Surg 2011; 54:1360-5. [DOI: 10.1016/j.jvs.2011.05.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/08/2011] [Accepted: 05/20/2011] [Indexed: 11/21/2022]
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Ouedraogo N, Mahe G, Marchand J, Saïdi K, Leftheriotis G, Abraham P. Validation of a new simple questionnaire to “estimate ambulation capacity by history” (EACH) in patients with claudication. J Vasc Surg 2011; 54:133-8. [DOI: 10.1016/j.jvs.2010.11.129] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 11/29/2010] [Accepted: 11/30/2010] [Indexed: 11/25/2022]
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Limitations of self-reported estimates of functional capacity using the Walking Impairment Questionnaire. Eur J Vasc Endovasc Surg 2010; 41:104-9. [PMID: 21123095 DOI: 10.1016/j.ejvs.2010.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 10/04/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A potential issue with the Walking Impairment Questionnaire (WIQ) is that it is relatively complex. We estimated the number of errors made by patients when self-completing the WIQ, and assessed the benefit of correcting missing, duplicate or paradoxical (i.e., reported lower difficulty for a higher-intensity task) answers. DESIGN Prospective non-interventional study. MATERIALS All consecutive new patients with claudication over a 3-month period. METHODS The WIQ was self-completed before patients performed a constant-load treadmill walking test (maximised to 750 m). MAIN OUTCOME MEASURE We analysed the coefficient of determination of the linear relationship between overall WIQ score (mean of the available subscales when at least two subscales are available) and treadmill maximal walking distance (MWD), before and after correction of errors. RESULTS We studied 73 patients. Thirty-seven questionnaires had to be corrected for one or more errors. The coefficient of determination between the overall WIQ score and MWD was R(2) = 0.391 (n = 56) and R(2) = 0.426 (n = 73) before and after correction, respectively. CONCLUSION Supervision of self-completed WIQs detects errors in almost half of the questionnaires, resulting in a missing overall WIQ score in 23% of cases among uncorrected questionnaires. The overall WIQ score correlates only moderately with MWD, even after correction. CLINICAL TRIAL REGISTRATION NIH database: NCT01114178.
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Mahé G, Zeenny M, Ouedraogo N, Vielle B, Leftheriotis G, Abraham P. Heart rate recovery after constant-load exercise tests is decreased in proportion to the importance (severity and diffusion) of exercise-induced lower-limb ischaemia. Clin Physiol Funct Imaging 2010; 31:48-53. [PMID: 20849524 DOI: 10.1111/j.1475-097x.2010.00978.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Conditions that may influence heart rate recovery at 1 min of recovery from exercise (HRR1: end-exercise heart rate minus heart rate 1 min after exercise) are not fully understood. We hypothesized that the 'importance' (both local severity and regional diffusion) of peripheral skeletal muscle ischaemia is associated with low HRR1. DESIGN AND METHODS In 529 patients with suspected or confirmed peripheral vascular disease not receiving beta-blockers (61·4 ± 11·3 years old), we retrospectively studied the relationship of HRR1 to exercise-induced changes in transcutaneous oxygen DROP index (limb changes minus chest changes from rest). The sum of DROP indices observed on both calves and both buttocks (DROPtot) provides the unique opportunity to estimate both the severity and the diffusion of exercise-induced ischaemia on the right and left side simultaneously. It was used during a constant-load treadmill test (3·2 km h(-1) ; 10% grade) to classify patients in quartiles, the fourth quartile representing the more 'important' ischaemias. RESULTS There was an inverse relationship between quartiles of DROPtot and HRR1, even after adjustment for heart rate reserve (Delta HR: end-exercise minus resting heart rate), age (≤ or >60 years), gender, body mass index, treadmill maximal walking distance and ankle brachial index: adjusted R = 0·629; P<0·0001. CONCLUSIONS During constant-load treadmill testing, DROPtot, an index of the 'importance' of exercise-induced lower-limb ischaemia, correlates with HRR1. Whether HRR1 is improved in proportion of DROPtot improvement in patients undergoing surgery or rehabilitation for peripheral artery disease is a fascinating issue for future studies.
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Affiliation(s)
- Guillaume Mahé
- Vascular investigations, University Hospital, Angers Cedex, France
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