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Garrigues‐Ramón M, Arca‐Arias A, Carrasco‐Ribelles LA, Barrios C. Haemodynamic effect of a leg compression bandage on the distal posterior tibial artery using 4D flow magnetic resonance imaging: A quantitative study. Int Wound J 2024; 21:e14901. [PMID: 38937919 PMCID: PMC11211091 DOI: 10.1111/iwj.14901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 06/29/2024] Open
Abstract
The uncertainty concerning the physiological effects of compression bandaging on the peripheral blood flow is a challenge for healthcare professionals. The main objective was to determine the haemodynamic impact on the distal posterior tibial artery after the application of a high-compression leg multicomponent bandaging system using 4D flow magnetic resonance imaging. Leg dominance disparities of the posterior tibial artery before and after the application of the compressive bandage were also analysed. Twenty-eight healthy female volunteers were recruited (mean: 25.71, standard deviation: 4.74 years old) through a non-probability convenience sampling. The 4D flow magnetic resonance imaging of the distal tibial posterior artery was performed in all participants, first under standard resting conditions and after the application of a compression bandage in the leg. When the strong compressive bandage was applied, the area of the assessed artery decreased by 14.2%, whilst the average speed increased by 19.6% and the flow rate increased by 184.8%. There were differences between the haemodynamic parameters of both legs according to dominance, being statistically significantly lower in the dominant leg. The application of strong compressive bandaging significantly increases the arterial flow and mean velocity in the distal segment of the posterior tibial artery, in healthy volunteers by 4D flow magnetic resonance imaging. In this study, leg dominance influenced some of the haemodynamic parameters. According to the results, leg compression bandages cannot be contraindicated in vascular ulcers with arterial compromise.
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Affiliation(s)
- Marta Garrigues‐Ramón
- Fundación Jiménez Díaz School of NursingAutonomous University of MadridMadridSpain
- Health Research Institute‐Fundación Jiménez Díaz University HospitalAutonomous University of Madrid (IIS‐FJD, UAM)MadridSpain
- School of DoctorateValencia Catholic UniversityValenciaSpain
| | | | - Lucía A. Carrasco‐Ribelles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol)BarcelonaSpain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal DisordersValencia Catholic University Saint Vicent MartyrValenciaSpain
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Citherlet T, Raberin A, Manferdelli G, Mota GR, Millet GP. Age and sex differences in microvascular responses during reactive hyperaemia. Exp Physiol 2024; 109:804-811. [PMID: 38509637 PMCID: PMC11061625 DOI: 10.1113/ep091652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Abstract
Microvascular impairments are typical of several cardiovascular diseases. Near-infrared spectroscopy (NIRS) combined with a vascular occlusion test provides non-invasive insights into microvascular responses by monitoring skeletal muscle oxygenation changes during reactive hyperaemia. Despite increasing interest in the effects of sex and ageing on microvascular responses, evidence remains inconsistent. Therefore, the present study aimed to investigate the effects of sex and age on microvascular responsiveness. Twenty-seven participants (seven young men and seven young women; seven older men and six older women; aged 26 ± 1, 26 ± 4, 67 ± 3 and 69 ± 4 years, respectively) completed a vascular occlusion test consisting of 5 min of arterial occlusion followed by 5 min reperfusion. Oxygenation changes in the vastus lateralis were monitored by near-infrared spectroscopy. The findings revealed that both women (referring to young and older women) and older participants (referring to both men and women) exhibited lower microvascular responsiveness. Notably, both women and older participants demonstrated reduced desaturation (-38% and -59%, respectively) and reperfusion rates (-24% and -40%, respectively) along with a narrower range of tissue oxygenation (-39% and -39%, respectively) and higher minimal tissue oxygenation levels (+34% and +21%, respectively). Women additionally displayed higher values in resting (+12%) and time-to-peak (+15%) tissue oxygenation levels. In conclusion, this study confirmed decreased microvascular responses in women and older individuals. These results emphasize the importance of considering sex and age when studying microvascular responses. Further research is needed to uncover the underlying mechanisms and clinical relevance of these findings, enabling the development of tailored strategies for preserving vascular health in diverse populations.
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Affiliation(s)
- Tom Citherlet
- Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
| | - Antoine Raberin
- Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
| | | | - Gustavo R. Mota
- Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
- Institute of Health SciencesFederal University of Triangulo MineiroUberabaBrazil
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Edwards SJ, Yao J, Schechter MC, Fayfman M, Santamarina G, Feiweier T, Blanco G, Alvarez J, Risk BB, Rajani R, Reiter DA. Feasibility of Multiparametric Perfusion Assessment in Diabetic Foot Ulcer Using Intravoxel Incoherent Motion and Blood Oxygenation-Level Dependent MRI. J Magn Reson Imaging 2024; 59:1555-1566. [PMID: 37596872 PMCID: PMC10875144 DOI: 10.1002/jmri.28955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Patients with type-2 diabetes (T2DM) are at increased risk of developing diabetic foot ulcers (DFU) and experiencing impaired wound healing related to underlying microvascular disease. PURPOSE To evaluate the sensitivity of intra-voxel incoherent motion (IVIM) and blood oxygen level dependent (BOLD) MRI to microvascular changes in patients with DFUs. STUDY TYPE Case-control. POPULATION 20 volunteers who were age and body mass index matched, including T2DM patients with DFUs (N = 10, mean age = 57.5 years), T2DM patients with controlled glycemia and without DFUs (DC, N = 5, mean age = 57.4 years) and healthy controls (HC, N = 5, mean age = 52.8 years). FIELD STRENGTH/SEQUENCE 3T/multi-b-value IVIM and dynamic BOLD. ASSESSMENT Resting IVIM parameters were obtained using a multi-b-value diffusion-weighted imaging sequence and two IVIM models were fit to obtain diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f) and microvascular volume fraction (MVF) parameters. Microvascular reactivity was evaluated by inducing an ischemic state in the foot with a blood pressure cuff during dynamic BOLD imaging. Perfusion indices were assessed in two regions of the foot: the medial plantar (MP) and lateral plantar (LP) regions. STATISTICAL TESTS Effect sizes of group mean differences were assessed using Hedge's g adjusted for small sample sizes. RESULTS DFU participants exhibited elevated D*, f, and MVF values in both regions (g ≥ 1.10) and increased D (g = 1.07) in the MP region compared to DC participants. DC participants showed reduced f and MVF compared to HC participants in the MP region (g ≥ 1.06). Finally, the DFU group showed reduced tolerance for ischemia in the LP region (g = -1.51) and blunted reperfusion response in both regions (g < -2.32) compared to the DC group during the cuff-occlusion challenge. DATA CONCLUSION The combined use of IVIM and BOLD MRI shows promise in differentiating perfusion abnormalities in the feet of diabetic patients and suggests hyperperfusion in DFU patients. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Scott J. Edwards
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Jingting Yao
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marcos C. Schechter
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Maya Fayfman
- Grady Memorial Hospital, Atlanta, Georgia, USA
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Gabriel Santamarina
- Grady Memorial Hospital, Atlanta, Georgia, USA
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Division of Vascular Surgery, Department of Surgery, Atlanta, GA, United States of America
| | | | - Gerardo Blanco
- Grady Memorial Hospital, Atlanta, Georgia, USA
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessica Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Benjamin B. Risk
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ravi Rajani
- Grady Memorial Hospital, Atlanta, Georgia, USA
- Division of Vascular Surgery, Department of Surgery, Atlanta, GA, United States of America
| | - David A. Reiter
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, USA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Orthopedics, Emory University School of Medicine, Atlanta, Georgia, USA
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Arvidsson J, Eriksson S, Johansson E, Lagerstrand K. Arterial occlusion duration affects the cuff-induced hyperemic response in skeletal muscle BOLD perfusion imaging as shown in young healthy subjects. MAGMA (NEW YORK, N.Y.) 2023; 36:897-910. [PMID: 37330431 PMCID: PMC10667151 DOI: 10.1007/s10334-023-01105-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE Dynamic BOLD MRI with cuff compression, inducing ischemia and post-occlusive hyperemia in skeletal muscle, has been pointed out as a potential diagnostic tool to assess peripheral limb perfusion. The objective was to explore the robustness of this technique and its sensitivity to the occlusion duration. MATERIALS AND METHODS BOLD images were acquired at 3 T in 14 healthy volunteers. [Formula: see text]-imaging with 5- and 1.5-min occlusions were acquired and several semi-quantitative BOLD parameters were derived from ROI-based [Formula: see text]-time curves. Differences in parameters from the two different occlusion durations were evaluated in the gastrocnemius and soleus muscles using non-parametrical tests. Intra- and inter-scan repeatability were evaluated with coefficient of variation. RESULTS Longer occlusion duration resulted in an increased hyperemic signal effect yielding significantly different values (p < 0.05) in gastrocnemius for all parameters describing the hyperemic response, and in soleus for two of these parameters. Specifically, 5-min occlusion yielded steeper hyperemic upslope in gastrocnemius (41.0%; p < 0.05) and soleus (59.7%; p = 0.03), shorter time to half peak in gastrocnemius (46.9%; p = 0.00008) and soleus (33.5%; p = 0.0003), and shorter time to peak in gastrocnemius (13.5%; p = 0.02). Coefficients of variation were lower than percentage differences that were found significant. DISCUSSION Findings show that the occlusion duration indeed influences the hyperemic response and thus should play a part in future methodological developments.
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Affiliation(s)
- Jonathan Arvidsson
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Stefanie Eriksson
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Kerstin Lagerstrand
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
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Leitão R, de Oliveira GV, Rezende C, Volino-Souza M, Mesquita J, de Carvalho LL, Alvares TS. Improved microvascular reactivity after aged garlic extract intake is not mediated by hydrogen sulfide in older adults at risk for cardiovascular disease: a randomized clinical trial. Eur J Nutr 2022; 61:3357-3366. [PMID: 35505122 DOI: 10.1007/s00394-022-02895-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to investigate the effects of AGE on microvascular reactivity, systolic blood pressure (SBP), and diastolic blood pressure (DBP) in older individuals at high risk for cardiovascular disease (CVD). Urinary thiosulfate was also investigated as an indirect marker of endogenous hydrogen sulfide (H2S) synthesis. The study was conducted in a randomized, double-blind, crossover, and placebo-controlled way. METHODS Twenty-eight participants (14 male), 67 ± 6 years old with CVD risk factors, ingested 2.4 g of AGE or placebo (PLA). Near-infrared spectroscopy evaluated tissue oxygen saturation (StO2) during a vascular occlusion test (30 s baseline, 5 min occlusion, and 2 min reperfusion). The upslope of StO2 signal after cuff release was calculated to measure microvascular reactivity. Urinary thiosulfate levels were measured using a high-performance liquid chromatography system. RESULTS The upslope of StO2 was significantly faster after AGE (1.01 ± 0.37% s-1) intake compared to PLA (0.83 ± 0.35% s-1; P < 0.001; d = 0.50). Relative changes in Δ% SBP from pre- to post-AGE intake (- 5.17 ± 5.77%) was significantly different compared to Δ% PLA (0.32 ± 5.99%; P = 0.001; d = 0.93). No significant changes in urinary thiosulfate concentrations were observed between interventions. Moreover, no significant gender effect in any parameter assessed was found. CONCLUSION This study demonstrated that a single dose of AGE improved microvascular reactivity in older adults at risk of CVD despite such an effect was not linked with urinary thiosulfate levels. This trial was registered at clinicaltrials.gov as NCT04008693 (May 19, 2020).
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Affiliation(s)
- Renata Leitão
- Nutrition and Exercise Metabolism Research Group, Food and Nutrition Institute, Federal University of Rio de Janeiro, Macaé Campus, Multidisciplinary Center UFRJ-Macaé, Estrada do Imburo, s/n, Macaé, RJ, 27979-000, Brazil
| | - Gustavo Vieira de Oliveira
- Nutrition and Exercise Metabolism Research Group, Food and Nutrition Institute, Federal University of Rio de Janeiro, Macaé Campus, Multidisciplinary Center UFRJ-Macaé, Estrada do Imburo, s/n, Macaé, RJ, 27979-000, Brazil
| | - Cristina Rezende
- Nutrition and Exercise Metabolism Research Group, Food and Nutrition Institute, Federal University of Rio de Janeiro, Macaé Campus, Multidisciplinary Center UFRJ-Macaé, Estrada do Imburo, s/n, Macaé, RJ, 27979-000, Brazil
| | - Mônica Volino-Souza
- Nutrition and Exercise Metabolism Research Group, Food and Nutrition Institute, Federal University of Rio de Janeiro, Macaé Campus, Multidisciplinary Center UFRJ-Macaé, Estrada do Imburo, s/n, Macaé, RJ, 27979-000, Brazil
| | - Jacilene Mesquita
- Nutrition and Exercise Metabolism Research Group, Food and Nutrition Institute, Federal University of Rio de Janeiro, Macaé Campus, Multidisciplinary Center UFRJ-Macaé, Estrada do Imburo, s/n, Macaé, RJ, 27979-000, Brazil
| | - Leandro Lara de Carvalho
- Laboratory of Catalysis and Synthesis of Bioactivity Substances, Federal University of Rio de Janeiro, Estrada do Imburo, s/n, Macaé, 27979-000, RJ, Brazil
| | - Thiago Silveira Alvares
- Nutrition and Exercise Metabolism Research Group, Food and Nutrition Institute, Federal University of Rio de Janeiro, Macaé Campus, Multidisciplinary Center UFRJ-Macaé, Estrada do Imburo, s/n, Macaé, RJ, 27979-000, Brazil.
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