1
|
Pinto Rodriguez P, Alameddine D, Huttler J, Damara FA, Slade M, Cardella J, Guzman RJ, Chaar CIO. Clinical Implications of Low Body Mass Index on Endovascular Lower Extremity Revascularization. Ann Vasc Surg 2024; 106:350-359. [PMID: 38810726 DOI: 10.1016/j.avsg.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/17/2024] [Accepted: 02/25/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The epidemic of obesity and associated cardiovascular morbidity continues to grow, attracting public attention and healthcare resources. However, the impact of malnutrition and being underweight continues to be overshadowed by obesity, especially in patients with peripheral arterial disease (PAD). This study assesses the characteristics and outcomes of patients with low body mass index (BMI ≤ 18.5) compared to patients with nonobese BMI undergoing peripheral vascular interventions (PVI). METHODS A retrospective analysis of patients undergoing PVI due to PAD registered in the Vascular Quality Initiative database. Patients were categorized into underweight (BMI ≤ 18.5) and nonobese BMI (BMI = 18.5-30). Patients in both groups were matched 3:1 for baseline demographic characteristics, comorbidities, medications, and indications. Kaplan-Meier analysis was done for long-term outcomes. RESULTS A total of 337,926 patients underwent PVI, of whom 12,935 (4%) were underweight, 215,728 (64%) were nonobese, and 109,263 (32%) were obese. Underweight patients were more likely to be older, female, smokers, with chronic obstructive pulmonary disorder, and more likely to present with chronic limb-threatening ischemia than nonobese patients. After propensity matching, there were 18,047 nonobese patients and 6,031 underweight patients. There were no significant differences in matched characteristics. Perioperatively, underweight patients were more likely to require a longer hospital length of stay. Underweight patients had statistically significantly higher 30-day mortality compared to patients with nonobese BMI (3% vs. 1.6%, P < 0.001) and a higher rate of thrombotic complications. As for long-term outcomes, underweight patients had a higher rate of reintervention (20% vs. 18%, P < 0.001) and major adverse limb events (27% vs. 22%, P < 0.001). The 4-year rate of amputation-free survival was significantly lower in underweight patients (70% vs. 82%, P < 0.001), and the 2-year freedom from major amputation (90% vs. 94%, P < 0.001) showed similar trends with worse outcomes in patients who were underweight. CONCLUSIONS Underweight patients with PAD are disproportionally more likely to be African American, females, and smokers and suffer worse outcomes after PVI than PAD patients with nonobese BMI. When possible, increased scrutiny and optimization of nutrition and other factors contributing to low BMI should be addressed prior to PVI.
Collapse
Affiliation(s)
- Paula Pinto Rodriguez
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT.
| | - Dana Alameddine
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | | | - Fachreza Aryo Damara
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | - Martin Slade
- Yale Occupational and Environmental Medicine Program, Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan Cardella
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | - Raul J Guzman
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
2
|
Li K, Dai M, Sacirovic M, Pagonas N, Ritter O, Kah J, Lauxmann MA, Bramlage P, Bondke Persson A, Buschmann I, Hillmeister P. Association of endothelial function and lower extremity perfusion in peripheral artery disease. VASA 2024; 53:333-340. [PMID: 38979892 DOI: 10.1024/0301-1526/a001131] [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] [Indexed: 07/10/2024]
Abstract
Background: The current study aims to investigate the association between endothelial function and lower extremity perfusion in patients with peripheral artery disease (PAD). Patients and methods: In total 229 patients with PAD (Rutherford stage 0-3) were enrolled in the current study. Endothelial function was assessed by measuring flow-mediated dilation (FMD) and endothelial cell proliferation capacity (ECPC). Lower extremity perfusion was assessed by measuring oscillometry-based ankle brachial index (oABI) and pulse wave index (PWI). In addition, carotid intima-media-thickness (cIMT) was also measured as a surrogate marker for atherosclerosis. Correlations between FMD, ECPC, oABI, PWI, and cIMT were analysed using Pearson correlation coefficient. The relationship between the above variables and the severity of PAD was investigated using ordinal logistic regression analysis. Results: Correlation analysis showed that FMD negatively associated with PWI (r = -0.183, p = 0.005), ECPC positively associated with oABI (r = 0.162, p = 0.014), and oABI negatively associated with PWI (r = -0.264, p < 0.001). Ordinal logistic regression analysis showed that ECPC (β = -0.009, p = 0.048), oABI (β = -5.290, p < 0.001), and age (β = -0.058, p = 0.002) negatively associated with the PAD Rutherford stages. In addition, PWI (β = 0.006, p < 0.001), cIMT (β = 18.363, p = 0.043) positively associated with the PAD Rutherford stages. Conclusions: Endothelial function significantly associates with lower extremity perfusion in patients with PAD, and both are related to the severity of PAD.
Collapse
Affiliation(s)
- Kangbo Li
- Department of Angiology, Center for Internal Medicine I, Deutsches Angiologie-Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mengjun Dai
- Department of Angiology, Center for Internal Medicine I, Deutsches Angiologie-Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mesud Sacirovic
- Department of Angiology, Center for Internal Medicine I, Deutsches Angiologie-Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Nikolaos Pagonas
- Department of Cardiology, Center for Internal Medicine I, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane, University of Potsdam, Brandenburg an der Havel, Germany
| | - Oliver Ritter
- Department of Cardiology, Center for Internal Medicine I, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane, University of Potsdam, Brandenburg an der Havel, Germany
| | - Janine Kah
- Department of Gastroenterology, Center for Internal Medicine II, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Martin A Lauxmann
- Institute of Biochemistry, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Anja Bondke Persson
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ivo Buschmann
- Department of Angiology, Center for Internal Medicine I, Deutsches Angiologie-Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane, University of Potsdam, Brandenburg an der Havel, Germany
| | - Philipp Hillmeister
- Department of Angiology, Center for Internal Medicine I, Deutsches Angiologie-Zentrum Brandenburg - Berlin, University Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane, University of Potsdam, Brandenburg an der Havel, Germany
| |
Collapse
|
3
|
Canonico ME, Verde N, Avvedimento M, Leone A, Cutillo M, Simonetti F, Esposito S, Bardi L, Giugliano G, Stabile E, Piccolo R, Esposito G. Safety and Efficacy of Combined Coronary and Peripheral Percutaneous Revascularization: A Proof-of-Concept Study. J Clin Med 2024; 13:4516. [PMID: 39124782 PMCID: PMC11313511 DOI: 10.3390/jcm13154516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 07/26/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Background. Lower extremity peripheral artery disease (LEPAD) frequently coexists with coronary artery disease (CAD) in patients with multisite vascular disease (MVD). While percutaneous revascularization is well-established for both LEPAD and CAD, limited evidence exists for patients eligible for both procedures. Specifically, the feasibility of concomitant LEPAD and CAD percutaneous revascularization remains unknown. Objectives. To compare the efficacy and safety of concomitant coronary and lower extremity elective percutaneous revascularization. Methods. Between 2012 and 2021, we included 135 patients in an observational, retrospective single-center registry. The population was stratified into two groups: 45 patients (concomitant group) underwent simultaneous coronary and peripheral percutaneous interventions, and 90 patients (deferred group) underwent two separate procedures within one year. The primary efficacy endpoint was major adverse cardiovascular events (MACE) at one year, while the primary safety endpoint was in-hospital contrast-induced nephropathy (CIN). Results. Study groups were well-balanced in baseline characteristics. In terms of coronary features, the concomitant revascularization group more often underwent single-vessel percutaneous coronary intervention (PCI), while the deferred group had multivessel PCI with diffuse coronary disease. No differences were detected in the number of LEPAD lesions between groups. For the primary efficacy endpoint, the incidence of MACE at one year was 37.8% in the concomitant group vs. 34.4% in the deferred group (HR 1.20, 95% CI 0.64-2.10; p = 0.61). No significant differences were found in CIN occurrence between the concomitant and deferred groups (11.1% vs. 8.9%; OR 1.30; 95% CI 0.36-4.21; p = 0.68). Conclusions. Multisite vascular disease patients eligible for CAD and LEPAD percutaneous revascularization exhibited a high cardiovascular risk profile with diffuse multivessel coronary and lower extremity disease. Our study suggests the efficacy and safety of concomitant coronary and lower extremity percutaneous revascularization based on one-year MACE incidence and in-hospital CIN. However, dedicated studies are warranted to confirm the short- and long-term outcomes of the concomitant revascularization strategy.
Collapse
Affiliation(s)
- Mario Enrico Canonico
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.E.C.)
- CPC Clinical Research, University of Colorado, Aurora, CO 80045, USA
| | - Nicola Verde
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.E.C.)
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.E.C.)
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC G1V0A6, Canada
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.E.C.)
- San Giuseppe Moscati Hospital, 83100 Avellino, Italy
| | - Maria Cutillo
- Italian National Institute of Health, 00161 Rome, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.E.C.)
| | - Salvatore Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.E.C.)
| | - Luca Bardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.E.C.)
| | - Giuseppe Giugliano
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.E.C.)
| | - Eugenio Stabile
- Division of Cardiology, Cardiovascular Department, Azienda Ospedaliera Regionale “San Carlo”, 85100 Potenza, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.E.C.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.E.C.)
| |
Collapse
|
4
|
Kawarada O, Zen K, Hozawa K, Obara H, Matsubara K, Yamamoto Y, Doijiri T, Tamai N, Ito S, Higashimori A, Kawasaki D, Doi H, Matsushita K, Tsukahara K, Noda K, Shimpo M, Tsuda Y, Sonoda S, Taniguchi T, Waseda K, Munehisa M, Taguchi E, Kinjo T, Sasaki Y, Yuba K, Yamaguchi S, Nakagami T, Ayabe S, Sakamoto S, Yagyu T, Ogata S, Nishimura K, Motomura H, Noguchi T, Ishihara M, Ogawa H, Yasuda S. Characteristics, Antithrombotic Patterns, and Prognostic Outcomes in Claudication and Critical Limb-Threatening Ischemia Undergoing Endovascular Therapy. J Endovasc Ther 2024; 31:622-633. [PMID: 36416475 DOI: 10.1177/15266028221134886] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
PURPOSE The underlying difference between intermittent claudication (IC) and critical limb-threatening ischemia (CLTI) still remains unclear. This prospective multicenter observational study aimed to clarify differences in clinical features and prognostic outcomes between IC and CLTI, and prognostic factors in patients undergoing endovascular therapy (EVT). MATERIALS AND METHODS A total of 692 patients with 808 limbs were enrolled from 20 institutions in Japan. The primary measurements were the 3-year rates of major adverse cardiovascular event (MACE) and reintervention. RESULTS Among patients, 79.0% had IC and 21.0% had CLTI. Patients with CLTI were more frequently women and more likely to have impaired functional status, undernutrition, comorbidities, hypercoagulation, hyperinflammation, distal artery disease, short single antiplatelet and long anticoagulation therapies, and late cilostazol than patients with IC. Aortoiliac and femoropopliteal diseases were dominant in patients with IC and infrapopliteal disease was dominant in patients with CLTI. Patients with CLTI underwent less frequently aortoiliac intervention and more frequently infrapopliteal intervention than patients with IC. Longitudinal change of ankle-brachial index (ABI) exhibited different patterns between IC and CLTI (pinteraction=0.002), but ABI improved after EVT both in IC and in CLTI (p<0.001), which was sustained over time. Dorsal and plantar skin perfusion pressure in CLTI showed a similar improvement pattern (pinteraction=0.181). Distribution of Rutherford category improved both in IC and in CLTI (each p<0.001). Three-year MACE rates were 20.4% and 42.3% and 3-year reintervention rates were 22.1% and 46.8% for patients with IC and CLTI, respectively (log-rank p<0.001). Elevated D-dimer (p=0.001), age (p=0.043), impaired functional status (p=0.018), and end-stage renal disease (p=0.019) were independently associated with MACE. After considering competing risks of death and major amputation for reintervention, elevated erythrocyte sedimentation rate (p=0.003) and infrainguinal intervention (p=0.002) were independently associated with reintervention. Patients with CLTI merely showed borderline significance for MACE (adjusted hazard ratio 1.700, 95% confidence interval 0.950-3.042, p=0.074) and reintervention (adjusted hazard ratio 1.976, 95% confidence interval 0.999-3.909, p=0.05). CONCLUSIONS The CLTI is characterized not only by more systemic comorbidities and distal disease but also by more inflammatory coagulation disorder compared with IC. Also, CLTI has approximately twice MACE and reintervention rates than IC, and the underlying inflammatory coagulation disorder per se is associated with these outcomes. CLINICAL IMPACT The underlying difference between intermittent claudication (IC) and critical limb-threatening ischemia (CLTI) still remains unclear. This prospective multicenter observational study, JPASSION study found that CLTI was characterized not only by more systemic comorbidities and distal disease but also by more inflammatory coagulation disorder compared to IC. Also, CLTI had approximately twice major adverse cardiovascular event (MACE) and reintervention rates than IC. Intriguingly, the underlying inflammatory coagulation disorder per se was independently associated with MACE and reintervention. Further studies to clarify the role of anticoagulation and anti-inflammatory therapies will contribute to the development of post-interventional therapeutics in the context of peripheral artery disease.
Collapse
Affiliation(s)
- Osami Kawarada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
- Kawarada Cardio Foot Vascular Clinic, Osaka, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Cardiology, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Koji Hozawa
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Matsubara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoshito Yamamoto
- Department of Cardiology, Iwaki City Medical Center, Iwaki, Japan
| | - Tatsuki Doijiri
- Department of Cardiology, Yamato Seiwa Hospital, Yamato, Japan
| | - Nozomu Tamai
- Division of Cardiology, Nagoya City University East Medical Center, Nagoya, Japan
| | - Shigenori Ito
- Division of Cardiology, Nagoya City University East Medical Center, Nagoya, Japan
| | | | - Daizo Kawasaki
- Department of Cardiology, Morinomiya Hospital, Osaka, Japan
| | - Hideki Doi
- Department of Cardiology, Kumamoto Rosai Hospital, Yatsushiro, Japan
| | - Kensuke Matsushita
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kengo Tsukahara
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsuo Noda
- Division of Cardiology, Kumamoto Central Hospital, Kumamoto, Japan
| | - Masahisa Shimpo
- Division of Cardiovascular Medicine, Department of Medicine, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yuki Tsuda
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shinjo Sonoda
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Cardiology, Saga University, Saga, Japan
| | - Takuya Taniguchi
- Department of Cardiovascular Medicine, North Medical Center, Kyoto Prefectural University of Medicine, Yosa-gun, Kyoto, Japan
| | - Katsuhisa Waseda
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Masato Munehisa
- Department of Cardiology, Yuri Kumiai General Hospital, Yurihonjo, Japan
| | - Eiji Taguchi
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Tatsuya Kinjo
- Department of Cardiology, Chidoribashi Hospital, Fukuoka, Japan
| | - Yohei Sasaki
- Department of Cardiology, Chidoribashi Hospital, Fukuoka, Japan
| | - Kenichiro Yuba
- Department of Cardiology, Tokushima Red Cross Hospital, Komatsushima, Japan
| | - Shinichiro Yamaguchi
- Department of Cardiology, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Takuo Nakagami
- Department of Cardiology, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Shinobu Ayabe
- Department of Plastic Surgery, Yao Tokushukai General Hospital, Yao, Japan
| | - Shingo Sakamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Yagyu
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hisashi Motomura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masaharu Ishihara
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
5
|
Zuo X, Ding X, Zhang Y, Kang YJ. Reversal of atherosclerosis by restoration of vascular copper homeostasis. Exp Biol Med (Maywood) 2024; 249:10185. [PMID: 38978540 PMCID: PMC11228934 DOI: 10.3389/ebm.2024.10185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/04/2024] [Indexed: 07/10/2024] Open
Abstract
Atherosclerosis has traditionally been considered as a disorder characterized by the accumulation of cholesterol and thrombotic materials within the arterial wall. However, it is now understood to be a complex inflammatory disease involving multiple factors. Central to the pathogenesis of atherosclerosis are the interactions among monocytes, macrophages, and neutrophils, which play pivotal roles in the initiation, progression, and destabilization of atherosclerotic lesions. Recent advances in our understanding of atherosclerosis pathogenesis, coupled with results obtained from experimental interventions, lead us to propose the hypothesis that atherosclerosis may be reversible. This paper outlines the evolution of this hypothesis and presents corroborating evidence that supports the potential for atherosclerosis regression through the restoration of vascular copper homeostasis. We posit that these insights may pave the way for innovative therapeutic approaches aimed at the reversal of atherosclerosis.
Collapse
Affiliation(s)
- Xiao Zuo
- Tasly Stem Cell Biology Laboratory, Tasly Biopharmaceutical Co., Tianjin, China
| | - Xueqin Ding
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yaya Zhang
- Tasly Stem Cell Biology Laboratory, Tasly Biopharmaceutical Co., Tianjin, China
| | - Y James Kang
- Tasly Stem Cell Biology Laboratory, Tasly Biopharmaceutical Co., Tianjin, China
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
6
|
Cook R, Robbins J, Truax L, Hingorani A. Patient selection for arterial procedures in office-based laboratories: A systematic review. Semin Vasc Surg 2024; 37:118-132. [PMID: 39151992 DOI: 10.1053/j.semvascsurg.2024.05.003] [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: 02/14/2024] [Revised: 05/04/2024] [Accepted: 05/16/2024] [Indexed: 08/19/2024]
Abstract
A dramatic increase in the number of vascular procedures performed in the office-based laboratory setting has been observed since 2008, when the Centers for Medicare and Medicaid Services increased reimbursement for procedures performed in the ambulatory setting. We sought to evaluate the appropriateness of arterial intervention in the office-based laboratory and patient selection. This systematic review was conducted with a search of Google Scholar and PubMed using the following search terms: office-based lab, outpatient, angioplasty, patient selection, arterial, and appropriateness. More than 500 publications were screened and 14 publications related to the topic were selected. The existing literature that examined patient selection for intervention in the outpatient setting, rates of complications after outpatient procedures, and short-term data on the safety and efficacy of these procedures is discussed. Gaps were identified in current knowledge about the long-term outcomes of peripheral arterial interventions performed in the office-based laboratory setting, as well as existing guidelines for the management of patients with peripheral arterial disease.
Collapse
Affiliation(s)
- Rebekah Cook
- Department of Surgery, HCA Florida Westside Hospital, 8201 W. Broward Boulevard, Plantation, FL, 33324.
| | - Justin Robbins
- Department of Surgery, Wright State University, Dayton, OH
| | - Lauren Truax
- Department of Surgery, Wright State University, Dayton, OH
| | - Anil Hingorani
- New York University Langone, 960 50th Street, Brooklyn, NY
| |
Collapse
|
7
|
Patil IV, Sharma P, Pisulkar G, Salwan A, Patel M. Complex Peripheral Arterial Disease in a Case of Multilevel Lesions Treated With Sequential Angioplasty. Cureus 2024; 16:e60982. [PMID: 38915963 PMCID: PMC11194135 DOI: 10.7759/cureus.60982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
Peripheral artery disease (PAD) is the buildup of calcium and fatty deposits in the arterial walls (atherosclerosis). This is an important clinical issue, specifically in cases with multilevel lesions. A patient underwent sequential angioplasty treatment for major PAD, which was characterized by multilevel lesions affecting both the infrapopliteal arteries. The proximal vessels and infrapopliteal vessels are mostly observed to be affected by PAD, thus the patient likely has PAD localized to the lower leg. In the femoropopliteal segment, lower extremity artery or aortic atherosclerotic occlusive disease can lead to significant outcomes. Severe claudication and pain during rest in both legs were observed in a patient with a history of hypertension and diabetes mellitus. With an angiography, the superficial femoral, popliteal, and tibial arteries have been shown to have major stenoses and occlusions. A progressive treatment was used because of the complexity of the lesions initiating with endovascular revascularization of the superficial femoral artery. The popliteal and tibial arteries were then repaired with angioplasty and stent placement. After the treatment, the patient's symptoms significantly improved, including elimination of their rest discomfort and claudication. Measurements of the ankle-brachial index (ABI) indicated that the affected limbs' perfusion was refined. Six months later, a follow-up angiography revealed intact vessels with no restenosis. This case report shows the successful outcome of recurrent angioplasty in curing complicated multilevel PAD, giving symptomatic relief and maintaining limb perfusion. This research is required to assess the long-term outcomes and longevity of this kind of treatment in patient populations that are comparable to others.
Collapse
Affiliation(s)
- Ishiqua V Patil
- Hospital Administration, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prerit Sharma
- Interventional Radiology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gajanan Pisulkar
- Orthopedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ankur Salwan
- Orthopedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Maharshi Patel
- General Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
8
|
Mazzolai L, Belch J, Venermo M, Aboyans V, Brodmann M, Bura-Rivière A, Debus S, Espinola-Klein C, Harwood AE, Hawley JA, Lanzi S, Madarič J, Mahé G, Malatesta D, Schlager O, Schmidt-Trucksäss A, Seenan C, Sillesen H, Tew GA, Visonà A. Exercise therapy for chronic symptomatic peripheral artery disease. Eur Heart J 2024; 45:1303-1321. [PMID: 38461405 DOI: 10.1093/eurheartj/ehad734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2024] Open
Abstract
All guidelines worldwide strongly recommend exercise as a pillar of the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended for clinicians to promote and assist for the set-up of comprehensive exercise programmes to best advice in patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are narratively described based on the current best evidence. The document ends by highlighting disparities in access to supervised exercise programmes across Europe and the series of gaps for evidence requiring further research.
Collapse
Affiliation(s)
- Lucia Mazzolai
- Angiology Department, Lausanne University Hospital, University of Lausanne, Ch. de Mont-Paisible 18, Lausanne 1011, Switzerland
| | - Jill Belch
- Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Maarit Venermo
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, France
- EpiMaCT, INSERM 1094/IRD270, Limoges University, Limoges, France
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University, Graz, Austria
| | | | - Sebastien Debus
- Department of Vascular Medicine, Vascular Surgery-Angiology-Endovascular Therapy, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Espinola-Klein
- Center of Cardiology, Department of Cardiology III-Angiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Amy E Harwood
- Department for Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - John A Hawley
- Exercise and Nutrition Research Programme, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Stefano Lanzi
- Angiology Department, Lausanne University Hospital, University of Lausanne, Ch. de Mont-Paisible 18, Lausanne 1011, Switzerland
| | - Juraj Madarič
- Department of Angiology, Comenius University, Bratislava, Slovakia
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Guillaume Mahé
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
- INSERM CIC 1414, Université de Rennes, Rennes, France
| | - Davide Malatesta
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Arno Schmidt-Trucksäss
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Chris Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Garry A Tew
- Institute for Health and Care Improvement, York St John University, York, UK
| | - Adriana Visonà
- Angiology Unit, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
| |
Collapse
|
9
|
Mazzolai L, Belch J, Venermo M, Aboyans V, Brodmann M, Bura-Rivière A, Debus S, Espinola-Klein C, Harwood AE, Hawley JA, Lanzi S, Madarič J, Mahé G, Malatesta D, Schlager O, Schmidt-Trucksäss A, Seenan C, Sillesen H, Tew GA, Visonà A. Exercise therapy for chronic symptomatic peripheral artery disease. VASA 2024; 53:87-108. [PMID: 38461401 DOI: 10.1024/0301-1526/a001112] [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] [Indexed: 03/11/2024]
Abstract
All guidelines worldwide strongly recommend exercise as a pillar in the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended to promote and assist the set up of comprehensive exercise programmes and best advice for patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are described based on the current best evidence. The document ends by highlighting supervised exercise programme access disparities across Europe and the evidence gaps requiring further research.
Collapse
Affiliation(s)
- Lucia Mazzolai
- Angiology Department, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Jill Belch
- Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Maarit Venermo
- Department of Vascular Surgery, Abdominal Centre, Helsinki University Hospital, Finland
- University of Helsinki, Finland
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, France
- EpiMaCT, INSERM 1094/IRD270, Limoges University, Limoges, France
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University, Graz, Austria
| | | | - Sebastien Debus
- Department of Vascular Medicine, Vascular Surgery - Angiology - Endovascular Therapy, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Espinola-Klein
- Centre of Cardiology, Department of Cardiology III-Angiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Amy E Harwood
- Department for Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - John A Hawley
- Exercise and Nutrition Research Programme, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Stefano Lanzi
- Angiology Department, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Juraj Madarič
- Department of Angiology, Comenius University, Bratislava, Slovakia
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Guillaume Mahé
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, France
- INSERM CIC 1414, Université de Rennes, France
| | - Davide Malatesta
- Institute of Sport Sciences, University of Lausanne, Switzerland
| | - Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Austria
| | - Arno Schmidt-Trucksäss
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland
| | - Chris Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Garry A Tew
- Institute for Health and Care Improvement, York St John University, York, UK
| | - Adriana Visonà
- Angiology Unit, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
| |
Collapse
|
10
|
McDermott MM, Tian L, Zhang D, Zhao L, Greenland P, Kibbe MR, Criqui MH, Thangada ND, Ferrucci L, Ho KJ, Guralnik JM, Polonsky TS. Discordance of patient-reported outcome measures with objectively assessed walking decline in peripheral artery disease. J Vasc Surg 2024; 79:893-903. [PMID: 38122859 DOI: 10.1016/j.jvs.2023.12.027] [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: 09/11/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Among people with peripheral artery disease (PAD), perceived change in walking difficulty over time, compared with people without PAD, is unclear. Among people reporting no change in walking difficulty over time, differences in objectively measured change in walking performance between people with and without PAD are unknown. METHODS A total of 1289 participants were included. Eight hundred seventy-four participants with PAD (aged 71.1 ± 9.1 years) were identified from noninvasive vascular laboratories and 415 without PAD (aged 69.9 ± 7.6 years) were identified from people with normal vascular laboratory testing or general medical practices in Chicago. The Walking Impairment Questionnaire and 6-minute walk were completed at baseline and 1-year follow-up. The Walking Impairment Questionnaire assessed perceived difficulty walking due to symptoms in the calves or buttocks on a Likert scale (range, 0-4). Symptom change was determined by comparing difficulty reported at 1-year follow-up to difficulty reported at baseline. RESULTS At 1-year follow-up, 31.9% of participants with and 20.6% of participants without PAD reported walking difficulty that was improved (P < .01), whereas 41.2% vs 55%, respectively, reported walking difficulty that was unchanged (P < .01). Among all reporting no change in walking difficulty, participants with PAD declined in 6-minute walk, whereas participants without PAD improved (-10 vs +15 meters; mean difference, -25; 95% confidence interval, -38 to -13; P < .01). CONCLUSIONS Most people with PAD reported improvement or no change in walking difficulty from calf or buttock symptoms at one-year follow-up. Among all participants who perceived stable walking ability, those with PAD had significant greater declines in objectively measured walking performance, compared with people without PAD.
Collapse
Affiliation(s)
- Mary M McDermott
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, CA
| | - Dongxue Zhang
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lihui Zhao
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip Greenland
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Melina R Kibbe
- Departments of Medical Science, Surgery, and Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, VA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA
| | - Neela D Thangada
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Karen J Ho
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jack M Guralnik
- Department of Epidemiology, University of Maryland, College Park, MD
| | - Tamar S Polonsky
- Department of Medicine, University of Chicago Medicine, Chicago, IL
| |
Collapse
|
11
|
Mazzolai L, Belch J, Venermo M, Aboyans V, Brodmann M, Bura-Rivière A, Debus S, Espinola-Klein C, Harwood AE, Hawley JA, Lanzi S, Madarič J, Mahé G, Malatesta D, Schlager O, Schmidt-Trucksäss A, Seenan C, Sillesen H, Tew GA, Visonà A. Exercise Therapy for Chronic Symptomatic Peripheral Artery Disease: A Clinical Consensus Document of the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases in Collaboration With the European Society of Vascular Medicine and the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg 2024; 67:S1078-5884(24)00011-X. [PMID: 38467522 DOI: 10.1016/j.ejvs.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
All guidelines worldwide strongly recommend exercise as a pillar in the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended to promote and assist the set up of comprehensive exercise programmes and best advice for patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are described based on the current best evidence. The document ends by highlighting supervised exercise programme access disparities across Europe and the evidence gaps requiring further research.
Collapse
Affiliation(s)
- Lucia Mazzolai
- Angiology Department, Lausanne University Hospital, University of Lausanne, Lausanne Switzerland.
| | - Jill Belch
- Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Maarit Venermo
- Department of Vascular Surgery, Abdominal Centre, Helsinki University Hospital, Helsinki; Department of Vascular Surgery, University of Helsinki, Helsinki
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital; EpiMaCT, INSERM 1094/IRD270, Limoges University, Limoges, France
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University, Graz, Austria
| | | | - Sebastien Debus
- Department of Vascular Medicine, Vascular Surgery - Angiology - Endovascular Therapy, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Espinola-Klein
- Centre of Cardiology, Department of Cardiology III-Angiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Amy E Harwood
- Department for Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - John A Hawley
- Exercise and Nutrition Research Programme, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Stefano Lanzi
- Angiology Department, Lausanne University Hospital, University of Lausanne, Lausanne Switzerland
| | - Juraj Madarič
- Department of Angiology, Comenius University; National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Guillaume Mahé
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France; INSERM CIC 1414, Université de Rennes, Rennes, France
| | - Davide Malatesta
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Arno Schmidt-Trucksäss
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Chris Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen
| | - Garry A Tew
- Institute for Health and Care Improvement, York St John University, York, UK
| | - Adriana Visonà
- Angiology Unit, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
| |
Collapse
|
12
|
Kim Y, Cho BS, DeCarlo CS, Latz CA, Majumdar M, Zacharias N, Mohapatra A, Dua A. Multi-institutional outcomes after femoropopliteal bypass in octogenarians. Vascular 2024; 32:84-90. [PMID: 36063379 DOI: 10.1177/17085381221125953] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Open lower extremity revascularization is controversial among octogenarians; however, the indications for surgical bypass are higher in the elderly population. The aim of the study was to compare postoperative outcomes between octogenarians and non-octogenarians following femoropopliteal bypass surgery. METHODS Our regional, multi-institutional database was queried for femoropopliteal bypass procedures performed between 1995 and 2020. Electronic medical records were individually reviewed for operative and postoperative data. Univariable and multivariable logistic regression were utilized to determine predictors of postoperative outcomes. RESULTS Among 1315 patients who underwent femoropopliteal bypass, 234 (17.8%) were octogenarians. Octogenarians more frequently underwent bypass for lower extremity tissue loss (48.7% vs 30.2%), whereas claudication was more common among non-octogenarians (24.0% vs 9.8%) (p < .001). Below-knee bypass target (72.2% vs 59.3%) and prosthetic conduit utilization (58.5% vs 43.7%) were more frequent in octogenarians (p < .001 each). Overall hospital length of stay was longer among patients > 80 years (median 6 days [interquartile range [IQR] 4-9] vs 5 days [IQR 4-8], p = .017). The overall 30-day (5.6% vs 1.5%) and one-year mortality rates (25.6% vs 7.9%) were higher among octogenarians (p < .001 each). On multivariable analysis, age greater than 80 years was found to be an independent risk factor for postoperative mortality (OR 3.79 [1.75-8.20], p = .0007). CONCLUSIONS Octogenarians undergoing bypass femoropopliteal bypass surgery have considerably worse postoperative outcomes, compared with non-octogenarians. These data may help inform elderly patients prior to undergoing open lower extremity revascularization.
Collapse
Affiliation(s)
- Young Kim
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Bennet S Cho
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Charles S DeCarlo
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher A Latz
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Monica Majumdar
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Nikolaos Zacharias
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Abhisekh Mohapatra
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
13
|
Rastogi A, Sudhayakumar A, Schaper NC, Jude EB. A paradigm shift for cardiovascular outcome evaluation in diabetes: Major adverse cardiovascular events (MACE) to major adverse vascular events (MAVE). Diabetes Metab Syndr 2023; 17:102875. [PMID: 37844433 DOI: 10.1016/j.dsx.2023.102875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND AIMS Drugs for diabetes are required to demonstrate cardiovascular safety through CV outcome trials (CVOT). The pre-defined end-points for cardiovascular outcome studies may not be sufficient to capture all clinically relevant atherosclerotic cardio vascular disease (ASCVD) events particularly peripheral arterial disease (PAD). METHODS We planned a scoping review and searched database to identify CVOT conducted in population with diabetes measuring lower limb events due to PAD as the primary outcome measure. We also searched CVOT for reported differential cardiovascular outcomes in population with PAD. RESULTS We identified that CV outcomes are measured as 3 point major adverse cardiovascular outcomes (3P-MACE) that includes nonfatal MI and nonfatal stroke or 4P-MACE that included additional unstable angina which is further expanded to 5P-MACE by the inclusion of hospitalization for heart failure (HHF). These CV end points are captured as surrogate for CV mortality based on the biological plausibility of relation between the surrogate and final outcome from pathophysiological studies. We found the prevalence of PAD is no lesser than other CV events in people with diabetes. Moreover, PAD contributes to the significant morbidity associated with diabetes as a surrogate for mortality. However, none of the CVOT with anti-diabetic drugs include PAD events as primary outcome measure despite the inclusion of 6-25 % participants with PAD in major CVOT. PAD outcomes are objectively measurable with tibial arterial waveforms and clinical end-point as lower extremity amputation. PAD outcomes do improve with treatment including intensive glycemic control and novel oral anticoagulants. We suggest the inclusion of PAD to MACE as a pre-specified outcome for a comprehensive capture of major adverse vascular event in future studies for people with diabetes. CONCLUSIONS MACE should be expanded to include PAD event as major adverse vascular event in cardiovascular outcome studies since PAD is clinically relevant and objectively measurable in diabetes.
Collapse
Affiliation(s)
- Ashu Rastogi
- Dept of Endocrinology, PGIMER, Chandigarh, 160012, India.
| | | | - Nicolaas C Schaper
- Division of Endocrinology, Department Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Edward B Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust and University of Manchester, Ashton under Lyne, UK
| |
Collapse
|
14
|
Leiherer A, Muendlein A, Saely CH, Geiger K, Brandtner EM, Heinzle C, Gaenger S, Mink S, Laaksonen R, Fraunberger P, Drexel H. Coronary Event Risk Test (CERT) as a Risk Predictor for the 10-Year Clinical Outcome of Patients with Peripheral Artery Disease. J Clin Med 2023; 12:6151. [PMID: 37834795 PMCID: PMC10573503 DOI: 10.3390/jcm12196151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: Ceramides are a new kind of lipid biomarker and have already been demonstrated to be valuable risk predictors in coronary patients. Patients with peripheral artery disease (PAD) are a population with a worse prognosis and higher mortality risk compared to coronary artery disease (CAD) patients. However, the value of ceramides for risk prediction in PAD patients is still vague, as addressed in the present study. (2)Methods: This observational study included 379 PAD patients. The primary endpoint was all-cause mortality at 10 years of follow-up. A set of ceramides was measured by LC-MS/MS and combined according to the Coronary Event Risk Test (CERT) score, which categorizes patients into one of four risk groups (low risk, moderate risk, high risk, very high risk). (3) Results: Kaplan-Meier survival curves revealed that the overall survival of patients decreased with the increasing risk predicted by the four CERT categories, advancing from low risk to very high risk. Cox regression analysis demonstrated that each one-category increase resulted in a 35% rise in overall mortality risk (HR = 1.35 [1.16-1.58]). Multivariable adjustment, including, among others, age, LDL-cholesterol, type 2 diabetes, and statin treatment before the baseline, did not abrogate this significant association (HR = 1.22 [1.04-1.43]). Moreover, we found that the beneficial effect of statin treatment is significantly stronger in patients with a higher risk, according to CERT. (4) Conclusions: We conclude that the ceramide-based risk score CERT is a strong predictor of the 10-year mortality risk in patients with PAD.
Collapse
Affiliation(s)
- Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
| | - Christoph H. Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, A-6800 Feldkirch, Austria
| | - Kathrin Geiger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Eva-Maria Brandtner
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
| | - Christine Heinzle
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Stella Gaenger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
| | - Sylvia Mink
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Reijo Laaksonen
- Finnish Cardiovascular Research Center, University of Tampere, FI-33014 Tampere, Finland;
- Zora Biosciences, FI-02150 Espoo, Finland
| | - Peter Fraunberger
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Vorarlberger Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, A-6800 Feldkirch, Austria
- Drexel University College of Medicine, Philadelphia, PA 19129, USA
| |
Collapse
|
15
|
Wang SH, Shyu VBH, Chiu WK, Huang RW, Lai BR, Tsai CH. An Overview of Clinical Examinations in the Evaluation and Assessment of Arterial and Venous Insufficiency Wounds. Diagnostics (Basel) 2023; 13:2494. [PMID: 37568858 PMCID: PMC10417660 DOI: 10.3390/diagnostics13152494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
Arterial and venous insufficiency are two major causes of chronic wounds with different etiology, pathophysiology, and clinical manifestations. With recent advancements in clinical examination, clinicians are able to obtain an accurate diagnosis of the underlying disease, which plays an important role in the treatment planning and management of patients. Arterial ulcers are mainly caused by peripheral artery diseases (PADs), which are traditionally examined by physical examination and non-invasive arterial Doppler studies. However, advanced imaging modalities, such as computed tomography angiography (CTA) and indocyanine green (ICG) angiography, have become important studies as part of a comprehensive diagnostic process. On the other hand, chronic wounds caused by venous insufficiency are mainly evaluated by duplex ultrasonography and venography. Several scoring systems, including Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification, the Venous Clinical Severity Score (VCSS), the Venous Disability Score, and the Venous Segmental Disease Score (VSDS) are useful in defining disease progression. In this review, we provide a comprehensive overlook of the most widely used and available clinical examinations for arterial and venous insufficiency wounds.
Collapse
Affiliation(s)
- Szu-Han Wang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei 110, Taiwan
| | - Victor Bong-Hang Shyu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Wen-Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Ren-Wen Huang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Bo-Ru Lai
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chia-Hsuan Tsai
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| |
Collapse
|
16
|
He C, Ye P, Zhang X, Esmaeili E, Li Y, Lü P, Cai C. The Role of TGF-β Signaling in Saphenous Vein Graft Failure after Peripheral Arterial Disease Bypass Surgery. Int J Mol Sci 2023; 24:10381. [PMID: 37373529 DOI: 10.3390/ijms241210381] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Saphenous vein bypass grafting is an effective technique used to treat peripheral arterial disease (PAD). However, restenosis is the major clinical challenge for the graft vessel among people with PAD postoperation. We hypothesize that there is a common culprit behind arterial occlusion and graft restenosis. To investigate this hypothesis, we found TGF-β, a gene specifically upregulated in PAD arteries, by bioinformatics analysis. TGF-β has a wide range of biological activities and plays an important role in vascular remodeling. We discuss the molecular pathway of TGF-β and elucidate its mechanism in vascular remodeling and intimal hyperplasia, including EMT, extracellular matrix deposition, and fibrosis, which are the important pathways contributing to stenosis. Additionally, we present a case report of a patient with graft restenosis linked to the TGF-β pathway. Finally, we discuss the potential applications of targeting the TGF-β pathway in the clinic to improve the long-term patency of vein grafts.
Collapse
Affiliation(s)
- Changhuai He
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Pin Ye
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xuecheng Zhang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Elham Esmaeili
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yiqing Li
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ping Lü
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chuanqi Cai
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| |
Collapse
|
17
|
Mesnard T, Dubosq M, Pruvot L, Azzaoui R, Patterson BO, Sobocinski J. Benefits of Prehabilitation before Complex Aortic Surgery. J Clin Med 2023; 12:jcm12113691. [PMID: 37297886 DOI: 10.3390/jcm12113691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/14/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
The purpose of this narrative review was to detail and discuss the underlying principles and benefits of preoperative interventions addressing risk factors for perioperative adverse events in open aortic surgery (OAS). The term "complex aortic disease" encompasses juxta/pararenal aortic and thoraco-abdominal aneurysms, chronic aortic dissection and occlusive aorto-iliac pathology. Although endovascular surgery has been increasingly favored, OAS remains a durable option, but by necessity involves extensive surgical approaches and aortic cross-clamping and requires a trained multidisciplinary team. The physiological stress of OAS in a fragile and comorbid patient group mandates thoughtful preoperative risk assessment and the implementation of measures dedicated to improving outcomes. Cardiac and pulmonary complications are one of the most frequent adverse events following major OAS and their incidences are correlated to the patient's functional status and previous comorbidities. Prehabilitation should be considered in patients with risk factors for pulmonary complications including advanced age, previous chronic obstructive pulmonary disease, and congestive heart failure with the aid of pulmonary function tests. It should also be combined with other measures to improve postoperative course and be included in the more general concept of enhanced recovery after surgery (ERAS). Although the current level of evidence regarding the effectiveness of ERAS in the setting of OAS remains low, an increasing body of literature has promoted its implementation in other specialties. Consequently, vascular teams should commit to improving the current evidence through studies to make ERAS the standard of care for OAS.
Collapse
Affiliation(s)
- Thomas Mesnard
- Service de Chirurgie Vasculaire, Centre de l'Aorte, CHU Lille, 59000 Lille, France
- Univ. Lille, INSERM U1008-Advanced Drug Delivery Systems and Biomaterials, 59000 Lille, France
| | - Maxime Dubosq
- Service de Chirurgie Vasculaire, Centre de l'Aorte, CHU Lille, 59000 Lille, France
| | - Louis Pruvot
- Service de Chirurgie Vasculaire, Centre de l'Aorte, CHU Lille, 59000 Lille, France
| | - Richard Azzaoui
- Service de Chirurgie Vasculaire, Centre de l'Aorte, CHU Lille, 59000 Lille, France
| | - Benjamin O Patterson
- Department of Vascular Surgery, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Jonathan Sobocinski
- Service de Chirurgie Vasculaire, Centre de l'Aorte, CHU Lille, 59000 Lille, France
- Univ. Lille, INSERM U1008-Advanced Drug Delivery Systems and Biomaterials, 59000 Lille, France
| |
Collapse
|
18
|
Moon SW, Byun MS, Yi D, Kim MJ, Jung JH, Kong N, Jung G, Ahn H, Lee JY, Kang KM, Sohn CH, Kim YK, Lee DY. Low Ankle-Brachial Index Relates to Alzheimer-Signature Cerebral Glucose Metabolism in Cognitively Impaired Older Adults. J Alzheimers Dis 2023; 93:87-95. [PMID: 36938732 DOI: 10.3233/jad-220911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Ankle-brachial index (ABI), an indicator of atherosclerosis or arterial stiffness, has been associated with Alzheimer's disease (AD) dementia and related cognitive impairment. Nevertheless, only limited information is available regarding its contribution to brain alterations leading to cognitive decline in late-life. OBJECTIVE We aimed to investigate the relationship of ABI with in vivo AD pathologies and cerebrovascular injury in cognitively impaired older adults. METHODS Total 127 cognitively impaired (70 mild cognitive impairment and 57 AD dementia) individuals, who participated in an ongoing prospective cohort study, were included. All participants underwent comprehensive clinical and neuropsychological assessment, ABI measurement, apolipoprotein E (APOE) ɛ4 genotyping, and multi-modal brain imaging including [11C] Pittsburgh Compound B (PiB)-positron emission tomography (PET) and [18F] fludeoxyglucose (FDG)-PET, and MRI. RESULTS General linear model analysis showed significant relationship between ABI strata (low ABI: <1.00, normal ABI: 1.00-1.29, and high ABI: ≥1.30) and AD-signature region cerebral glucose metabolism (AD-CM), even after controlling age, sex, clinical dementia rating-sum of box, and APOE ɛ4 positivity (p = 0.029). Post hoc comparison revealed that low ABI had significantly lower AD-CM than middle and high ABI, while no difference of AD-CM was found between middle and high ABI. There was no significant difference of global Aβ deposition, AD-signature region cortical thickness, and white matter hyperintensity volume between the three ABI strata. CONCLUSION Our findings suggest that lower ABI, likely related to atherosclerosis, may contribute to the aggravation of AD-related regional neurodegeneration in cognitively impaired older adults.
Collapse
Affiliation(s)
- Seok Woo Moon
- Department of Neuropsychiatry & Research Institute of Medical Science, Konkuk University School of Medicine, Chungju, Republic of Korea
| | - Min Soo Byun
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dahyun Yi
- Institute of Human Behavioral Medicine, Medical Research Center Seoul National University, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Psychiatry, Eulji University Nowon Eulji Medical Center, Seoul, Republic of Korea
| | - Joon Hyung Jung
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Nayeong Kong
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gijung Jung
- Institute of Human Behavioral Medicine, Medical Research Center Seoul National University, Seoul, Republic of Korea
| | - Hyejin Ahn
- Institute of Human Behavioral Medicine, Medical Research Center Seoul National University, Seoul, Republic of Korea
| | - Jun-Young Lee
- Department of Neuropsychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Human Behavioral Medicine, Medical Research Center Seoul National University, Seoul, Republic of Korea
| | | |
Collapse
|
19
|
Frey CB, Park R, Robinson R, Yoder C. Nagging Pain and Foot Ulcers Can be Treated into Remission. Endocrinol Metab Clin North Am 2023; 52:119-133. [PMID: 36754488 DOI: 10.1016/j.ecl.2022.09.003] [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] [Indexed: 12/23/2022]
Abstract
Lower extremity ulcerations are very common in patients with diabetes. These wounds lead to amputation in a surprisingly large percentage of patients with diabetes. The mortality rate following amputation in a patient with diabetes is alarmingly high. Preventive treatment is pivotal to avoid the numerous complications associated with diabetic ulcerations. However, at the onset of ulceration, early treatment under the supervision and guidance of a specialist can result in remission. Diabetic peripheral neuropathy is also a life-altering and debilitating disease. Although some patients experience numbness, some experience pain that can be sharp, shooting, and tingling. Although treatment is challenging and often requires medication, newer modalities, such as stimulation and physical therapy, have shown promise in reversing the devastating effects of peripheral neuropathy.
Collapse
Affiliation(s)
- Craig B Frey
- University Hospitals Podiatric Medicine and Surgery, University Hospitals Advanced Limb Salvage and Reconstruction, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Richard Park
- University Hospitals Podiatric Medicine and Surgery, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Rachel Robinson
- University Hospitals Podiatric Medicine and Surgery, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Courtney Yoder
- University Hospitals Podiatric Medicine and Surgery, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| |
Collapse
|
20
|
Pinto B, Correia MV, Paredes H, Silva I. Detection of Intermittent Claudication from Smartphone Inertial Data in Community Walks Using Machine Learning Classifiers. SENSORS (BASEL, SWITZERLAND) 2023; 23:1581. [PMID: 36772621 PMCID: PMC9920000 DOI: 10.3390/s23031581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
Peripheral arterial disease (PAD) causes blockage of the arteries, altering the blood flow to the lower limbs. This blockage can cause the individual with PAD to feel severe pain in the lower limbs. The main contribution of this research is the discovery of a solution that allows the automatic detection of the onset of claudication based on data analysis from patients' smartphones. For the data-collection procedure, 40 patients were asked to walk with a smartphone on a thirty-meter path, back and forth, for six minutes. Each patient conducted the test twice on two different days. Several machine learning models were compared to detect the onset of claudication on two different datasets. The results suggest that we can identify the onset of claudication using inertial sensors with a best case accuracy of 92.25% for the Extreme Gradient Boosting model.
Collapse
Affiliation(s)
- Bruno Pinto
- INESC Technology and Science, 4200-465 Porto, Portugal
- Faculdade de Ciências, Universidade do Porto, 4169-007 Porto, Portugal
| | - Miguel Velhote Correia
- INESC Technology and Science, 4200-465 Porto, Portugal
- Faculdade de Engenharia, Universidade do Porto, 4200-465 Porto, Portugal
| | - Hugo Paredes
- INESC Technology and Science, 4200-465 Porto, Portugal
- School of Science and Technology, Universidade de Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal
| | - Ivone Silva
- Angiology and Vascular Surgery, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
| |
Collapse
|
21
|
Chou TH, Rimmerman ET, Patel S, Wynveen MK, Eisert SN, Musini KN, Janse SA, Bobbey AJ, Sarac TP, Atway SA, Go MR, Stacy MR. Vessel-by-vessel analysis of lower extremity 18F-NaF PET/CT imaging quantifies diabetes- and chronic kidney disease-induced active microcalcification in patients with peripheral arterial disease. EJNMMI Res 2023; 13:3. [PMID: 36648583 PMCID: PMC9845537 DOI: 10.1186/s13550-023-00951-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Positron emission tomography (PET)/computed tomography (CT) imaging with fluorine-18 (18F)-sodium fluoride (NaF) provides assessment of active vascular microcalcification, but its utility for evaluating diabetes mellitus (DM)- and chronic kidney disease (CKD)-induced atherosclerosis in peripheral arterial disease (PAD) has not been comprehensively evaluated. This study sought to use 18F-NaF PET/CT to quantify and compare active microcalcification on an artery-by-artery basis in healthy subjects, PAD patients with or without DM, and PAD patients with or without CKD. Additionally, we evaluated the contributions of DM, CKD, statin use and established CT-detectable calcium to 18F-NaF uptake for each lower extremity artery. METHODS PAD patients (n = 48) and healthy controls (n = 8) underwent lower extremity 18F-NaF PET/CT imaging. Fused PET/CT images guided segmentation of arteries of interest (i.e., femoral-popliteal, anterior tibial, tibioperoneal trunk, posterior tibial, and peroneal) and quantification of 18F-NaF uptake. 18F-NaF uptake was assessed for each artery and compared between subject groups. Additionally, established calcium burden was quantified for each artery using CT calcium mass score. Univariate and multivariate analyses were performed to evaluate DM, CKD, statin use, and CT calcium mass as predictors of 18F-NaF uptake in PAD. RESULTS PAD patients with DM or CKD demonstrated significantly higher active microcalcification (i.e., 18F-NaF uptake) for all arteries when compared to PAD patients without DM or CKD. Univariate and multivariate analyses revealed that concomitant DM or CKD was associated with increased microcalcification for all arteries of interest and this increased disease risk remained significant after adjusting for patient age, sex, and body mass index. Statin use was only associated with decreased microcalcification for the femoral-popliteal artery in multivariate analyses. Established CT-detectable calcium was not significantly associated with 18F-NaF uptake for 4 out of 5 arteries of interest. CONCLUSIONS 18F-NaF PET/CT imaging quantifies vessel-specific active microcalcification in PAD that is increased in multiple lower extremity arteries by DM and CKD and decreased in the femoral-popliteal artery by statin use. 18F-NaF PET imaging is complementary to and largely independent of established CT-detectable arterial calcification. 18F-NaF PET/CT imaging may provide an approach for non-invasively quantifying vessel-specific responses to emerging anti-atherogenic therapies or CKD treatment in patients with PAD.
Collapse
Affiliation(s)
- Ting-Heng Chou
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA
| | - Eleanor T. Rimmerman
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA ,grid.261331.40000 0001 2285 7943Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH USA
| | - Surina Patel
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA
| | - Molly K. Wynveen
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA
| | - Susan N. Eisert
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA
| | - Kumudha Narayana Musini
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA
| | - Sarah A. Janse
- grid.261331.40000 0001 2285 7943Center for Biostatistics, The Ohio State University, Columbus, OH USA
| | - Adam J. Bobbey
- grid.240344.50000 0004 0392 3476Department of Radiology, Nationwide Children’s Hospital, Columbus, OH USA
| | - Timur P. Sarac
- grid.261331.40000 0001 2285 7943Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH USA
| | - Said A. Atway
- grid.261331.40000 0001 2285 7943Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH USA
| | - Michael R. Go
- grid.261331.40000 0001 2285 7943Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH USA
| | - Mitchel R. Stacy
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA ,grid.261331.40000 0001 2285 7943Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH USA ,grid.261331.40000 0001 2285 7943Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH USA
| |
Collapse
|
22
|
Zamzam A, Syed MH, Rotstein OD, Eikelboom J, Klein DJ, Singh KK, Abdin R, Qadura M. Validating fatty acid binding protein 3 as a diagnostic and prognostic biomarker for peripheral arterial disease: A three-year prospective follow-up study. EClinicalMedicine 2023; 55:101766. [PMID: 36531981 PMCID: PMC9755058 DOI: 10.1016/j.eclinm.2022.101766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with peripheral arterial disease (PAD) often remain undiagnosed and therefore suboptimally managed. Here, we investigated the diagnostic and prognostic potential of fatty acid binding protein 3 (FABP3) in patients with PAD. METHODS In the discovery phase, 374 PAD and 184 non-PAD patients were recruited from vascular surgery ambulatory clinics at St. Michael's Hospital (Toronto, Ontario, Canada) between October 4, 2017 to October 29, 2018. The diagnostic ability of baseline FABP3 level was investigated through receiver operator characteristic (ROC) curves to determine two cutoff points: 1) an exclusionary "rule out" cutoff point, and 2) a confirmatory "rule in" cutoff point. Next, these cutoff points were confirmed in the external validation phase using a separate cohort of 312 patients (180 PAD and 132 non-PAD) recruited from ambulatory vascular surgery clinics at St. Michael's Hospital (Canada) between November 6, 2018-July 30, 2019. Cox regression analyses were used to explore the independent association between FABP3 and major adverse limb events (MALE - defined as need for arterial revascularization or major amputation) and decrease in ankle-brachial index (ABI -defined as drop ≥0.15) during 3 years of follow-up. FINDINGS In the discovery phase, FABP3 levels were significantly elevated in patients with PAD compared to non-PAD patients. ROC analysis demonstrated that FABP3 had an AUC of 0.83 (95% CI: 0.81-0.86, p-value < 0.001). FABP3 exclusionary cutoff was <1.55 ng/ml (sensitivity = 96%; specificity = 40%), whereas FABP3 confirmatory cutoff was >3.55 ng/ml (sensitivity = 43%; specificity = 95%) - values that were confirmed in the external validation phase. Cox regression analysis demonstrated FABP3 to be an independent predictor of increase in MALE [HR = 1.14 (1.03-1.29); p-value = 0.010] and worsening PAD status (drop in ABI >0.15 [HR = 1.11 (1.02-1.19); p-value = 0.009]). INTERPRETATION Our findings suggested that FABP3 levels can be used as both a diagnostic and prognostic biomarker for PAD, and may facilitate risk stratification in select individuals for purposes of vascular evaluation or intensive medical management. FUNDING Funding for this study was provided by the Bill and Vicky Blair Foundation.
Collapse
Affiliation(s)
- Abdelrahman Zamzam
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada
| | - Muzammil H. Syed
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada
| | - 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
| | - John Eikelboom
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - David J. Klein
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Critical Care, St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada
| | - Krishna K. Singh
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London ON, N6A 5C1, Canada
| | - Rawand Abdin
- Department of Medicine, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Mohammad Qadura
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada
- 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
- Corresponding author. St. Michael's Hospital, 30 Bond St, 7-076 Bond Wing, Toronto, Ontario, M5B 1W8, Canada.
| |
Collapse
|
23
|
Scalabrin M, Engman V, Maccannell A, Critchlow A, Roberts LD, Yuldasheva N, Bowen TS. Temporal analysis of skeletal muscle remodeling post hindlimb ischemia reveals intricate autophagy regulation. Am J Physiol Cell Physiol 2022; 323:C1601-C1610. [PMID: 36252128 PMCID: PMC9722248 DOI: 10.1152/ajpcell.00174.2022] [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] [Indexed: 11/22/2022]
Abstract
Hind limb ischemia (HLI) is the most severe form of peripheral arterial disease, associated with a substantial reduction of limb blood flow that impairs skeletal muscle homeostasis to promote functional disability. The molecular regulators of HLI-induced muscle perturbations remain poorly defined. This study investigated whether changes in the molecular catabolic-autophagy signaling network were linked to temporal remodeling of skeletal muscle in HLI. HLI was induced in mice via hindlimb ischemia (femoral artery ligation) and confirmed by Doppler echocardiography. Experiments were terminated at time points defined as early- (7 days; n = 5) or late- (28 days; n = 5) stage HLI. Ischemic and nonischemic (contralateral) limb muscles were compared. Ischemic versus nonischemic muscles demonstrated overt remodeling at early-HLI but normalized at late-HLI. Early-onset fiber atrophy was associated with excessive autophagy signaling in ischemic muscle; protein expression increased for Beclin-1, LC3, and p62 (P < 0.05) but proteasome-dependent markers were reduced (P < 0.05). Mitophagy signaling increased in early-stage HLI that aligned with an early and sustained loss of mitochondrial content (P < 0.05). Upstream autophagy regulators, Sestrins, showed divergent responses during early-stage HLI (Sestrin2 increased while Sestrin1 decreased; P < 0.05) in parallel to increased AMP-activated protein kinase (AMPK) phosphorylation (P < 0.05) and lower antioxidant enzyme expression. No changes were found in markers for mechanistic target of rapamycin complex 1 signaling. These data indicate that early activation of the sestrin-AMPK signaling axis may regulate autophagy to stimulate rapid and overt muscle atrophy in HLI, which is normalized within weeks and accompanied by recovery of muscle mass. A complex interplay between Sestrins to regulate autophagy signaling during early-to-late muscle remodeling in HLI is likely.
Collapse
Affiliation(s)
- Mattia Scalabrin
- School of Biomedical Science, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Viktor Engman
- School of Biomedical Science, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Amanda Maccannell
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Annabel Critchlow
- School of Biomedical Science, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Lee D Roberts
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Nadira Yuldasheva
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - T Scott Bowen
- School of Biomedical Science, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| |
Collapse
|
24
|
Wang J, Miao R, Chen Z, Wang J, Yuan H, Li J, Huang Z. Age-specific association between non-HDL-C and arterial stiffness in the Chinese population. Front Cardiovasc Med 2022; 9:981028. [PMID: 36225964 PMCID: PMC9548648 DOI: 10.3389/fcvm.2022.981028] [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: 06/29/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background While some epidemiological studies have found correlations between non-high-density lipoprotein cholesterol (non-HDL-C) and arterial stiffness, there are still exist controversial and age-stratified analysis are scarce yet. Methods All individuals in this study were recruited in the Third Xiangya Hospital of Central South University from 2012 to 2016. Arterial stiffness was defined as brachial-ankle pulse wave velocity (baPWV) ≥1,400 cm/s. Association between non-HDL-C and arterial stiffness were explored using Cox proportional-hazards model. We also conducted subanalysis stratified by age. Furthermore, restricted cubic splines were used to model exposure-response relationships in cohort sample. Results This cohort study included 7,276 participants without arterial stiffness at baseline. Over a median follow-up of 1.78 years (IQR, 1.03–2.49), 1,669 participants have identified with incident arterial stiffness. In multivariable-adjusted analyses, higher non-HDL-C concentration was associated with incident arterial stiffness with an adjusted hazard ratio (HR) of 1.09 [95% confidence interval (CI), 1.02–1.17] per 1 mmol/L increase. Compared with the lowest tertile, the HR for arterial stiffness with respect to the highest tertile of non-HDL-C was 1.26 (95% CI, 1.07–1.48). The results were similar in the analysis of young participants (age <60 years). Conclusion Our study identified that non-HDL-C as a potential risk factor of arterial stiffness, especially for younger. The clinical benefits of decreasing non-HDL-C concentration should be further considered in the future.
Collapse
Affiliation(s)
- Jie Wang
- Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Rujia Miao
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhiheng Chen
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jiangang Wang
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Hong Yuan
- Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jing Li
- Department of Rehabilitation, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Jing Li
| | - Zheng Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- Zheng Huang
| |
Collapse
|
25
|
Willems LH, Maas DPMSM, Kramers K, Reijnen MMPJ, Riksen NP, Ten Cate H, van der Vijver-Coppen RJ, de Borst GJ, Mees BME, Zeebregts CJ, Hannink G, Warlé MC. Antithrombotic Therapy for Symptomatic Peripheral Arterial Disease: A Systematic Review and Network Meta-Analysis. Drugs 2022; 82:1287-1302. [PMID: 35997941 PMCID: PMC9499921 DOI: 10.1007/s40265-022-01756-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND High-quality evidence from trials directly comparing single antiplatelet therapies in symptomatic peripheral arterial disease (PAD) to dual antiplatelet therapies or acetylsalicylic acid (ASA) plus low-dose rivaroxaban is lacking. Therefore, we conducted a network meta-analysis on the effectiveness of all antithrombotic regimens studied in PAD. METHODS A systematic search was conducted to identify randomized controlled trials. The primary endpoints were major adverse cardiovascular events (MACE) and major bleedings. Secondary endpoints were major adverse limb events (MALE) and acute limb ischaemia (ALI). For each outcome, a frequentist network meta-analysis was used to compare relative risks (RRs) between medication and ASA. ASA was the universal comparator since a majority of studies used ASA as in the reference group. RESULTS Twenty-four randomized controlled trials were identified including 48,759 patients. With regard to reducing MACE, clopidogrel [RR 0.78, 95% confidence interval (CI) 0.66-0.93], ticagrelor (RR 0.79, 95% CI 0.65-0.97), ASA plus ticagrelor (RR 0.79, 95% CI 0.64-0.97), and ASA plus low-dose rivaroxaban (RR 0.84, 95% CI 0.76-0.93) were more effective than ASA, and equally effective to one another. As compared to ASA, major bleedings occurred more frequently with vitamin K antagonists, rivaroxaban, ASA plus vitamin K antagonists, and ASA plus low-dose rivaroxaban. All regimens were similar to ASA concerning MALE, while ASA plus low-dose rivaroxaban was more effective in preventing ALI (RR 0.67, 95% CI 0.55-0.80). Subgroup analysis in patients undergoing peripheral revascularization revealed that ≥ 3 months after intervention, evidence of benefit regarding clopidogrel, ticagrelor, and ASA plus ticagrelor was lacking, while ASA plus low-dose rivaroxaban was more effective in preventing MACE (RR 0.87, 95% CI 0.78-0.97) and MALE (RR 0.89, 95% CI 0.81-0.97) compared to ASA. ASA plus clopidogrel was not superior to ASA in preventing MACE ≥ 3 months after revascularization. Evidence regarding antithrombotic treatment strategies within 3 months after a peripheral intervention was lacking. CONCLUSION Clopidogrel, ticagrelor, ASA plus ticagrelor, and ASA plus low-dose rivaroxaban are superior to ASA monotherapy and equally effective to one another in preventing MACE in PAD. Of these four therapies, only ASA plus low-dose rivaroxaban provides a higher risk of major bleedings. More than 3 months after peripheral vascular intervention, ASA plus low-dose rivaroxaban is superior in preventing MACE and MALE compared to ASA but again at the cost of a higher risk of bleeding, while other treatment regimens show non-superiority. Based on the current evidence, clopidogrel may be considered the antithrombotic therapy of choice for most PAD patients, while in patients who underwent a peripheral vascular intervention, ASA plus low-dose rivaroxaban could be considered for the long-term (> 3 months) prevention of MACE and MALE.
Collapse
Affiliation(s)
- Loes H Willems
- Department of Surgery, Radboud University Medical Center, Postbus 9101 (Intern 618), 6500 HB, Nijmegen, The Netherlands.
| | - Dominique P M S M Maas
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kees Kramers
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Michel M P J Reijnen
- Department of Surgery, Rijnstate Hospital, Arnhem, and Multi-Modality Medical Imaging Group, University of Twente, Enschede, The Netherlands
| | - Niels P Riksen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hugo Ten Cate
- Departments of Internal Medicine and Biochemistry, Maastricht University Medical Center and CARIM School for Cardiovascular diseases, Maastricht, The Netherlands
- Center for Thrombosis and Haemostasis, Gutenberg University Medical Center, Mainz, Germany
| | | | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Barend M E Mees
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Clark J Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel C Warlé
- Department of Surgery, Radboud University Medical Center, Postbus 9101 (Intern 618), 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
26
|
Sinharoy A, Reddy N, Lin JK, Nambi V, Yang EY, Kougias P, Taylor AA, Lumsden AB, Ballantyne CM, Morrisett JD, Brunner G. Magnetic resonance imaging based superficial femoral artery velocity measurements in peripheral artery disease. Magn Reson Imaging 2022; 93:128-134. [DOI: 10.1016/j.mri.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/07/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022]
|
27
|
Engel C, Meade R, Harroun N, Penrose A, Shafqat M, Jin X, DeSilva G, Semenkovich C, Zayed M. Altered Peroxisome Proliferator-Activated Receptor Alpha Signaling in Variably Diseased Peripheral Arterial Segments. Front Cardiovasc Med 2022; 9:834199. [PMID: 35783870 PMCID: PMC9248745 DOI: 10.3389/fcvm.2022.834199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/04/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Peripheral atherosclerosis that accumulates in the extracranial carotid and lower extremity arteries can lead to significant morbidity and mortality. However, atherosclerotic disease progression is often not homogenous and is accelerated by diabetes. We previously observed increased phospholipid content in minimally (Min)-diseased arterial segments compared to maximally (Max)-diseased segments. Since Peroxisome Proliferator-Activated Receptor alpha (PPARα) is a key regulator of lipid metabolism, we hypothesized that it may have differential expression and signaling in Min vs. Max-diseased peripheral arterial segments. Methods Eighteen patients who underwent carotid endarterectomy (CEA), and 34 patients who underwent major lower extremity amputation were prospectively enrolled into a vascular tissue biobank. Min and Max-diseased segments were obtained in real-time from CEA plaque and amputated lower extremity arterial segments. mRNA and protein were isolated from specimens and the relative expression of ppara, and its downstream genes Acyl-CoA Oxidase 1 (acox1) and Carnitine Palmitoyltransferase 1A (cpt1a) were also evaluated. We evaluated gene expression and protein content relative to atherosclerotic disease severity and clinical diabetes status. Gene expression was also evaluated relative to Hemoglobin A1c and serum lipid profiles. Results In CEA segments of patients with diabetes, we observed significantly higher ppara and acox1 gene expression (p < 0.01 and p < 0.001 respectively), and higher PPARα protein content (p < 0.05). Hemoglobin A1c significantly correlated with expression of ppara (R2 = 0.66, p < 0.001), acox1 (R2 = 0.31, p < 0.05), and cpt1a (R2 = 0.4, p < 0.05). There was no significant difference in gene expression between Min vs. Max-diseased CEA plaque segments. Conversely, in lower extremity arterial segments of patients with diabetes, we observed significantly lower ppara, acox1, and cpt1a expression (p < 0.05, p < 0.001, and p < 0.0001 respectively). Interestingly, CPT1A content was lower in arterial segments of patients with diabetes (p < 0.05). Hemoglobin A1c and HDL-cholesterol had negative correlations with ppara (R2 = 0.44, p < 0.05; R2 = 0.42, p < 0.05; respectively). Conclusion This study demonstrates the significant differential expression of ppara and its immediate downstream genes in human carotid and lower extremity arteries relative to disease severity and diabetes. These findings highlight that mechanisms that influence atheroprogression in the carotid and lower extremities peripheral arteries are not homogenous and can be impacted by patient diabetes status and serum cholesterol profiles. Further elucidating these differential molecular mechanisms can help improve targeted therapy of atherosclerosis in different peripheral arterial beds.
Collapse
Affiliation(s)
- Connor Engel
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Rodrigo Meade
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Nikolai Harroun
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Amanda Penrose
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Mehreen Shafqat
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Xiaohua Jin
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Gayan DeSilva
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Clay Semenkovich
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Mohamed Zayed
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States,Division of Molecular Cell Biology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States,Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO, United States,Veterans Affairs St. Louis Health Care System, St. Louis, MO, United States,*Correspondence: Mohamed Zayed,
| |
Collapse
|
28
|
Gao Y, Huang H, Ni C, Feng Y, Yu J, Huang Y, Luo L, Jiang Y, Wang A. Comparison of Five Expressions of Handgrip Strength for Predicting Cardiovascular Disease Risk Factors in Chinese Middle-Aged Community Residents. Front Public Health 2022; 10:903036. [PMID: 35769791 PMCID: PMC9234447 DOI: 10.3389/fpubh.2022.903036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the predictive performance of five handgrip strengths for cardiovascular disease (CVD) risk factors. Methods A total of 804 Chinese middle-aged community residents' health medical examinations were collected. The absolute handgrip strength was denoted as HGS. HGS/body weight (HGS/BW), HGS/body mass index (HGS/BMI), HGS/lean body mass (HGS/LBM), and HGS/muscle mass (HGS/MM) represented relative handgrip strength (RHGS). To assess predictive performance, receiver operating characteristic (ROC) curves and the area under the curve (AUC) were constructed. Results HGS was not associated with most CVD risk biomarkers; however, RHGS showed a negative correlation trend after controlling for covariates (sex, age, smoking, and exercise). HGS/BMI and HGS/BW had better AUCs for predicting CVD risk factors than HGS/LBM or HGS/MM. HGS/BMI and HGS/BW can successfully predict all CVD risk factors in men with AUCs 0.55–0.65; similarly, women may effectively predict arteriosclerosis, hyperglycemia, hyperuricemia, and metabolic syndrome with AUCs 0.59–0.64, all p < 0.05. The optimal HGS/BW cut-off points for identifying different CVD risk factors were 0.59–0.61 in men and 0.41–0.45 in women, while the HGS/BMI were 1.75–1.79 in men and 1.11–1.15 in women. Conclusions Almost all CVD risk biomarkers and CVD risk factors were unrelated to HGS. There is, however, a significant inverse relationship between RHGS and CVD risk factors. HGS/BMI or HGS/BW should be recommended to be the best choice for predicting the risk of CVD risk factors in five expressions of handgrip strength. We also acquired the recommended optimal cut-off points of HGS/BMI and HGS/BW for predicting CVD risk factors.
Collapse
Affiliation(s)
- Yanan Gao
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, China
| | - Huiming Huang
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, China
- *Correspondence: Huiming Huang
| | - Chunxia Ni
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, China
| | - Yong Feng
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, China
| | - Junwu Yu
- Ningbo College of Health Sciences, Ningbo, China
- Ningbo Puyuan Sports Rehabilitation Clinic, Ningbo, China
| | - Yutong Huang
- Ningbo College of Health Sciences, Ningbo, China
- Ningbo Puyuan Sports Rehabilitation Clinic, Ningbo, China
| | - Lijun Luo
- Ningbo College of Health Sciences, Ningbo, China
- Ningbo Puyuan Sports Rehabilitation Clinic, Ningbo, China
| | - Yongbao Jiang
- Affiliated Hospital of Ningbo University, Ningbo, China
| | - Aiwen Wang
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, China
| |
Collapse
|
29
|
Patient Age at Diagnosis of Peripheral Artery Disease and Its Impact on Cardiovascular and Limb Outcomes. Am J Cardiol 2022; 177:144-150. [DOI: 10.1016/j.amjcard.2022.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 11/17/2022]
|
30
|
Barraclough JY, Yu J, Figtree GA, Perkovic V, Heerspink HJL, Neuen BL, Cannon CP, Mahaffey KW, Schutte AE, Neal B, Arnott C. Cardiovascular and renal outcomes with canagliflozin in patients with peripheral arterial disease: Data from the CANVAS Program and CREDENCE trial. Diabetes Obes Metab 2022; 24:1072-1083. [PMID: 35166429 DOI: 10.1111/dom.14671] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 01/10/2023]
Abstract
AIM To define the proportional and absolute benefits of the sodium-glucose co-transporter-2 inhibitor canagliflozin in patients with type 2 diabetes (T2D) with and without peripheral arterial disease (PAD). MATERIALS AND METHODS We pooled individual participant data from the CANVAS Program (n = 10 142) and CREDENCE trial (n = 4401). In this post hoc analysis, the main outcomes of interest were major adverse cardiovascular events (MACE: non-fatal myocardial infarction, non-fatal stroke or cardiovascular death), kidney outcomes, and extended major adverse limb events (MALE). Cox proportional hazards models were used to assess canagliflozin treatment effects in those with and without PAD. Absolute risk reductions per 1000 patients treated for 2.5 years were estimated using Poisson regression. RESULTS Of 14 543 participants, 3159 (21.7%) had PAD at baseline. In patients with PAD, canagliflozin reduced MACE (hazard ratio, 0.76; 95% confidence interval, 0.62-0.92), with similar relative benefits for other cardiovascular and kidney outcomes in participants with or without PAD at baseline (all Pinteraction > .268). There was no increase in the relative risk of extended MALE with canagliflozin, irrespective of baseline PAD history (Pinteraction > .864). The absolute benefits of canagliflozin were greater in those with PAD. CONCLUSIONS Patients with T2D and PAD derived similar relative cardiorenal benefits from canagliflozin treatment but higher absolute benefits compared with those without PAD, with no increase in extended MALE.
Collapse
Affiliation(s)
- Jennifer Y Barraclough
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jie Yu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Gemma A Figtree
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Kolling Institute, Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Vlado Perkovic
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Hiddo J L Heerspink
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Brendon L Neuen
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Aletta E Schutte
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Clare Arnott
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
31
|
Zhao Z, Swartchick CB, Chan J. Targeted contrast agents and activatable probes for photoacoustic imaging of cancer. Chem Soc Rev 2022; 51:829-868. [PMID: 35094040 PMCID: PMC9549347 DOI: 10.1039/d0cs00771d] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Photoacoustic (PA) imaging has emerged as a powerful technique for the high resolution visualization of biological processes within deep tissue. Through the development and application of exogenous targeted contrast agents and activatable probes that can respond to a given cancer biomarker, researchers can image molecular events in vivo during cancer progression. This information can provide valuable details that can facilitate cancer diagnosis and therapy monitoring. In this tutorial review, we provide a step-by-step guide to select a cancer biomarker and subsequent approaches to design imaging agents for in vivo use. We envision this information will be a useful summary to those in the field, new members to the community, and graduate students taking advanced imaging coursework. We also highlight notable examples from the recent literature, with emphasis on the molecular designs and their in vivo PA imaging performance. To conclude, we provide our outlook and future perspective in this exciting field.
Collapse
Affiliation(s)
- Zhenxiang Zhao
- Department of Chemistry, Beckman Institute for Advanced Science and Technology, and Cancer Center at Illinois, University of Illinois at Urbana-Champaign, 600 South Mathews Avenue, Urbana, Illinois, USA.
| | - Chelsea B Swartchick
- Department of Chemistry, Beckman Institute for Advanced Science and Technology, and Cancer Center at Illinois, University of Illinois at Urbana-Champaign, 600 South Mathews Avenue, Urbana, Illinois, USA.
| | - Jefferson Chan
- Department of Chemistry, Beckman Institute for Advanced Science and Technology, and Cancer Center at Illinois, University of Illinois at Urbana-Champaign, 600 South Mathews Avenue, Urbana, Illinois, USA.
| |
Collapse
|
32
|
Inflammation as a mechanism and therapeutic target in peripheral artery disease. Can J Cardiol 2022; 38:588-600. [PMID: 35114347 DOI: 10.1016/j.cjca.2022.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 12/24/2022] Open
Abstract
Peripheral artery disease is one of three major clinical manifestations of atherosclerosis, the other two being coronary artery and cerebrovascular disease. Despite progress in surgery, antithrombotic therapy and therapies that modify conventional risk factors (lipid-, blood pressure-, and glucose-lowering interventions), patients with peripheral artery disease have unacceptably high risk of vascular complications. Additional strategies to reduce this residual risk are needed. The accumulated evidence that inflammation plays an important role in the pathogenesis of atherosclerosis has spurred recent efforts to evaluate anti-inflammatory agents as an additional therapeutic approach for atherothrombosis prevention and treatment. In this review, we examine the evidence supporting the role of inflammation in atherosclerosis, review recent trials evaluating anti-inflammatory approaches to reduce cardiovascular complications, and offer insights into the opportunities for novel anti-inflammatory strategies to reduce the burden of cardiovascular and limb complications in patients with peripheral artery disease.
Collapse
|
33
|
Evaluation of Hyperspectral Imaging for Follow-Up Assessment after Revascularization in Peripheral Artery Disease. J Clin Med 2022; 11:jcm11030758. [PMID: 35160210 PMCID: PMC8836513 DOI: 10.3390/jcm11030758] [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: 12/14/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Assessment of tissue oxygenation is an important aspect of detection and monitoring of patients with peripheral artery disease (PAD). Hyperspectral imaging (HSI) is a non-contact technology for assessing microcirculatory function by quantifying tissue oxygen saturation (StO2). This study investigated whether HSI can be used to monitor skin oxygenation in patients with PAD after appropriate treatment of the lower extremities. Methods: For this purpose, 37 patients with PAD were studied by means of ankle–brachial index (ABI) and HSI before and after surgical or endovascular therapy. Thereby, the oxygenation parameter StO2 and near infrared (NIR) perfusion index were quantified in seven angiosomes on the diseased lower leg and foot. In addition, the effects of skin temperature and physical activity on StO2 and the NIR perfusion index and the respective inter-operator variability of these parameters were investigated in 25 healthy volunteers. Results: In all patients, the ABI significantly increased after surgical and endovascular therapy. In parallel, HSI revealed significant changes in both StO2 and NIR perfusion index in almost all studied angiosomes depending on the performed treatment. The increase in tissue oxygenation saturation was especially pronounced after surgical treatment. Neither heat nor cold, nor physical activity, nor repeated assessments of HSI parameters by independent investigators significantly affected the results on StO2 and the NIR perfusion index. Conclusions: Tissue oxygen saturation data obtained with HSI are robust to external confounders, such as temperature and physical activity, and do not show inter-operator variability; therefore, can be used as an additional technique to established methods, such as the ABI, to monitor peripheral perfusion in patients with PAD.
Collapse
|
34
|
Ramacciotti E, Agati LB, Volpiani GG, Brito KF, Ribeiro CM, Aguiar VCR, Ramacciotti LS, Paganotti A, Pereira FM, Caffaro RA, Fioranelli A, Krakauer R, Rached HRS, Wolosker N, Anand SS, Eikelboom JW, Lopes RD. Rivaroxaban with Aspirin Versus Aspirin for Peripheral Arterial Disease and Intermittent Claudication. Rationale and Design of the COMPASS CLAUDICATION Trial. Clin Appl Thromb Hemost 2022; 28:10760296211073922. [PMID: 35043716 PMCID: PMC8796110 DOI: 10.1177/10760296211073922] [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: 11/17/2022] Open
Abstract
BACKGROUND The COMPASS trial demonstrated that in patients with peripheral arterial disease, the combination of rivaroxaban and aspirin compared with aspirin reduces the risk of major adverse limb events, but it is not known whether this combination can also improve symptoms in patients with intermittent claudication. The primary objective of this study is to evaluate the effect of the combination on claudication distance. STUDY DESIGN Eighty-eight patients with intermittent claudication will be randomized to receive rivaroxaban 2.5 mg twice daily plus aspirin 100 mg once daily or aspirin 100 mg once daily for 24 weeks. The primary outcome is the change in claudication distance from the baseline to 24 weeks, measured by 6 min walking test and treadmill test. The primary safety outcome is the incidence of major bleeding and clinically relevant non-major bleeding according to the International Society on Thrombosis and Hemostasis criteria. SUMMARY The COMPASS CLAUDICATION trial will provide high-quality evidence regarding the effect of the combination of rivaroxaban and aspirin on claudication distance in patients with peripheral arterial disease.
Collapse
Affiliation(s)
- Eduardo Ramacciotti
- 600818Science Valley Research Institute, Santo André, São Paulo, Brazil.,Hospital e Maternidade Dr. Christóvão da Gama, DASA, São Paulo, SP, Brazil.,25815Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
| | | | - Giuliano Giova Volpiani
- 600818Science Valley Research Institute, Santo André, São Paulo, Brazil.,Hospital e Maternidade Dr. Christóvão da Gama, DASA, São Paulo, SP, Brazil.,67742Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | - Karen Falcão Brito
- 67742Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | | | | | | | - Alexia Paganotti
- 67742Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | | | | | - Alexandre Fioranelli
- 67742Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | - Rogério Krakauer
- Hospital e Maternidade Dr. Christóvão da Gama, DASA, São Paulo, SP, Brazil
| | | | | | | | | | | |
Collapse
|
35
|
Lower Extremity Artery Disease and Cognitive Impairment. Artery Res 2022. [DOI: 10.1007/s44200-021-00010-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Background
The association between cerebrovascular disease and cognitive impairment is well known, but the impact of lower extremity arterial disease (LEAD) on neuropsychological performance is less established.
Objectives
The aim of this study was to investigate the influence of LEAD on cognitive impairment.
Materials and Methods
A total of 20 patients with LEAD, classified by Fountain’s stage IIB, qualified for revascularization surgery has been included in this prospective study. Neuropsychological assessments have been done using MoCA and CANTAB test. Fifteen patients qualified for hernia surgery, without peripheral artery disease served as a control group. Linear regression model has been applied to assess the connection between LEAD and cognitive impairment.
Results
Differences between the study groups reach significance in both MoCA and CANTAB test. In MoCA test, patients with LEAD had lower levels of performance in attention (p = 0.0254), visuospatial/executive (p = 0.0343) and delayed recall (p = 0.0032). The mean MoCA score was below 26 points. In CANTAB test, patients with LEAD performed worse in visual memory and learning. After adjusted for common cerebrovascular risk factors, LEAD was significantly correlated with cognitive impairment defined as MoCA score < 26 points.
Conclusions
Lower extremity artery disease is associated with cognitive impairment independently of cerebrovascular risk factors.
Collapse
|
36
|
Yadav M, Haseen M, Rizvi S, Yadav M. Role of ankle brachial pressure index (ABI) in screening patients with risk factors for developing peripheral vascular disease. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_99_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
37
|
Cardiac-derived stem cell engineered with constitutively active HIF-1α gene enhances blood perfusion of hindlimb ischemia. J IND ENG CHEM 2022. [DOI: 10.1016/j.jiec.2021.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
38
|
Leiherer A, Mündlein A, Brandtner EM, Säly CH, Ramadani H, Vonbank A, Mader A, Dopheide JF, Jylhä A, Lääperi M, Laaksonen R, März W, Fraunberger P, Kleber M, Drexel H. Lipid profiles of patients with manifest coronary versus peripheral atherosclerosis - Is there a difference? J Intern Med 2021; 290:1249-1263. [PMID: 34337800 DOI: 10.1111/joim.13368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM Peripheral arterial disease (PAD) and coronary artery disease (CAD) are both caused by atherosclerosis. Serum lipids and lipoproteins are predictive of the development of atherosclerosis but it is not clear if they differ in the two manifestations, PAD and CAD. We tested whether a more detailed characterization of the lipid and lipoprotein patterns of PAD and CAD allows a clear differentiation between the two atherosclerotic phenotypes. METHODS A cohort of 274 statin-naïve patients with either newly diagnosed imaging proven PAD (n = 89) or stable CAD (n = 185) was characterized using nuclear magnetic resonance- and liquid chromatography-tandem mass spectrometry-based advanced lipid and lipoprotein analysis. An independent cohort of 1239 patients with PAD and CAD was used for validation. RESULTS We found a significant difference in markers of inflammation as well as ceramide and phosphatidylcholine levels between patients with PAD and CAD. In contrast, basic lipid markers including total cholesterol, LDL cholesterol, HDL cholesterol, lipoprotein(a) or detailed lipoprotein profiles did not differ significantly between patients with PAD and CAD. Applying ratios and scores derived from ceramides and phosphatidylcholines further improved the discrimination between PAD and CAD. These significant differences were independent of body composition, from the status of smoking or type 2 diabetes mellitus, and also from apolipoprotein C-III and other inflammatory parameters which were different between CAD and PAD. CONCLUSION The present study clearly suggests that PAD and CAD differ in terms of their ceramide- and phosphatidylcholine-based lipid patterns but not in lipoprotein characteristics.
Collapse
Affiliation(s)
- Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein.,Medical Central Laboratories, Feldkirch, Austria
| | - Axel Mündlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Eva Maria Brandtner
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Christoph H Säly
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Hana Ramadani
- Division of Angiology, Swiss Cardiovascular Center, University Hospital of Bern, Bern, Switzerland
| | - Alexander Vonbank
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Arthur Mader
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Jörn F Dopheide
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Division of Angiology, Swiss Cardiovascular Center, University Hospital of Bern, Bern, Switzerland
| | | | | | - Reijo Laaksonen
- Zora Biosciences, Espoo, Finland.,Finnish Cardiovascular Research Center, University of Tampere, Tampere, Finland
| | - Winfried März
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.,Synlab Academy, Synlab Holding, Mannheim, Germany
| | - Peter Fraunberger
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein.,Medical Central Laboratories, Feldkirch, Austria
| | - Marcus Kleber
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Division of Angiology, Swiss Cardiovascular Center, University Hospital of Bern, Bern, Switzerland.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein.,Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.,Department of Internal Medicine, Academic Teaching Hospital Bregenz, Bregenz, Austria
| |
Collapse
|
39
|
Tóth-Vajna G, Tóth-Vajna Z, Konkoly Thege B, Balog P. Depression among predictors of intermittent claudication: A cross-sectional study. Physiol Int 2021; 108:440-449. [PMID: 34662292 DOI: 10.1556/2060.2021.00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 09/12/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of the present cross-sectional study was to investigate the relationship between depression and intermittent claudication (IC), independently of traditional risk factors. MAIN METHODS The sample consisted of 300 individuals (M age = 65.3 ± 8.7 years, 61.0% female) recruited from the offices of 33 general practitioners. Participants' medical history and the presence of major cardiovascular risk factors were recorded. Participants completed the Edinburgh Claudication Questionnaire. The role of depression (assessed by a shortened version of the Beck Depression Inventory) in predicting IC was examined using a binary logistic regression analysis - controlled for sex, age, hypertonia, diabetes, smoking, hypercholesterinemia, hazardous drinking, and body mass index (BMI). RESULTS The descriptive data indicated that the prevalence of depression was 57.9% in the IC subgroup and 16.1% in those free of IC. The bivariate analyses indicated that hypercholesterinemia, smoking, hazardous drinking, BMI, and depression were significantly associated with IC. Male sex and age showed a trend toward being a significant correlate of IC. Results of the multivariate analyses indicated that depressive symptomatology was significant in predicting IC (OR: 1.08 (1.05-1.11)), even after controlling for lifestyle and traditional risk factors such as smoking, hazardous drinking, and BMI. Among traditional risk factors, smoking (OR: 2.44 (1.26-4.74)), hazardous drinking (OR: 1.19 (1.02-1.40)), and hypercholesterinemia (OR: 2.17 (1.26-3.75)) showed a significant, positive relationship with IC. CONCLUSIONS These results underscore the importance of a multidisciplinary approach that focuses on supporting health-related behavioral changes and managing mental health symptoms when providing care for patients with IC.
Collapse
Affiliation(s)
- Gergely Tóth-Vajna
- 1 Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - Zsombor Tóth-Vajna
- 2 Heart and Vascular Center, Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | - Barna Konkoly Thege
- 3 Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario,Canada
- 4 Department of Psychiatry, University of Toronto, Toronto, Ontario,Canada
| | - Piroska Balog
- 1 Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| |
Collapse
|
40
|
Van Den Hoven P, Goncalves LN, Quax PHA, Van Rijswijk CSP, Van Schaik J, Schepers A, Vahrmeijer AL, Hamming JF, Van Der Vorst JR. Perfusion Patterns in Patients with Chronic Limb-Threatening Ischemia versus Control Patients Using Near-Infrared Fluorescence Imaging with Indocyanine Green. Biomedicines 2021; 9:biomedicines9101417. [PMID: 34680534 PMCID: PMC8533354 DOI: 10.3390/biomedicines9101417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 01/01/2023] Open
Abstract
In assessing the severity of lower extremity arterial disease (LEAD), physicians rely on clinical judgements supported by conventional measurements of macrovascular blood flow. However, current diagnostic techniques provide no information about regional tissue perfusion and are of limited value in patients with chronic limb-threatening ischemia (CLTI). Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has been used extensively in perfusion studies and is a possible modality for tissue perfusion measurement in patients with CLTI. In this prospective cohort study, ICG NIR fluorescence imaging was performed in patients with CLTI and control patients using the Quest Spectrum Platform® (Middenmeer, The Netherlands). The time–intensity curves were analyzed using the Quest Research Framework. Fourteen parameters were extracted. Successful ICG NIR fluorescence imaging was performed in 19 patients with CLTI and in 16 control patients. The time to maximum intensity (seconds) was lower for CLTI patients (90.5 vs. 143.3, p = 0.002). For the inflow parameters, the maximum slope, the normalized maximum slope and the ingress rate were all significantly higher in the CLTI group. The inflow parameters observed in patients with CLTI were superior to the control group. Possible explanations for the increased inflow include damage to the regulatory mechanisms of the microcirculation, arterial stiffness, and transcapillary leakage.
Collapse
Affiliation(s)
- Pim Van Den Hoven
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
| | - Lauren N. Goncalves
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
| | - Paulus H. A. Quax
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
| | | | - Jan Van Schaik
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
| | - Alexander L. Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
| | - Jaap F. Hamming
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
| | - Joost R. Van Der Vorst
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
- Correspondence: ; Tel.: +31-71-529-9143
| |
Collapse
|
41
|
Syed MH, Zamzam A, Khan H, Singh K, Forbes TL, Rotstein O, Abdin R, Eikelboom J, Qadura M. Fatty acid binding protein 3 is associated with peripheral arterial disease. JVS Vasc Sci 2021; 1:168-175. [PMID: 34617045 PMCID: PMC8489205 DOI: 10.1016/j.jvssci.2020.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/17/2020] [Indexed: 12/30/2022] Open
Abstract
Background Peripheral arterial disease (PAD) affects more than 150 million people worldwide and is associated with high rates of lower extremity amputation, myocardial infarction, stroke and death. Fatty acid binding protein 3 (FABP3) is released into circulation in patients with skeletal muscle injury. In this pilot study, we investigated a possible association between PAD and blood levels of FABP3. Methods Blood samples were collected from patients with clinical symptoms and diagnostic findings indicative of PAD (PAD group; ankle-brachial index [ABI] <0.9; n = 75) and in those without clinical or diagnostic features of PAD (non-PAD group; ABI >0.9; n = 75) presenting to vascular surgery ambulatory clinics at St. Michael's Hospital. Plasma samples were analyzed by protein multiplex to quantify FABP3 levels. Results PAD patients were found to have higher blood levels of FABP3 compared to patients without PAD (mean 3.90 ± 1.69 vs 2.03 ± 0.78; P < .001). A subgroup analysis demonstrated that the FABP3 levels were increased by almost two-fold in patients with PAD, independent of coronary artery disease (P < .001) or diabetes mellitus status (P < .001). Moreover, a significant negative correlation between FABP3 and the ABI was observed in PAD and patients without PAD matched groups (r = –0.51; P = .001). Last, immunohistochemistry demonstrated elevated expressions of FABP3 within skeletal muscle obtained from patients with the most severe form of PAD, chronic limb-threatening ischemia, when compared with patients without PAD. Conclusions Patients with PAD have elevated plasma levels of FABP3. An increasing severity of PAD is associated with higher FABP3 levels. There is a pressing need for a simple, readily accessible, blood-based biomarker for PAD. In this study, we found elevated levels of FABP3 in patients with PAD. This increase in FABP3 was irrespective of history of coronary artery disease or diabetes. Furthermore, our data suggest that an increasing severity of PAD is associated with higher FABP3 levels. Subsequently, FABP3 may be a potential diagnostic biomarker for PAD. However, further studies are needed to confirm the capability of FABP3 to serve as a valid and reliable biomarker for PAD.
Collapse
Affiliation(s)
- Muzammil H Syed
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Abdelrahman Zamzam
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Hamzah Khan
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Krishna Singh
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ori Rotstein
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rawand Abdin
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John Eikelboom
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Mohammad Qadura
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| |
Collapse
|
42
|
Local and Systemic Inflammation and Oxidative Stress After a Single Bout of Maximal Walking in Patients With Symptomatic Peripheral Artery Disease. J Cardiovasc Nurs 2021; 36:498-506. [DOI: 10.1097/jcn.0000000000000686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
43
|
Alagha M, Aherne TM, Hassanin A, Zafar AS, Joyce DP, Mahmood W, Tubassam M, Walsh SR. Diagnostic Performance of Ankle-Brachial Pressure Index in Lower Extremity Arterial Disease. Surg J (N Y) 2021; 7:e132-e137. [PMID: 34295970 PMCID: PMC8289682 DOI: 10.1055/s-0041-1731444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/17/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction
Ankle-brachial pressure indices (ABIs) continue to form the basis of diagnostics for lower extremity arterial disease (LEAD). However, there remains a paucity of data to support its accuracy. This study aims to evaluate its diagnostic sensitivity and specificity using established arterial-imaging modalities as a benchmark.
Methods
In this retrospective study, a regional, prospectively maintained, vascular laboratory database was interrogated to identify referred patients with arterial disease who underwent concomitant assessment with ABI and lower limb arterial duplex ultrasound (DUS). Duplex acted as the reference standard. Those who had peripheral computed tomography angiogram (CTA) within 3 months of initial assessment were included in a subgroup analysis to correlate ABI with CTA. The primary end point was the sensitivity and specificity of ABI compared with DUS as the reference standard.
Results
Concomitant assessment was performed in 438 limbs (250 patients) over a 27-month period. The ABI was normal (0.9 to 1.4) in 196 limbs (44.9%) and abnormal in the remaining 241 limbs (55.1%). False-positive results occurred in 83 out of 241 limbs (34.4%), and false-negative results occurred in 54 limbs out of 196 (27.5%). True-positive results were 158 out of 241 limbs (65.6%), whereas true-negative results were 142 out of 196 limbs (72.4%). ABI using DUS as a benchmark identified a sensitivity for peripheral artery disease of 72.3% and a specificity of 69.3%. Concomitant CTA imaging was available in 200 limbs. The sensitivity and specificity of ABI correlated with CTA were 65.5 and 68.8%, respectively.
Conclusion
ABIs have a moderate predictive value in the diagnosis of LEAD. Normal range outcomes cannot be taken to infer the absence of LEAD and, as such, further arterial imaging in the form of DUS or angiography should be strongly considered in those with suspected underlying disease requiring intervention. Further noninvasive tests such as exercise studies or pulse volume waveforms should be considered, if diagnostic uncertainty exists, in those requiring nonoperative intervention and risk factor control.
Collapse
Affiliation(s)
- Mohammed Alagha
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
| | - Thomas M Aherne
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
| | - Ahmed Hassanin
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
| | - Adeel S Zafar
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
| | - Doireann P Joyce
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
| | - Waqas Mahmood
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
| | - Muhammad Tubassam
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
| | - Stewart R Walsh
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
| |
Collapse
|
44
|
Functional and Cardiovascular Measurements in Patients With Peripheral Artery Disease: COMPARISON BETWEEN MEN AND WOMEN. J Cardiopulm Rehabil Prev 2021; 40:24-28. [PMID: 31348126 DOI: 10.1097/hcr.0000000000000437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE To compare functional and cardiovascular variables of men and women with peripheral artery disease (PAD). METHODS This observational, cross-sectional study included 67 women and 144 men (age 66 ± 9 and 67 ± 10 yr, respectively) with PAD. Patients were submitted to a clinical evaluation, 6-min walk test (6MWT) and cardiovascular evaluation, including blood pressure, arterial stiffness variables, and heart rate variability. RESULTS Women had lower claudication onset distance (P = .033) and 6MWT distance (P < .001), and similar percentage of the predicted 6MWT distance (P > .05). Women had higher pulse pressure (P = .002), augmentation index (P < .001), augmentation index corrected by 75 bpm (P < .001), and brachial and central systolic blood pressure (P = .041 and P = .029). Diastolic blood pressure, pulse wave velocity, and heart rate variability were similar between sexes (P > .05). CONCLUSION Although predicted 6MWT performance was similar between sexes, women had higher blood pressure and wave reflection variables compared with men. Interventions to reduce blood pressure and wave reflection should be emphasized in women with PAD.
Collapse
|
45
|
Barraclough JY, Harmer JA, Yu J, Figtree GA, Arnott C. Why Are We Forgetting Patients With Peripheral Arterial Disease? Heart Lung Circ 2021; 30:939-942. [PMID: 33965306 DOI: 10.1016/j.hlc.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Jason A Harmer
- The George Institute for Global Health, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jie Yu
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Gemma A Figtree
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Clare Arnott
- The George Institute for Global Health, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
46
|
Andrade-Lima A, Silva Junior N, Chehuen M, Miyasato R, Souza RWA, Leicht AS, Brum PC, de Oliveira EM, Wolosker N, Forjaz CLM. Walking Training Improves Systemic and Local Pathophysiological Processes in Intermittent Claudication. Eur J Vasc Endovasc Surg 2021; 61:954-963. [PMID: 33875324 DOI: 10.1016/j.ejvs.2021.02.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/25/2021] [Accepted: 02/16/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study examined the impact of submaximal walking training (WT) on local and systemic nitric oxide (NO) bioavailability, inflammation, and oxidative stress in patients with intermittent claudication (IC). METHODS The study employed a randomised, controlled, parallel group design and was performed in a single centre. Thirty-two men with IC were randomly allocated to two groups: WT (n = 16, two sessions/week, 15 cycles of two minutes walking at an intensity corresponding to the heart rate obtained at the pain threshold interspersed by two minutes of upright rest) and control (CO, n = 16, two sessions/week, 30 minutes of stretching). NO bioavailability (blood NO and muscle nitric oxide synthase [eNOS]), redox homeostasis (catalase [CAT], superoxide dismutase [SOD], lipid peroxidation [LPO] measured in blood and muscle), and inflammation (interleukin-6 [IL-6], C-reactive protein [CRP], tumour necrosis factor α [TNF-α], intercellular adhesion molecules [ICAM], vascular adhesion molecules [VCAM] measured in blood and muscle) were assessed at baseline and after 12 weeks. RESULTS WT statistically significantly increased blood NO, muscle eNOS, blood SOD and CAT, and muscle SOD and abolished the increase in circulating and muscle LPO observed in the CO group. WT decreased blood CRP, ICAM, and VCAM and muscle IL-6 and CRP and eliminated the increase in blood TNF-α and muscle TNF-α, ICAM and VCAM observed in the CO group. CONCLUSION WT at an intensity of pain threshold improved NO bioavailability and decreased systemic and local oxidative stress and inflammation in patients with IC. The proposed WT protocol provides physiological adaptations that may contribute to cardiovascular health in these patients.
Collapse
Affiliation(s)
- Aluisio Andrade-Lima
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
| | - Natan Silva Junior
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Marcel Chehuen
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Roberto Miyasato
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Rodrigo W A Souza
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Anthony S Leicht
- Sport & Exercise Science, James Cook University, Townsville, Australia
| | - Patricia C Brum
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | | | - Claudia L M Forjaz
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
47
|
Arakelian VS. [Amputation as an anticipated consequence of peripheral artery disease and ways to improve the prognosis of limb salvage]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:182-190. [PMID: 33825747 DOI: 10.33529/angio2021101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Peripheral artery disease is a common and acute social burden worldwide. The main method of treatment of PAD consists in open surgical or endovascular revascularization. However, despite steady growth of the number and quality of interventions, the incidence of lower-limb amputation still remains at a high level. Lower-limb amputation is a severe psychological blow for the patient and leads to significant deterioration of his or her quality of life, as well as has an extremely negative prognosis concerning the frequency of subsequent complications and survival. Consequences of amputations include not only severe disability but also an unfavourable prognosis of life, thus determining the necessity of adequate prevention of such events. Reconstructive and endovascular operations, as well as amputations are associated with a significant increase of the probability of the development of major adverse cardiovascular events, the frequency of repeat hospitalizations and, finally, the cost of treatment. Prescribing pathogenetically substantiated antithrombotic therapy is considered to be one of the methods to improve the results of surgical treatment and prognosis for the patient. Presented in the article is a literature review making it possible to assess the risks and consequences of amputations in patients with PAD, as well as to determine therapy capable of improving the prognosis.
Collapse
Affiliation(s)
- V S Arakelian
- Department of Surgery for Arterial Pathology, National Medical Research Centre named after A.N. Bakulev under the RF Ministry of Public Health, Moscow, Russia
| |
Collapse
|
48
|
Hau HM, Jahn N, Brunotte M, Wagner T, Rademacher S, Branzan D, Sucher E, Seehofer D, Sucher R. Pre-operative ankle-brachial index for cardiovascular risk assessment in simultaneous pancreas-kidney transplant recipients: a simple and elegant strategy! BMC Surg 2021; 21:156. [PMID: 33752640 PMCID: PMC7983212 DOI: 10.1186/s12893-021-01159-6] [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] [Received: 01/14/2021] [Accepted: 03/15/2021] [Indexed: 12/24/2022] Open
Abstract
Background Patients with insulin-dependent diabetes mellitus type 1 (IDDM1) and end-stage kidney disease (ESKD) undergoing simultaneous pancreas kidney transplantation (SPKT) are a population with diffuse atherosclerosis and elevated risk of cardio- and cerebrovascular morbidity and mortality. We aimed to investigate the feasibility of preoperative screening for peripheral arterial disease (PAD), specifically ankle-brachial index (ABI) testing, to predict peri- and postoperative outcomes in SPKT recipients. Methods Medical data (2000–2016) from all patients with IDDM and ESKD undergoing SPKT at our transplant center were retrospectively analyzed. The correlation between PAD (defined by an abnormal ABI before SPKT and graft failure and mortality rates as primary end points, and the occurrence of acute myocardial infarction, cerebrovascular and peripheral vascular complications as secondary end points were investigated after adjustment for known cardiovascular risk factors. Results Among 101 SPKT recipients in our transplant population who underwent structured physiological arterial studies, 17 patients (17%) were diagnosed with PAD before transplantation. PAD, as defined by a low ABI index, was an independent and significant predictor of death (HR, 2.99 (95% CI 1.00–8.87), p = 0.049) and pancreas graft failure (HR, 4.3 (95% CI 1.24–14.91), p = 0.022). No significant differences were observed for kidney graft failure (HR 1.85 (95% CI 0.76–4.50), p = 0.178). In terms of the secondary outcomes, patients with PAD were more likely to have myocardial infarction, stroke, limb ischemia, gangrene or amputation (HR, 2.90 (95% CI 1.19–7.04), p = 0.019). Conclusions Pre-transplant screening for PAD and cardiovascular risk factors with non-invasive ABI testing may help to reduce perioperative complications in high-risk patients. Future research on long-term outcomes might provide more in depth insights in optimal treatment strategies for PAD among SPKT recipients.
Collapse
Affiliation(s)
- Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany. .,Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. .,Department of Surgery, University Hospital of Dresden, Fetscherstrasse 74, 03107, Dresden, Germany.
| | - Nora Jahn
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Max Brunotte
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Tristan Wagner
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Daniela Branzan
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Elisabeth Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| |
Collapse
|
49
|
Smolderen KG, Pacheco C, Provance J, Stone N, Fuss C, Decker C, Bunte M, Jelani QUA, Safley DM, Secemsky E, Sepucha KR, Spatz ES, Mena-Hurtado C, Spertus JA. Treatment decisions for patients with peripheral artery disease and symptoms of claudication: Development process and alpha testing of the SHOW-ME PAD decision aid. Vasc Med 2021; 26:273-280. [PMID: 33627058 DOI: 10.1177/1358863x20988780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with peripheral artery disease (PAD) face a range of treatment options to improve survival and quality of life. An evidence-based shared decision-making tool (brochure, website, and recorded patient vignettes) for patients with new or worsening claudication symptoms was created using mixed methods and following the International Patient Decision Aids Standards (IPDAS) criteria. We reviewed literature and collected qualitative input from patients (n = 28) and clinicians (n = 34) to identify decisional needs, barriers, outcomes, knowledge, and preferences related to claudication treatment, along with input on implementation logistics from 59 patients and 27 clinicians. A prototype decision aid was developed and tested through a survey administered to 20 patients with PAD and 23 clinicians. Patients identified invasive treatment options (endovascular or surgical revascularization), non-invasive treatments (supervised exercise therapy, claudication medications), and combinations of these as key decisions. A total of 65% of clinicians thought the brochure would be useful for medical decision-making, an additional 30% with suggested improvements. For patients, those percentages were 75% and 25%, respectively. For the website, 76.5% of clinicians and 85.7% of patients thought it would be useful; an additional 17.6% of clinicians and 14.3% of patients thought it would be useful, with improvements. Suggestions were incorporated in the final version. The first prototype was well-received among patients and clinicians. The next step is to implement the tool in a PAD specialty care setting to evaluate its impact on patient knowledge, engagement, and decisional quality. ClinicalTrials.gov Identifier: NCT03190382.
Collapse
Affiliation(s)
- Kim G Smolderen
- Department of Internal Medicine, Vascular Medicine Outcomes (VAMOS) Program, Cardiovascular Medicine Section, Yale University, New Haven, CT, USA
| | - Christina Pacheco
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jeremy Provance
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Nancy Stone
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Christine Fuss
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Carole Decker
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Matthew Bunte
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Qurat-Ul-Ain Jelani
- Department of Internal Medicine, Vascular Medicine Outcomes (VAMOS) Program, Cardiovascular Medicine Section, Yale University, New Haven, CT, USA
| | - David M Safley
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Eric Secemsky
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Karen R Sepucha
- Dana Farber/Harvard Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Erica S Spatz
- Department of Internal Medicine, Cardiovascular Medicine Section Yale University/Center for Outcomes Research and Evaluation, Yale New Haven Health Hospital, New Haven, CT, USA
| | - Carlos Mena-Hurtado
- Department of Internal Medicine, Vascular Medicine Outcomes (VAMOS) Program, Cardiovascular Medicine Section, Yale University, New Haven, CT, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| |
Collapse
|
50
|
Noble C, Carlson KD, Neumann E, Doherty S, Dragomir-Daescu D, Lerman A, Erdemir A, Young M. Evaluation of the role of peripheral artery plaque geometry and composition on stent performance. J Mech Behav Biomed Mater 2021; 116:104346. [PMID: 33529996 DOI: 10.1016/j.jmbbm.2021.104346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 11/27/2022]
Abstract
Peripheral stent fracture is a major precursor to restenosis of femoral artery atherosclerosis that has been treated with stent implantation. In this work, we validate a workflow for performing in silico stenting on a patient specific peripheral artery with heterogeneous plaque structure. Six human cadaveric femoral arteries were imaged ex vivo using intravascular ultrasound virtual histology (IVUS-VH) to obtain baseline vessel geometry and plaque structure. The vessels were then stented and the imaging repeated to obtain the stented vessel lumen area. Finite element (FE) models were then constructed using the IVUS-VH images, where the material property constants for each finite element were calculated using the proportions of each plaque component in the element, as identified by the IVUS-VH images. A virtual stent was deployed in each FE model, and the model lumen area was calculated and compared to the experimental lumen area to validate the modeling approach. The model was then used to compare stent performance for heterogeneous and homogeneous artery models, to determine whether plaque geometry or composition had added effects on stent performance. We found that the simulated lumen areas were similar to the corresponding experimental values, despite using generic material constants. Additionally, the heterogeneous and homogeneous lumen areas were also similar, implying that plaque geometry is a stronger predictor of stent expansion performance than plaque composition. Comparing stent stress and strain for heterogeneous and homogeneous models, it was found that stress from these two models had a strong linear correlation, while the strain correlation was weaker but still present. This implies that stent performance may be predicted with a simple homogeneous material models accounting for overall geometry of the plaque, providing that stent fatigue is calculated using stress criteria.
Collapse
Affiliation(s)
- Christopher Noble
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kent D Carlson
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Erica Neumann
- Department of Biomedical Engineering and Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sean Doherty
- Department of Biomedical Engineering and Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dan Dragomir-Daescu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ahmet Erdemir
- Department of Biomedical Engineering and Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melissa Young
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|