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Poredos P, Stanek A, Catalano M, Boc V. Ankle-Brachial Index: Diagnostic Tool of Peripheral Arterial Disease and Predictor of Cardiovascular Risk-An Update of Current Knowledge. Angiology 2024:33197241226512. [PMID: 38176685 DOI: 10.1177/00033197241226512] [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: 01/06/2024]
Abstract
The ankle-brachial index (ABI) was introduced as a screening method for the diagnosis of lower extremity peripheral arterial disease (PAD). Later findings recognized ABI as a prognostic marker of adverse cardiovascular events due to its relation to atherosclerosis in other vascular territories. This narrative review aims to appraise the validity, reliability, and utility of ABI in the detection of PAD and the determination of global atherosclerotic cardiovascular risk. While the ABI value can be influenced by different physiological characteristics including age, sex, body position, and techniques used for ABI determination, it has high specificity and reproducibility in the assessment of vascular patients. In conclusion, when used correctly, the ABI remains a reliable and invaluable indicator of lower-limb perfusion and a useful tool for predicting the risk of future cardiovascular events. However, its underutilization in clinical settings is noteworthy.
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Affiliation(s)
- Pavel Poredos
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Milan, Italy
| | - Agata Stanek
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Milan, Italy
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Bytom, Poland
| | - Mariella Catalano
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Milan, Italy
- Inter-University Research Centre on Vascular Diseases, University of Milan, Milan, Italy
| | - Vinko Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Sykora D, Firth C, Girardo M, Tseng A, Wennberg P, Liedl D, Shamoun F. Limb and cardiovascular event risk in type 1 and 2 diabetic patients with peripheral artery disease. VASA 2023; 52:310-316. [PMID: 37519117 DOI: 10.1024/0301-1526/a001086] [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: 08/01/2023]
Abstract
Background: Peripheral artery disease (PAD) is a risk factor for adverse limb events (LE) and cardiovascular events (CVE) that coexists with type 1 (T1) and 2 (T2) diabetes mellitus (DM). Little is known about comparative risk of LE and CVE in T1/T2 DM patients with PAD. Patients and methods: We queried our database of 40,144 patients ≥18 years old who underwent ankle brachial index (ABI) measurement from 01/1996-02/2020. We isolated T1/T2 DM patients with PAD diagnosed by ankle brachial index (ABI; low [<1.0] or elevated [>1.4]) and retrieved demographics including glycated hemoglobin (HbA1c). Primary outcomes were LE (critical limb ischemia/vascular amputation) and CVE (myocardial infarction/ischemic stroke). All-cause mortality was a secondary outcome. Multivariable Cox proportional regression yielded hazard ratios (HR) with 95% confidence intervals (CI) after adjusting for pertinent risk factors including age, hypertension, hyperlipidemia, smoking, and HbA1c. Results: Our study found 10,156 patients with PAD and DM (34% T1DM, 66% T2DM) with median follow-up time 34 mo (IQR 85 mo). T1DM patients were younger than T2DM (mean age 67 vs. 70 years), with higher median HbA1c (7.7 [IQR 1.9] vs. 6.7% [IQR 1.6]), and more prevalent hypertension, hyperlipidemia, CAD, and CKD. Antiplatelet and statin use was equivocal. Elevated ABI was more common in T1DM (47 vs. 28%). LE occurred in 23% and CVE in 12% patients. LE risk was higher in T1 than T2 DM patients (HR 1.58 [95% CI 1.44, 1.73], p<0.0001), but CVE and all-cause mortality were equivocal. These observations were preserved across ABI and HbA1c subgroup analyses. Conclusions: PAD patients with T1DM had a higher LE risk than those with T2DM, even after adjustment for glycemic control and pertinent risk factors, but CVE risk and all-cause mortality were equivocal. These data suggest a potential role for more intensive LE risk modification in PAD patients with T1DM, but further investigation is needed.
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Affiliation(s)
- Daniel Sykora
- Mayo Clinic School of Graduate Medical Education, Rochester, MN, USA
| | - Christine Firth
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
| | - Marlene Girardo
- Department of Biomedical Statistics and Informatics, Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, USA
| | - Paul Wennberg
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - David Liedl
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Fadi Shamoun
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
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3
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Prevalence and outcomes of low ankle brachial index by atherosclerotic cardiovascular disease risk level: Insights from the National Health and Nutrition Examination Survey (NHANES). Am J Med Sci 2023; 365:121-129. [PMID: 36152814 DOI: 10.1016/j.amjms.2022.08.022] [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: 09/29/2021] [Revised: 06/20/2022] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Ankle brachial index (ABI) as a risk-enhancing factor in addition to the pooled cohort equation (PCE) in assessing cardiovascular risk for primary prevention of atherosclerotic cardiovascular disease (ASCVD) is uncertain. METHODS We analyzed data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES), for 5130 participants, aged 40 and older, without known cardiovascular disease or diabetes, with available data on standard ASCVD risk and ABI. Prevalence of low ABI (ABI<0.9) and all-cause mortality in persons with low, borderline and intermediate ASCVD risk categories using PCE was assessed. RESULTS The overall prevalence of low ABI was 3.1%. The participants with low ABI were predominantly clustered in the intermediate (33%) and high (33%) ASCVD risk categories while most participants with a normal ABI were in the low (56%) and intermediate (23%) risk categories. All-cause mortality was higher among participants with low ABI compared to those with a normal ABI in both the intermediate/borderline and high-risk categories, p<0.001 but not in the low-risk ASCVD category, p = 0.323. CONCLUSIONS Using the PCE, two-third of the participants with low ABI were classified as having a low, borderline or intermediate risk of ASCVD. Low ABI was associated with an increased all-cause mortality in the overall cohort and specifically among those with a borderline/intermediate or high risk of ASCVD but not in those with a low risk of ASCVD. Our study supports consideration of ABI as a risk enhancer for primary prevention among patients classified as borderline or intermediate risk of ASCVD.
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Sykora D, Firth C, Girardo M, Bhatt S, Tseng A, Chamberlain A, Liedl D, Wennberg P, Shamoun FE. Peripheral artery disease and the risk of venous thromboembolism. VASA 2022; 51:365-371. [DOI: 10.1024/0301-1526/a001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Summary: Background: Peripheral artery disease (PAD) impacts 3–12% of patients worldwide and is characterized by endothelial dysfunction and inflammatory pathways which are also common to venous thromboembolism (VTE), but there is a paucity of evidence regarding VTE risk in PAD patients. We investigated whether PAD is an independent risk factor for VTE. Patients and methods: We reviewed medical records of patients undergoing ABI studies at Mayo Clinic from 01/1996-02/2020. We classified patients by ABI (low [<1.0], normal [1.0–1.4], or elevated [>1.4]), as well as by specific low ABI subgroup: severely reduced (ABI: 0.00–0.39), moderately reduced (0.40–0.69), mildly reduced (0.70–0.90), and borderline reduced (0.91–0.99). The primary outcome was incident VTE event (acute lower extremity deep vein thrombosis or pulmonary embolism) after ABI measurement. Multivariable Cox proportional regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI) after adjusting for age, sex, active smoking, cancer, previous VTE, thrombophilia, anticoagulation, and revascularization. Results: 39,834 unique patients (mean age 66.3±14.3 years, median follow-up 34 months) were identified. 2,305 VTE events occurred in patients without PAD (13.0%), 2,218 in low ABI patients (13.0%), and 751 in elevated ABI patients (14.8%). After risk factor adjustment, VTE risk was modestly increased for PAD overall (HR: 1.12, 95% CI [1.06, 1.18]), including low ABI (HR: 1.11, 95% CI [1.04, 1.18]) and elevated ABI groups (HR: 1.15, 95% CI [1.04, 1.26]), compared to patients without PAD. The greatest VTE risk was in severely low ABI patients (HR: 1.46, 95% CI [1.31, 1.64]). Conclusions: In a large longitudinal cohort, we present strong clinical evidence of PAD, with low and elevated ABI, as an independent VTE risk factor, with the highest risk seen in patients with severely low ABI. Continued research is required to further investigate this relationship and its intersection with functional performance status to optimize VTE risk reduction or anticoagulation strategies in the PAD population.
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Affiliation(s)
- Daniel Sykora
- Mayo Clinic School of Graduate Medical Education, Rochester, MN, USA
| | - Christine Firth
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
| | - Marlene Girardo
- Department of Biomedical Statistics and Informatics, Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Shubhang Bhatt
- Mayo Clinic School of Graduate Medical Education, Scottsdale, AZ, USA
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - David Liedl
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Paul Wennberg
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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5
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Tóth-Vajna Z, Tóth-Vajna G, Vajna A, Járai Z, Sótonyi P. One-year follow-up of patients screened for lower extremity arterial disease. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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6
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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]
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7
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McBane RD, Murphree DH, Liedl D, Lopez-Jimenez F, Attia IZ, Arruda-Olson A, Scott CG, Prodduturi N, Nowakowski SE, Rooke TW, Casanegra AI, Wysokinski WE, Swanson KE, Houghton DE, Bjarnason H, Wennberg PW. Artificial intelligence for the evaluation of peripheral artery disease using arterial Doppler waveforms to predict abnormal ankle-brachial index. Vasc Med 2022; 27:333-342. [PMID: 35535982 DOI: 10.1177/1358863x221094082] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with peripheral artery disease (PAD) are at increased risk for major adverse limb and cardiac events including mortality. Developing screening tools capable of accurate PAD identification is a necessary first step for strategies of adverse outcome prevention. This study aimed to determine whether machine analysis of a resting Doppler waveform using deep neural networks can accurately identify patients with PAD. METHODS Consecutive patients (4/1/2015 - 12/31/2020) undergoing rest and postexercise ankle-brachial index (ABI) testing were included. Patients were randomly allocated to training, validation, and testing subsets (70%/15%/15%). Deep neural networks were trained on resting posterior tibial arterial Doppler waveforms to predict normal (> 0.9) or PAD (⩽ 0.9) using rest and postexercise ABI. A separate dataset of 151 patients who underwent testing during a period after the model had been created and validated (1/1/2021 - 3/31/2021) was used for secondary validation. Area under the receiver operating characteristic curves (AUC) were constructed to evaluate test performance. RESULTS Among 11,748 total patients, 3432 patients met study criteria: 1941 with PAD (mean age 69 ± 12 years) and 1491 without PAD (64 ± 14 years). The predictive model with highest performance identified PAD with an AUC 0.94 (CI = 0.92-0.96), sensitivity 0.83, specificity 0.88, accuracy 0.85, and positive predictive value (PPV) 0.90. Results were similar for the validation dataset: AUC 0.94 (CI = 0.91-0.98), sensitivity 0.91, specificity 0.85, accuracy 0.89, and PPV 0.89 (postexercise ABI comparison). CONCLUSION An artificial intelligence-enabled analysis of a resting Doppler arterial waveform permits identification of PAD at a clinically relevant performance level.
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Affiliation(s)
- Robert D McBane
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Cardiovascular Department, Mayo Clinic, Rochester, MN, USA
| | - Dennis H Murphree
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
| | - David Liedl
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Francisco Lopez-Jimenez
- Cardiovascular Department, Mayo Clinic, Rochester, MN, USA.,Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Itzhak Zachi Attia
- Cardiovascular Department, Mayo Clinic, Rochester, MN, USA.,Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Thom W Rooke
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Cardiovascular Department, Mayo Clinic, Rochester, MN, USA
| | - Ana I Casanegra
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Cardiovascular Department, Mayo Clinic, Rochester, MN, USA
| | - Waldemar E Wysokinski
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Cardiovascular Department, Mayo Clinic, Rochester, MN, USA
| | - Keith E Swanson
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Cardiovascular Department, Mayo Clinic, Rochester, MN, USA
| | - Damon E Houghton
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Cardiovascular Department, Mayo Clinic, Rochester, MN, USA
| | - Haraldur Bjarnason
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - Paul W Wennberg
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Cardiovascular Department, Mayo Clinic, Rochester, MN, USA
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8
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Cardiovascular and metabolic changes in Brazilian truck drivers. JOURNAL OF VASCULAR NURSING 2022; 40:112-116. [DOI: 10.1016/j.jvn.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 05/20/2021] [Accepted: 05/01/2022] [Indexed: 12/24/2022]
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9
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Caicedo D, Alvarez CV, Perez-Romero S, Devesa J. The Inflammatory Pattern of Chronic Limb-Threatening Ischemia in Muscles: The TNF-α Hypothesis. Biomedicines 2022; 10:biomedicines10020489. [PMID: 35203700 PMCID: PMC8962305 DOI: 10.3390/biomedicines10020489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/23/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Vascular inflammation plays a crucial role in peripheral arterial disease (PAD), although the role of the mediators involved has not yet been properly defined. The aim of this work is to investigate gene expression and plasma biomarkers in chronic limb-threating ischemia (CLTI). Methods: Using patients from the GHAS trial, both blood and ischemic muscle samples were obtained to analyze plasma markers and mRNA expression, respectively. Statistical analysis was performed by using univariate (Spearman, t-Student, and X2) and multivariate (multiple logistic regression) tests. Results: A total of 35 patients were available at baseline (29 for mRNA expression). Baseline characteristics (mean): Age: 71.4 ± 12.4 years (79.4% male); TNF-α: 10.7 ± 4.9 pg/mL; hsCRP:1.6 ± 2.2 mg/dL; and neutrophil-to-lymphocyte ratio (NLR): 3.5 ± 2.8. Plasma TNF-α was found elevated (≥8.1) in 68.6% of patients, while high hsCRP (≥0.5) was found in 60.5%. Diabetic patients with a high level of inflammation showed significantly higher levels of NOX4 expression at baseline (p = 0.0346). Plasma TNF-α had a negative correlation with NOS3 (eNOS) expression (−0.5, p = 0.015) and plasma hsCRP with VEGFA (−0.63, p = 0.005). The expression of NOX4 was parallel to that of plasma TNF-α (0.305, p = 0.037), especially in DM. Cumulative mortality at 12 months was related to NLR ≥ 3 (p = 0.019) and TNF-α ≥ 8.1 (p = 0.048). The best cutoff point for NLR to predict mortality was 3.4. Conclusions: NOX4 and TNF-α are crucial for the development and complications of lower limb ischemia, especially in DM. hsCRP could have a negative influence on angiogenesis too. NLR and TNF-α represent suitable markers of mortality in CLTI. These results are novel because they connect muscle gene expression and plasma information in patients with advanced PAD, deepening the search for new and accurate targets for this condition.
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Affiliation(s)
- Diego Caicedo
- Angiology and Vascular Surgery Department, Complejo Hospitalario de Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Correspondence: ; Tel.: +34-981-950-043
| | - Clara V. Alvarez
- Neoplasia & Endocrine Differentiation P0L5, Centro de Investigación en Medicina Molecular y Enferme-dades Crónicas (CIMUS), University of Santiago de Compostela (USC), 15783 Santiago de Compostela, Spain; (C.V.A.); (S.P.-R.)
| | - Sihara Perez-Romero
- Neoplasia & Endocrine Differentiation P0L5, Centro de Investigación en Medicina Molecular y Enferme-dades Crónicas (CIMUS), University of Santiago de Compostela (USC), 15783 Santiago de Compostela, Spain; (C.V.A.); (S.P.-R.)
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10
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Détriché G, Guédon A, Mohamedi N, Sellami O, Cheng C, Galloula A, Goudot G, Khider L, Mortelette H, Sitruk J, Gendron N, Sapoval M, Julia P, Smadja DM, Mirault T, Messas E. Women Specific Characteristics and 1-Year Outcome Among Patients Hospitalized for Peripheral Artery Disease: A Monocentric Cohort Analysis in a Tertiary Center. Front Cardiovasc Med 2022; 9:824466. [PMID: 35198617 PMCID: PMC8858944 DOI: 10.3389/fcvm.2022.824466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/17/2022] [Indexed: 12/24/2022] Open
Abstract
Although women have lower age-standardized cardiovascular disease incidence, prevalence, and death-related rates than men, there are also reports indicating that women with cardiovascular disease receive less care, fewer investigations, and have poorer outcomes after a coronary event. The aims of this study were to compare the characteristics of men and women hospitalized for peripheral artery disease (PAD), their cardiovascular and limb outcomes, and their 1-year mortality. The study is a prospective registry collecting data about all consecutive patients hospitalized for PAD within the vascular department of the tertiary center Georges-Pompidou European Hospital (Paris, France). Patients were required to have one of three inclusion criteria: previous revascularization of the lower limb or any lower limb artery occlusion due to an atherosclerotic vascular disease or hemodynamic evidence of PAD. Exclusion criteria were patients with lower extremity arterial occlusion due to another cause. All patients were followed-up for at least 12 months after the initial hospitalization. Among the 235 patients included, there were 61 women (26%), older than men with a median age of 75.6 and 68.3 years, respectively. Main cardiovascular risk factors and comorbidities were similar for men and women except more former or current smokers [145 (83.4%) vs. 33 (54.1%)] and more history of coronary heart disease [42 (24.1%) vs. 7 (11.5%)] in men. Most patients [138 (58.8%)] had critical limb ischemia and 97 (41.3%) had claudication, with no difference for sex. After discharge, 218 patients received an antithrombotic therapy (93.2%), 195 a lipid-lowering drug (83.3%), 185 an angiotensin converting enzyme inhibitor or angiotensin-receptor blocker (78.9%), similarly between sex. At 1-year, overall mortality, major adverse cardiovascular events, major adverse limb events did not differ with 23 (13.2%), 11 (6.3%) and 32 (18.4%) in men, and 8 (13.1%), 3 (4.9%), 15 (24.6%) in women, respectively, despite the difference in age. Overall mortality, cardiovascular outcomes, limb revascularization or amputation did not differ between men and women, 1-year after hospitalization for PAD although the latter were older, less smoker and had less coronary artery disease. Due to the small size of this cohort, larger studies and future research are needed to better understand sex-specific mechanisms in the pathophysiology and natural history of PAD.
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Affiliation(s)
- Grégoire Détriché
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
- *Correspondence: Grégoire Détriché
| | - Alexis Guédon
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Nassim Mohamedi
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Olfa Sellami
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Charles Cheng
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Alexandre Galloula
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Guillaume Goudot
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
- Université de Paris, Paris Research Cardiovascular Center (PARCC), INSERM U970, Paris, France
| | - Lina Khider
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
| | - Hélène Mortelette
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Jonas Sitruk
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Nicolas Gendron
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
- Hematology Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Marc Sapoval
- Université de Paris, Paris Research Cardiovascular Center (PARCC), INSERM U970, Paris, France
- Interventional Radiology Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Universit de Paris (APHP-CUP), Paris, France
| | - Pierre Julia
- Université de Paris, Paris Research Cardiovascular Center (PARCC), INSERM U970, Paris, France
- Vascular Surgery Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - David M. Smadja
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
- Hematology Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Tristan Mirault
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
- Université de Paris, Paris Research Cardiovascular Center (PARCC), INSERM U970, Paris, France
| | - Emmanuel Messas
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
- Université de Paris, Paris Research Cardiovascular Center (PARCC), INSERM U970, Paris, France
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Yamaji K, Iwanaga Y, Kawamura T, Fujita K, Yasuda M, Takase T, Hirase C, Ueno M, Nakazawa G. Plaque characteristics and prognosis in patients with peripheral arterial disease by angioscopic analysis. J Cardiol 2022; 80:94-100. [DOI: 10.1016/j.jjcc.2022.02.004] [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: 10/23/2021] [Revised: 01/11/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
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12
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Kulkarni A, Jawahar A, Krishnamurthy V, Kumar TA. Study of Ankle–Brachial index among the patients of metabolic syndrome. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_804_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
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13
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Disparate effects of ankle-brachial index on mortality in the 'very old' and 'younger old' populations-the PolSenior survey. Heart Vessels 2021; 37:665-672. [PMID: 34643792 PMCID: PMC8917102 DOI: 10.1007/s00380-021-01949-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/24/2021] [Indexed: 12/29/2022]
Abstract
To assess the relationship between ankle-brachial index (ABI) and up to 10-year mortality in older individuals below and above the age of 80 years. In a multicenter survey of health status in the community dwelling subjects aged 55-59 and 65 + years in Poland, we assessed baseline medical history including risk-factors. We measured ABI, and serum creatinine, cholesterol, NT-proBNP, and interleukin-6 (IL-6) concentrations. We assessed mortality based on public registry. Between 2009 and 2019, 27.3% of 561 participants < 80 years, and 79.4% of 291 participants ≥ 80 years, died (p < 0.001); 67.8, 41.5, and 40.3% in the ABI groups < 0.9, 0.9-1.4, and > 1.4, respectively (p < 0.01). In the unadjusted Cox models, ABI was associated with mortality in the entire group, and < 80 years. In the entire group, analysis adjusted for age and sex showed mortality risk increased by 11% per year, and 50% with male sex. Mortality decreased by 37% per 1 unit ABI increase. In the group of people ≥ 80 years, only age was significantly associated with mortality (p < 0.001). In stepwise regression ABI < 0.9, male sex, active smoking, and NT-proBNP level were associated with risk of death < 80 years. In the ≥ 80 years old, mortality risk was associated with older age, and higher levels of IL-6, but not ABI. The ABI < 0.9 is associated with higher mortality in older people, but not among the oldest-old. In the oldest age group, age is the strongest predictor of death. In this age group, inflammageing is of importance.
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Rymer JA, Mulder H, Narcisse DI, Rockhold F, Hiatt WR, Fowkes FG, Baumgartner I, Berger JS, Katona BG, Mahaffey K, Norgren L, Blomster JI, Jones WS, Patel MR. Association of Disease Progression With Cardiovascular and Limb Outcomes in Patients With Peripheral Artery Disease: Insights From the EUCLID Trial. Circ Cardiovasc Interv 2020; 13:e009326. [PMID: 33040584 DOI: 10.1161/circinterventions.120.009326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with peripheral artery disease have a high risk of future cardiovascular disease events and mortality. Little is known about the changes in symptom classification over time in patients with peripheral artery disease and the association of changes in symptom classification with subsequent cardiovascular disease events. METHODS In this analysis of the EUCLID trial (Examining Use of Ticagrelor in Peripheral Artery Disease), we examined the changes in Rutherford classification (RC) of patients over 12 months. We examined the baseline characteristics of patients by change in symptom classification at 12 months (improved=decreased RC, no change, or worsened=increased RC), and the association between changes in symptom classification (RC) at 12 months and subsequent cardiovascular disease events. RESULTS Among 12 759 patients, 3240 (25%) were classified as improved by RC at 12 months, 8132 (64%) as no change, and 1387 (11%) as worsened. At 12 months, many patients who were asymptomatic or had mild/moderate claudication at enrollment had no change in symptom classification over 12 months (73.7% and 70.9%). Patients who worsened over 12 months were more likely to have comorbidities (diabetes mellitus and prior myocardial infarction) and more events (myocardial infarction, amputation, and major bleeding) by 12 months postrandomization, all P<0.001. Worsened symptom classification over 12 months was associated with increased risk of all-cause death (adjusted hazard ratio, 1.29 [95% CI, 1.03-1.62]), major amputation (adjusted hazard ratio, 4.12 [95% CI, 2.46-6.88]), and a composite of cardiovascular death, myocardial infarction, or stroke (adjusted hazard ratio, 1.30 [95% CI, 1.05-1.62]), all P<0.05 after 12 months postrandomization. CONCLUSIONS Patients with comorbidities and prior history of cardiovascular disease events at baseline and within the first 12 months of the trial were more likely to have worsened symptom classification at 12 months. Worsening symptom classification over 12 months was associated subsequently with an increased risk of all-cause death, amputation, and a composite of cardiovascular death, myocardial infarction, or stroke. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Jennifer A Rymer
- Division of Cardiology, Duke University Medical Center, Durham, NC (J.A.R., D.I.N., W.S.J., M.R.P.)
| | - Hillary Mulder
- Duke Clinical Research Institute, Durham, NC (H.M., F.R.)
| | - Dennis I Narcisse
- Division of Cardiology, Duke University Medical Center, Durham, NC (J.A.R., D.I.N., W.S.J., M.R.P.)
| | - Frank Rockhold
- Duke Clinical Research Institute, Durham, NC (H.M., F.R.)
| | - William R Hiatt
- University of Colorado School of Medicine, CPC Clinical Research, Aurora (W.R.H.)
| | - F Gerry Fowkes
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (F.G.F)
| | | | - Jeffrey S Berger
- Division of Cardiology, NYU Langone Health, New York, NY (J.S.B.)
| | | | - Kenneth Mahaffey
- Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.M.)
| | - Lars Norgren
- Faculty of Medicine and Health, Orebro University, Sweden (L.N.)
| | | | - W Schuyler Jones
- Division of Cardiology, Duke University Medical Center, Durham, NC (J.A.R., D.I.N., W.S.J., M.R.P.)
| | - Manesh R Patel
- Division of Cardiology, Duke University Medical Center, Durham, NC (J.A.R., D.I.N., W.S.J., M.R.P.)
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Abstract
An estimated 237 million people suffer from peripheral arterial disease (PAD), which is associated with high morbidity and mortality, and prevalence is still increasing. Currently, we do not have any randomized trials that compare screening to no screening specifically for PAD in the general population. Presently, PAD screening is not generally established. This systematic review gives an overview of relevant literature and guidelines. Screening usually focuses on ankle-brachial index (ABI)-measurement, which enables detection of asymptomatic and symptomatic PAD, but has limitations in diabetics. There are no sufficient data on PAD screening. Guideline recommendations are heterogeneous. While some advocate no screening until better data are available, most recommend selective screening despite insufficient data on morbidity and mortality reduction in consequence of screening. We support the only evidence-based screening strategy for PAD: combined screening for abdominal aortic aneurysm (AAA), PAD and arterial hypertension in men aged 65-74 according to the VIVA study. We additionally suggest a new simple three-step screening strategy for symptomatic PAD in all individuals aged 40 and older, who see a general practitioner: Asking one question ("Do you have pain or cramps in the legs during normal walking?") followed by physical examination (normal lower extremity pulse status?) in those, whose answer is "yes", and ABI measurement unless all pulses are normal.
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Affiliation(s)
- Arne G Kieback
- Medical University Department, Division of Angiology, Kantonsspital Aarau, Aargau, Switzerland
| | - Roman Gähwiler
- Medical University Department, Division of Angiology, Kantonsspital Aarau, Aargau, Switzerland
| | - Christoph Thalhammer
- Medical University Department, Division of Angiology, Kantonsspital Aarau, Aargau, Switzerland
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Siasos G, Skotsimara G, Oikonomou E, Sagris M, Vasiliki-Chara M, Bletsa E, Stampouloglou P, Theofilis P, Charalampous G, Tousoulis D. Antithrombotic Treatment in Diabetes Mellitus: A Review of the Literature about Antiplatelet and Anticoagulation Strategies Used for Diabetic Patients in Primary and Secondary Prevention. Curr Pharm Des 2020; 26:2780-2788. [PMID: 32303164 DOI: 10.2174/1381612826666200417145605] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/10/2020] [Indexed: 02/06/2023]
Abstract
Background:
Diabetes mellitus (DM) is on the rise globally. Its prevalence has nearly doubled
during the last two decades and it is estimated to affect 8.8% of the global population.
Cardiovascular disease (CVD) is the leading cause of death in diabetic population and despite
modern anti-inflammatory and cardioprotective therapeutic strategies diabetic patients have at
least a twice fold risk of cardiovascular events. Prothrombotic state in DM is associated with
multiple determinants such as platelet alterations, oxidative stress, endothelial changes,
circulating mediators. Thus, proper antithrombotic strategies to reduce the risk of CVD in this
population is critical.
Methods:
This article reviews the current antiplatelet and anticoagulant
agents in the aspect of primary and secondary prevention of CVD in the diabetic population.
Results:
The use of aspirin may be considered only at high-risk patients in the absence of
contraindications. Cangrelor was not inferior to clopidogrel in preventing the composite outcome
of CV death, myocardial infraction and revascularization without increasing major bleeding.
Triple therapy in the subpopulation with DM significantly reduced the composite primary
outcome of CV death, myocardial infraction or repeat target lesion revascularization. That was
not the case for stent thrombosis, which was similar in both groups. Importantly, triple therapy
did not result in increased bleeding complications, which were similar in both groups. However,
cilostazol is linked to various adverse effects (e.g., headache, palpitations, and gastrointestinal
disturbances) that drive many patients to withdrawal.
Conclusion:
In conclusion, DM is a
rapidly growing disease that increases the risk of CVD, AF, and CV mortality. Proper
antithrombotic strategies to reduce CVD risk in DM is a necessity. Also, new antithrombotic
treatments and combination therapies may play a critical role to overcome antiplatelet resistance
in DM patients and reduce morbidity and mortality attributed to CVD.
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Affiliation(s)
- Gerasimos Siasos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Georgia Skotsimara
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Evangelos Oikonomou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Marios Sagris
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Mystakidi Vasiliki-Chara
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Evanthia Bletsa
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Panagiota Stampouloglou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Panagiotis Theofilis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Georgios Charalampous
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
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Dopheide JF, Ramadani H, Adam L, Gahl B, Papac L, Veit J, Kaspar M, Schindewolf M, Baumgartner I, Drexel H. Development of a 3-Dimensional Prognostic Score for Patients With Symptomatic Peripheral Artery Disease: PAD 3D Score. Angiology 2020; 71:658-665. [PMID: 32342699 DOI: 10.1177/0003319720920155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Peripheral artery disease (PAD) is a high-risk condition for cardiovascular (CV) events, but no specific prognosis assessment tool exists. We developed an individual risk score (PAD3D) based on the combined predictive value for mortality, including (1) age, (2) severity of PAD, and (3) extent of atherosclerosis. Patients (n = 1310) with symptomatic PAD were followed up for a mean of 50 ± 26 months. The cohort was randomly subdivided into a test and validation cohort. All-cause and CV mortality were prospectively analyzed for PAD3D score and in combination with classical risk factors. For the test and validation cohort (n = 655 each), all-cause and CV mortality were predicted (P < .001) by the PAD3D score. Additional inclusion of classical risk factors did not increase discrimination compared with PAD3D as "area under receiver-operating characteristic" curves were similar for both scores at any time point. Thus, the addition of the classical risk factors to PAD3D did not further improve the prognostic value. The PAD3D score provides a risk gradient of a 4.5-fold increase in all-cause and CV mortality. We developed a score for precise prediction of all-cause and CV mortality. The PAD3D score promises to allow for personalized goals in risk intervention.
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Affiliation(s)
- Jörn F Dopheide
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Hana Ramadani
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Luise Adam
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Lucija Papac
- Division of Cardiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jonas Veit
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Mathias Kaspar
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Marc Schindewolf
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.,Drexel University College of Medicine, Philadelphia, PA, USA
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18
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External validation of the Vascular Quality Initiative prediction model for survival in no-option chronic limb-threatening ischemia patients. J Vasc Surg 2020; 72:1659-1666.e1. [PMID: 32249040 DOI: 10.1016/j.jvs.2020.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Chronic limb-threatening ischemia (CLTI) is associated with high morbidity and mortality rates. More than 50% of all CLTI patients die within 5 years after presentation. Patient-specific survival prediction is critical for informing treatment strategies, even for those without a clear option for revascularization. We validated a survival prediction model, developed in a revascularized Vascular Quality Initiative (VQI) cohort, in a Western European no-option CLTI cohort. METHODS The VQI survival prediction model was applied to the validation cohort (N = 150) to compare estimated mortality and observed mortality at 2 years after baseline. Performance of the VQI model was tested by evaluating discrimination using the receiver operating characteristic area under the curve and calibration using the Hosmer-Lemeshow goodness-of-fit test. RESULTS The 2-year survival rate was 79% in the validation cohort compared with 83% in the VQI cohort. Baseline characteristics were significantly different for 13 of 17 variables. The C statistic was 0.86 (95% confidence interval, 0.78-0.95), which indicates good discrimination. The Hosmer-Lemeshow goodness-of-fit test had a P value of .30, which indicates good fit. CONCLUSIONS This is the first external validation of the VQI survival prediction model. The good model performance suggests that this model can be used in different CLTI populations, including no-option CLTI, and underlines its contributory role in this challenging population.
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19
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Park JW, Lee JH. Prevalence and Risk Factors of Peripheral Arterial Disease in Patients with Lumbar Spinal Stenosis and Intermittent Claudication: CT Angiography Study. J Korean Med Sci 2020; 35:e87. [PMID: 32242344 PMCID: PMC7131903 DOI: 10.3346/jkms.2020.35.e87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/05/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND It can be difficult to differentiate between vascular and neurogenic intermittent claudication. The exact diagnosis often cannot be made on clinical evidence and ultimately requires imaging. Perioperative screening for peripheral arterial disease (PAD) in lumbar spinal stenosis (LSS) patients is important because untreated PAD increases the risk of severe vascular events. The aims of this study were to study the prevalence of PAD in LSS patients with symptoms of intermittent claudication, and to study the independent risk factors for PAD. We specified the cases where it was necessary to perform computed tomography angiography (CTA) as a preoperative screening tool in surgery for spinal stenosis. METHODS This study involved a retrospective analysis of 186 consecutive subjects with radiographic evidence of LSS and symptoms of intermittent claudication, who underwent 3D CTA of the lower extremities at our institution during a three-year period. More than 50% luminal narrowing on CT angiograms was determined to be clinically significant and placed in the PAD group. RESULTS Thirty-two subjects were diagnosed with PAD and referred to the general vascular team in our hospital, where they received treatment for PAD. In the non-PAD group (154 subjects), 117 underwent definitive surgery for spinal stenosis such as posterior lumbar interbody fusion and a further 37 underwent conservative treatment. Only hypertension, diabetes, and men gender were found to be statistically significant predictors of PAD. CONCLUSION The current study showed that man gender, diabetes and hypertension were the greatest risk factors for PAD. We conclude that man patients with diabetes and/or hypertension should be put under serious consideration for routine CTA examination when under evaluation for LSS and intermittent claudication.
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Affiliation(s)
- Jin Woo Park
- Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Ji Ho Lee
- Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
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Farkas K, Kolossváry E, Járai Z. Simple assessment of quality of life and lower limb functional capacity during cilostazol treatment – results of the SHort-tERm cIlostazol eFFicacy and quality of life (SHERIFF) study. VASA 2020; 49:235-242. [DOI: 10.1024/0301-1526/a000845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Summary: Background: Symptomatic peripheral arterial disease (intermittent claudication) is a major cause of disability and mobility loss in older men and women and thus has a significant negative impact on the patients’ quality of life. Both surgical and endovascular revascularization procedures and noninvasive medical therapies, such as supervised training and drug treatment, can improve walking capacity. Cilostazol is the only drug having a class I (level of evidence A) recommendation for the treatment of intermittent claudication (IC). The aim of this study was to evaluate the effect of three-month cilostazol treatment on the health-related quality of life and on the lower limb functional capacity in patients with IC in the clinical practice. Patients and methods: The study was a multicenter, non-interventional trial, performed in Hungary in 2018. 812 PAD patients (Fontaine II stage, mean age: 67.17 years, male/female: 58.25/41.75 %) were enrolled, who received cilostazol (50 or 100 mg b.i.d.) for 3 months. 802 patients completed the study. Quality of life was evaluated with the EQ-5D-3L questionnaire functional capacity with the WELCH (Walking Estimated-Limitation Calculated by History) questionnaire. Pain-free and maximal walking distance, ankle-brachial index (ABI) were measured at baseline and after 3-month treatment. Results: Upon conclusion of the study, the EQ-5D-3L index improved (baseline: –0.46 ± 0.22, 3rd month: –0.26 ± 0.18; p < 0.0001) and there was a significant increase in the WELCH score as well (19 ± 14, 31 ± 18; respectively, p < 0.0001). Both pain-free and maximal walking distance improved significantly by 54.52 % (median: 53.85 %) and 42.5 % (median: 34.68 %); respectively (p < 0.001). Adverse events occurred in 10 patients, 1 patient stopped cilostazol treatment because of side effects. Conclusions: Three months cilostazol treatment significantly improved quality of life and lower limb functional capacity in patients with intermittent claudication. The WELCH questionnaire is a useful tool for the evaluation of intermittent claudication treatment in the clinical practice.
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Affiliation(s)
- Katalin Farkas
- Department of Angiology, Szent Imre University Teaching Hospital, Budapest, Hungary
| | - Endre Kolossváry
- Department of Angiology, Szent Imre University Teaching Hospital, Budapest, Hungary
| | - Zoltán Járai
- Department of Cardiology, Szent Imre University Teaching Hospital, Budapest, Hungary
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Hsu PC, Lee WH, Tsai WC, Chen YC, Chi NY, Chang CT, Chu CY, Lin TH, Lee CS, Lai WT, Sheu SH, Su HM. Upstroke Time Per Cardiac Cycle as A Novel Parameter for Mortality Prediction in Patients with Acute Myocardial Infarction. J Clin Med 2020; 9:jcm9040904. [PMID: 32218225 PMCID: PMC7231203 DOI: 10.3390/jcm9040904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Acute myocardial infarction (AMI) is one of the leading causes of death in the world. How to simply predict mortality for AMI patients is important because the appropriate treatment should be done for the patients with higher risk. Recently, a novel parameter of upstroke time per cardiac cycle (UTCC) in lower extremities was reported to be a good predictor of peripheral artery disease and mortality in elderly. However, there was no literature discussing the usefulness of UTCC for prediction of cardiovascular (CV) and overall mortality in AMI patients. Methods: 184 AMI patients admitted to the cardiac care unit were enrolled. Ankle-brachial index (ABI) and UTCC were measured by an ABI-form device in the same day of admission. Results: The median follow-up to mortality was 71 months. There were 36 CV and 124 overall mortality. Higher UTCC was associated with increased CV and overall mortality after multivariable analysis (P = 0.033 and P < 0.001, respectively). However, ABI was only associated with CV mortality and overall mortality in the univariable analysis but became insignificant after the multivariable analysis. In addition, after adding UTCC into a basic model including important clinical parameters, left ventricular ejection fraction, Charlson comorbidity index, and ABI, we found the basic model + UTCC had a better predictive value for overall mortality than the basic model itself (P < 0.001). Conclusions: Our study is the first one to evaluate the usefulness of UTCC in AMI patients for prediction of long-term mortality. Our study showed UTCC was an independent predictor of long-term CV and overall mortality and had an additive predictive value for overall mortality beyond conventional parameters. Therefore, screening AMI patients by UTCC might help physicians to identify the high-risk group with increased mortality.
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Affiliation(s)
- Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (W.-H.L.); (W.-C.T.); (Y.-C.C.); (N.-Y.C.); (C.-S.L.); (W.-T.L.); (S.-H.S.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Wen-Hsien Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (W.-H.L.); (W.-C.T.); (Y.-C.C.); (N.-Y.C.); (C.-S.L.); (W.-T.L.); (S.-H.S.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan
| | - Wei-Chung Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (W.-H.L.); (W.-C.T.); (Y.-C.C.); (N.-Y.C.); (C.-S.L.); (W.-T.L.); (S.-H.S.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ying-Chih Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (W.-H.L.); (W.-C.T.); (Y.-C.C.); (N.-Y.C.); (C.-S.L.); (W.-T.L.); (S.-H.S.)
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan
| | - Nai-Yu Chi
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (W.-H.L.); (W.-C.T.); (Y.-C.C.); (N.-Y.C.); (C.-S.L.); (W.-T.L.); (S.-H.S.)
| | - Ching-Tang Chang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (W.-H.L.); (W.-C.T.); (Y.-C.C.); (N.-Y.C.); (C.-S.L.); (W.-T.L.); (S.-H.S.)
| | - Chun-Yuan Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (W.-H.L.); (W.-C.T.); (Y.-C.C.); (N.-Y.C.); (C.-S.L.); (W.-T.L.); (S.-H.S.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (W.-H.L.); (W.-C.T.); (Y.-C.C.); (N.-Y.C.); (C.-S.L.); (W.-T.L.); (S.-H.S.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chee-Siong Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (W.-H.L.); (W.-C.T.); (Y.-C.C.); (N.-Y.C.); (C.-S.L.); (W.-T.L.); (S.-H.S.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (W.-H.L.); (W.-C.T.); (Y.-C.C.); (N.-Y.C.); (C.-S.L.); (W.-T.L.); (S.-H.S.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Sheng-Hsiung Sheu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (W.-H.L.); (W.-C.T.); (Y.-C.C.); (N.-Y.C.); (C.-S.L.); (W.-T.L.); (S.-H.S.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ho-Ming Su
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (W.-H.L.); (W.-C.T.); (Y.-C.C.); (N.-Y.C.); (C.-S.L.); (W.-T.L.); (S.-H.S.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-8036783-3441; Fax: +886-7-8063346
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Abstract
BACKGROUND Glucose variability is predictive of cardiovascular events and all-cause mortality. However, the association between peripheral artery disease and glucose variability has not been thoroughly investigated. Therefore, the standard deviation of annual haemoglobin A1c was assessed in patients with type 2 diabetes for evaluating the different risks of peripheral artery disease. METHODS A total of 4144 patients underwent an evaluation for the ankle-brachial index and the percentage of mean arterial pressure at the ankle. The first haemoglobin A1c record was retrospectively collected from each year until the ankle-brachial index measurement. RESULTS The standard deviation of annual haemoglobin A1c was higher in patients with ankle-brachial index ⩽0.90 than in those with ankle-brachial index >0.90 (1.1 ± 0.9% vs 1.0 ± 0.8%, p = 0.009) and was higher in patients with percentage of mean arterial pressure ⩾45% than in those with percentage of mean arterial pressure <45% (1.1 ± 0.8% vs 1.0 ± 0.8%, p = 0.007). A high standard deviation and mean of annual haemoglobin A1c are associated with high-risk peripheral artery disease, which is defined as a combination of ankle-brachial index ⩽0.90, percentage of mean arterial pressure ⩾45% or both (odds ratio = 1.306; 95% confidence interval = 1.057-1.615; p = 0.014). CONCLUSION Fluctuation in the haemoglobin A1c value indicates higher risk for peripheral artery disease in patients with type 2 diabetes and poor glucose control.
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Affiliation(s)
- I-Te Lee
- Division of Endocrinology and
Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital,
Taichung City
- School of Medicine, National Yang-Ming
University, Taipei City
- School of Medicine, Chung Shan Medical
University, Taichung City
- College of Science, Tunghai University,
Taichung City
- I-Te Lee, Division of Endocrinology and
Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital,
No. 1650, Section 4, Taiwan Boulevard, Taichung 40705.
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Lee JJ, Heo JH, Han JH, Kim BR, Gwon HY, Yoon YR. Prediction of Ankle Brachial Index with Photoplethysmography Using Convolutional Long Short Term Memory. J Med Biol Eng 2020. [DOI: 10.1007/s40846-020-00507-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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24
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Frank U, Nikol S, Belch J, Boc V, Brodmann M, Carpentier PH, Chraim A, Canning C, Dimakakos E, Gottsäter A, Heiss C, Mazzolai L, Madaric J, Olinic DM, Pécsvárady Z, Poredoš P, Quéré I, Roztocil K, Stanek A, Vasic D, Visonà A, Wautrecht JC, Bulvas M, Colgan MP, Dorigo W, Houston G, Kahan T, Lawall H, Lindstedt I, Mahe G, Martini R, Pernod G, Przywara S, Righini M, Schlager O, Terlecki P. ESVM Guideline on peripheral arterial disease. VASA 2019; 48:1-79. [DOI: 10.1024/0301-1526/a000834] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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25
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Nossent AY, Ektefaie N, Wojta J, Eichelberger B, Kopp C, Panzer S, Gremmel T. Plasma Levels of snoRNAs are Associated with Platelet Activation in Patients with Peripheral Artery Disease. Int J Mol Sci 2019; 20:ijms20235975. [PMID: 31783567 PMCID: PMC6929168 DOI: 10.3390/ijms20235975] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/20/2019] [Accepted: 11/23/2019] [Indexed: 01/20/2023] Open
Abstract
In addition to supervised walking therapy, antithrombotic therapy and the management of risk factors, the treatment of peripheral artery disease (PAD) is limited to endovascular and surgical interventions, i.e., angioplasty with stent implantation and bypass surgery, respectively. Both are associated with a high restenosis rate. Furthermore, patients with PAD often suffer atherothrombotic events like myocardial infarction, transient ischemic attacks or stroke. Small ribonucleic acids (RNAs) have proven reliable biomarkers because of their remarkable stability. Small nucleolar RNAs (snoRNAs) guide modifications to small nuclear RNAs and ribosomal RNAs, enabling protein synthesis. In the current study, we measured four snoRNAs in 104 consecutive PAD patients who underwent elective infrainguinal angioplasty with stent implantation. We selected snoRNAs that showed significant overexpression in the plasma of end-stage PAD patients in a previous study. All four snoRNAs are transcribed from the 14q32 locus, which is strongly linked to human cardiovascular disease, including PAD and restenosis. We showed that the four selected 14q32 snoRNAs were abundantly expressed in the plasma of PAD patients. The plasma levels of these snoRNAs were not directly associated with target vessel restenosis, however, levels of SNORD113.2 and SNORD114.1 were strongly linked to platelet activation, which is an important determinant of long-term outcome, in PAD, and in cardiovascular disease in general.
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Affiliation(s)
- Anne Yaël Nossent
- Department for Laboratory Medicine, Medical University of Vienna, 1090 Vienna, Austria;
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria (J.W.); (C.K.)
- Department of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Neda Ektefaie
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria (J.W.); (C.K.)
| | - Johann Wojta
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria (J.W.); (C.K.)
- Core Facilities, Medical University of Vienna, 1090 Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research, 1090 Vienna, Austria
| | - Beate Eichelberger
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Christoph Kopp
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria (J.W.); (C.K.)
| | - Simon Panzer
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Gremmel
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria (J.W.); (C.K.)
- Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, 2700 Wiener Neustadt, Austria
- Correspondence: ; Tel.: +43-1-40400-46700; Fax: +43-1-40400-46650
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One simple claudication question as first step in Peripheral Arterial Disease (PAD) screening: A meta-analysis of the association with reduced Ankle Brachial Index (ABI) in 27,945 subjects. PLoS One 2019; 14:e0224608. [PMID: 31682633 PMCID: PMC6827909 DOI: 10.1371/journal.pone.0224608] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/17/2019] [Indexed: 12/31/2022] Open
Abstract
Purpose and methods A meta-analysis using data from seven German population-based cohorts was performed by the German Epidemiological consortium of Peripheral Arterial Disease (GEPArD) to investigate whether one question about claudication is more efficient for PAD screening than established questionnaires. Claudication was defined on the basis of the answer to one question asking for pain in the leg during normal walking. This simple question was compared with established questionnaires, including the Edinburgh questionnaire. The associations of claudication with continuous ABI values and decreased ABI were analyzed by linear and logistic regression analysis, respectively. The results of the studies were pooled in a random effect meta-analysis, which included data from 27,945 individuals (14,052 women, age range 20–84 years). Results Meta-analysis revealed a significant negative association between claudication and ABI, which was stronger in men (β = -0.07; 95%CI -0.10, -0.04) than in women (β = -0.02; 95%CI -0.02, -0.01). Likewise, the presence of claudication symptoms was related to an increased odds of a decreased ABI in both men (Odds ratio = 5.40; 95%CI 4.20, 6.96) and women (Odds ratio = 1.99; 95%CI 1.58, 2.51). Conclusions Asking only one question about claudication was able to identify many individuals with a high likelihood of a reduced ABI with markedly higher sensitivity and only slightly reduced specificity compared to more complex questionnaires. At least in men, this question should be established as first screening step.
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Mayr V, Hirschl M, Klein-Weigel P, Girardi L, Kundi M. A randomized cross-over trial in patients suspected of PAD on diagnostic accuracy of ankle-brachial index by Doppler-based versus four-point oscillometry based measurements. VASA 2019; 48:516-522. [DOI: 10.1024/0301-1526/a000808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary. Background: For diagnosis of peripheral arterial occlusive disease (PAD), a Doppler-based ankle-brachial-index (dABI) is recommended as the first non-invasive measurement. Due to limitations of dABI, oscillometry might be used as an alternative. The aim of our study was to investigate whether a semi-automatic, four-point oscillometric device provides comparable diagnostic accuracy. Furthermore, time requirements and patient preferences were evaluated. Patients and methods: 286 patients were recruited for the study; 140 without and 146 with PAD. The Doppler-based (dABI) and oscillometric (oABI and pulse wave index – PWI) measurements were performed on the same day in a randomized cross-over design. Specificity and sensitivity against verified PAD diagnosis were computed and compared by McNemar tests. ROC analyses were performed and areas under the curve were compared by non-parametric methods. Results: oABI had significantly lower sensitivity (65.8%, 95% CI: 59.2%–71.9%) compared to dABI (87.3%, CI: 81.9–91.3%) but significantly higher specificity (79.7%, 74.7–83.9% vs. 67.0%, 61.3–72.2%). PWI had a comparable sensitivity to dABI. The combination of oABI and PWI had the highest sensitivity (88.8%, 85.7–91.4%). ROC analysis revealed that PWI had the largest area under the curve, but no significant differences between oABI and dABI were observed. Time requirement for oABI was significantly shorter by about 5 min and significantly more patients would prefer oABI for future testing. Conclusions: Semi-automatic oABI measurements using the AngER-device provide comparable diagnostic results to the conventional Doppler method while PWI performed best. The time saved by oscillometry could be important, especially in high volume centers and epidemiologic studies.
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Affiliation(s)
- Verena Mayr
- Department of Angiology, Hanusch Hospital, Vienna, Austria
| | - Mirko Hirschl
- Department of Angiology, Hanusch Hospital, Vienna, Austria
| | | | - Luka Girardi
- Department for Angiology, Gesundheitszentrum Mariahilf, Vienna, Austria
| | - Michael Kundi
- Center for Public Health, Medical University Vienna, Vienna, Austria
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Clinical examination of peripheral arterial disease and ankle-brachial index in a nationwide cohort of older subjects: practical implications. Aging Clin Exp Res 2019; 31:1443-1449. [PMID: 30560433 DOI: 10.1007/s40520-018-1095-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/07/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prevalence of peripheral arterial disease increases with age and is related to increased morbidity and mortality. The clinical diagnosis includes the measurement of ankle-brachial index (ABI). AIMS To check the prevalence of abnormal ABI, and the value of physical examination of arterial system in detection of ABI < 0.9. METHODS We performed subgroup analysis of patients included in the PolSenior survey. We measured ABI, performed physical examination of arterial system, assessed laboratory and questionnaire factors related to atherosclerosis. Participants were divided according to ABI strata of < 0.9, 0.9-1.4 and > 1.4. Clinical score of abnormalities on physical examination was proposed. Using logistic regression, we obtained areas under the curve (AUC). RESULTS The mean age of 844 participants (53.3% men) was 74.7 (10.6) years. ABI < 0.9 was found in 20.3% participants and it was linked to history of myocardial infarction, hypertension and renal failure. In the entire group, 72.4% of subjects declared, that they were able to walk a distance of 200 m without interruption. Higher clinical score was associated with lower ABI. Full physical examination (AUC = 0.67) followed by examination of lower extremities (AUC = 0.65) showed strongest diagnostic value for PAD based on ABI. Neither ABI nor clinical examination was a good predictor of the inability to walk 200 meters without difficulties. DISCUSSION/CONCLUSIONS Full clinical examination, only moderately, adds to detection of PAD. The ability to walk 200 m is not a good measure of PAD in older subjects.
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Tóth-Vajna Z, Tóth-Vajna G, Gombos Z, Szilágyi B, Járai Z, Berczeli M, Sótonyi P. Screening of peripheral arterial disease in primary health care. Vasc Health Risk Manag 2019; 15:355-363. [PMID: 31686829 PMCID: PMC6709362 DOI: 10.2147/vhrm.s208302] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/01/2019] [Indexed: 12/24/2022] Open
Abstract
Background and purpose The screening tool for diagnosing lower extremity arterial disease is the assessment of the ankle-brachial index (ABI), which is widely used in general practice. However, resting ABI can easily produce a false negative result. In light of this, our goal was to determine the proportion of definitive diagnoses (peripheral arterial disease [PAD] confirmed or refuted) among patients screened in general practice, and the rate of cases in which the need for further specialized examination is necessary, with special attention to groups having non-compressible arteries and ABI negative symptomatic status. The aim of our work is to improve the efficiency of primary health care screening in PAD and reduce the extremely high domestic amputation ratio. Patients and methods Eight hundred and sixteen patients were screened. We used the Edinburgh Questionnaire and recorded medical histories, major risk factors, current complaints, and medication. Physical examinations were performed, including ABI testing. Results Thirty-three percent complained about lower extremity claudication; 23% had abnormal ABI values; 13% of the patients within the normal ABI range had complaints of dysbasia; and 12% were in the non-compressible artery group. The ABI-negative symptomatic group’s risk factor profile showed a close similarity to the clear PAD-positive and non-compressible artery groups. Conclusion The percentage of PAD could be higher than the number of patients diagnosed by ABI screening. Nearly a quarter of the population fell into the non-compressible artery and ABI-negative symptomatic groups, together defined as the “murky zone”. When screening purposely for PAD, these patients deserve special attention due to the insufficient selectivity and sensitivity of measurements. If there is high clinical suspicion of PAD in spite of normal ABI values, further assessment may be considered.
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Affiliation(s)
- Zsombor Tóth-Vajna
- Heart and Vascular Center, Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | | | - Zsuzsanna Gombos
- Heart and Vascular Center, Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | - Brigitta Szilágyi
- Department of Geometry, Institute of Mathematics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Zoltán Járai
- Department of Cardiology, St. Emeric University Teaching Hospital, Budapest, Hungary.,Heart and Vascular Center, Department of Vascular Surgery, Department of Angiology, Semmelweis University, Budapest, Hungary
| | - Márton Berczeli
- Heart and Vascular Center, Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | - Péter Sótonyi
- Heart and Vascular Center, Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
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Tomai F, Piccoli A, Castriota F, Weltert L, Reimers B, Pesarini G, Borioni R, De Persio G, Nerla R, Pacchioni A, Cremonesi A, Ribichini F. Long-Term Outcomes of Coronary and Carotid Artery Disease Revascularization in the FRIENDS Study. J Interv Cardiol 2019; 2019:8586927. [PMID: 31772548 PMCID: PMC6739755 DOI: 10.1155/2019/8586927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 05/21/2019] [Accepted: 06/02/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The aim of this study is to assess long-term-outcomes of patients with concomitant CAD and COD treated with different revascularization strategies. BACKGROUND Multisite artery disease is common and patients with combined disease have poor prognosis. The best therapeutic strategy for patients with concomitant carotid obstructive disease (COD) and coronary artery disease (CAD) remains controversial. METHODS This observational registry enrolled, between January 2006 and December 2012, 1022 consecutive patients from high volume institutions with concomitant CAD and COD suitable for endovascular, surgical, or hybrid revascularization in both territories selected by consensus of a multidisciplinary team. RESULTS The cumulative incidence of 5-year major cardiovascular events (MACCE) including cardiovascular death, myocardial infarction (MI), or stroke in the overall population was 12%. The incidence of 5-year MACCE was not statistically different in the surgical, endovascular, or hybrid patients group (10.1% vs. 13.0% vs. 13.2%, P = .257, respectively). However, the hybrid group exhibited rates of myocardial infarction, chronic kidney disease, and cumulative incidence of all clinical events higher than the surgical group. After propensity score matching, the incidence of 5-year MACCE was similar in the three groups (13.0% vs. 15.0% vs. 16.0%, p = .947, respectively). CONCLUSIONS An individualized revascularization approach of patients with combined CAD and COD yields very good results at long-term follow-up, despite the high risk of this multilevel population even when the baseline clinical features are equalized.
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Affiliation(s)
- Fabrizio Tomai
- Cardiovascular Department, European Hospital, Rome, Italy
| | - Anna Piccoli
- Division of Cardiology, University of Verona, Italy
| | - Fausto Castriota
- Cardiovascular Department of Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Luca Weltert
- Cardiovascular Department, European Hospital, Rome, Italy
| | - Bernhard Reimers
- Division of Cardiology, Istituto Clinico Humanitas, Rozzano, Italy
| | | | - Raoul Borioni
- Cardiovascular Department, European Hospital, Rome, Italy
| | | | - Roberto Nerla
- Cardiovascular Department of Humanitas Gavazzeni Hospital, Bergamo, Italy
| | | | - Alberto Cremonesi
- Cardiovascular Department of Humanitas Gavazzeni Hospital, Bergamo, Italy
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Samba H, Guerchet M, Ndamba-Bandzouzi B, Kehoua G, Mbelesso P, Desormais I, Aboyans V, Preux PM, Lacroix P. Ankle Brachial Index (ABI) predicts 2-year mortality risk among older adults in the Republic of Congo: The EPIDEMCA-FU study. Atherosclerosis 2019; 286:121-127. [PMID: 31136913 DOI: 10.1016/j.atherosclerosis.2019.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/15/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Peripheral artery disease (PAD) is known to be associated with mortality in high income countries but no data regarding Sub-Saharan Africa (SSA) populations are documented. This study aimed at assessing the prognostic value of the Ankle Brachial Index (ABI) among older adults in the Republic of Congo. METHODS Congolese subjects ≥65 years were included in a longitudinal population-based survey (EPIDEMCA-FU). Demographic, biological, and clinical data were collected at baseline. PAD was defined by an ABI≤0.90. Information on mortality was collected from key informants in participants' households. Cox proportional hazard models, adjusted for traditional and cardiovascular risk factors, were fitted to evaluate the association between an ABI≤0.90 and death. RESULTS 1029 participants were recruited at baseline. ABI measurement was obtained from 927 participants, of whom 17.4% presented an ABI≤0.90. During a 2-year follow-up, a total of 83 (9.1%) deaths were recorded. Mortality was higher in the low-ABI group with 23 deaths (14.7%) vs. 57 (7.8%) and 3 (12.0%), respectively among those with 0.90 < ABI<1.4 and ABI≥1.40 (p = 0.039). After adjustment, an ABI≤0.90 was associated with an increased risk of mortality (HR = 1.86; 95%CI 1.04-3.87). Mortality was also independently associated with increasing age (HR = 1.05; 95%CI 1.02-1.09), dementia (HR = 2.73; 95% CI 1.15-8.05), alcohol use (HR = 0.51; 95%CI 0.29-0.88) and female sex (HR = 0.37; 95%CI 0.19-0.72). CONCLUSIONS In this study, a low ABI predicted an increased mortality risk among older people. ABI may represent a simple and inexpensive tool to identify older people at high risk of death in SSA.
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Affiliation(s)
- Harielle Samba
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France
| | - Maëlenn Guerchet
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France; King's College London, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Bébène Ndamba-Bandzouzi
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Department of Neurology, Brazzaville University Hospital, Brazzaville, Congo
| | - Gilles Kehoua
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France
| | - Pascal Mbelesso
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Department of Neurology, Amitié Hospital, Bangui, Central African Republic
| | - Ileana Desormais
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France; Department of Vascular Medicine, Limoges University Hospital, Limoges, France
| | - Victor Aboyans
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France; Department of Cardiology, Limoges University Hospital, Limoges, France
| | - Pierre-Marie Preux
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France; CHU, CEBIMER, Limoges, France
| | - Philippe Lacroix
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France; Department of Vascular Medicine, Limoges University Hospital, Limoges, France
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Kowall B, Erbel R, Moebus S, Lehmann N, Kröger K, Stang A. Decline in ankle-brachial index is stronger in poorly than in well controlled diabetes: Results from the Heinz Nixdorf Recall cohort study. Atherosclerosis 2019; 284:37-43. [PMID: 30870706 DOI: 10.1016/j.atherosclerosis.2019.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS The ankle-brachial index (ABI) is a marker of atherosclerosis and a diagnostic criterion for peripheral arterial disease (PAD). We studied the association between HbA1c and ABI in subjects with and without diabetes. METHODS In the Heinz Nixdorf Recall Study, a population-based cohort study in Germany (N = 4,814, age 45-75 years), ABI was measured at baseline, at 5- and 10-year follow-up. Subjects with ABI <0.9, ABI >1.4 or self-reported PAD at baseline were excluded from analyses. In 3199 participants, we assessed associations between HbA1c and incident PAD (ABI < 0.9) and change in ABI, respectively, using logistic and linear regression models. Subjects without diabetes, with HbA1c < 5.7% were used as reference group. RESULTS Compared to the reference group, 10-year decline in ABI was -0.066 (95% confidence interval: -0.117; -0.016) and -0.021 (-0.063; 0.021) in subjects with poorly (≥7.0% HbA1c) and well (<7.0% HbA1c) controlled previously known diabetes; -0.010 (-0.054; 0.034) in those with newly detected diabetes diagnosed by HbA1c ≥ 6.5%, and -0.005 (-0.023; 0.013) in those without diabetes, with HbA1c 5.7-6.4%. For poorly controlled diabetes, odds ratios for low ABI (<0.9) were 3.5 (1.6-7.9), and 3.1 (1.3-7.0) after 5- and 10-year follow-up, respectively. The incidence of Mönckeberg disease (ABI > 1.4) was low (6/288 (2.4%) over 5 years). CONCLUSIONS Decline in ABI was stronger in poorly than well-controlled diabetes. Subjects with newly detected diabetes diagnosed by the new HbA1c criterion (≥6.5%) did not show an increased decline in ABI over 10 years.
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Affiliation(s)
- Bernd Kowall
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany.
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - Susanne Moebus
- Center for Urban Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, Essen, Germany
| | - Nils Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - Knut Kröger
- Clinic of Vascular Medicine, Helios Klinikum Krefeld, Krefeld, Germany
| | - Andreas Stang
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany; School of Public Health, Department of Epidemiology Boston University, 715 Albany Street, Talbot Building, Boston, MA, 02118, USA
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Ploenes C. [Intermittent claudication]. MMW Fortschr Med 2019; 161:46-48. [PMID: 30887327 DOI: 10.1007/s15006-019-0274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Christoph Ploenes
- Fachzentrum Angiologie, Schön Klinik Düsseldorf, Am Heerdter Krankenhaus 2, D-45049, Düsseldorf, Deutschland.
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Rehabilitative Exercise Reduced the Impact of Peripheral Artery Disease on Vascular Outcomes in Elderly Patients with Claudication: A Three-Year Single Center Retrospective Study. J Clin Med 2019; 8:jcm8020210. [PMID: 30736443 PMCID: PMC6406499 DOI: 10.3390/jcm8020210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 12/13/2022] Open
Abstract
The study retrospectively evaluated the association between rehabilitative outcomes and risk of peripheral revascularizations in elderly peripheral artery disease (PAD) patients with claudication. Eight-hundred thirty-five patients were enrolled. Ankle-brachial index (ABI) and maximal walking speed (Smax) were measured at baseline and at discharge from a structured home-based rehabilitation program. For the analysis, patients were divided according to a baseline ABI value (severe: ≤0.5; moderate: ≥0.5) and according to hemodynamic or functional rehabilitative response (responder: ABI ≥ 0.10 and/or Smax > 0.5 km/h). Three-year outcomes were collected from the regional registry. According to the inclusion criteria (age 60–80, ABI < 0.80; program completion) 457 patients, 146 severe and 311 moderate, were studied. The whole population showed significant functional and hemodynamic improvements at discharge, with 56 revascularizations and 69 deaths at follow-up. Compared to the moderate group, the severe group showed a higher rate of revascularizations (17% vs. 10%, p < 0.001) and deaths (29% and 8%, respectively; p < 0.001). However, patients with severe PAD who were ABI responders after rehabilitation showed less revascularizations than non-responders (13% vs. 21%; hazard ratio (HR): 0.52) and were not different from patients with moderate disease (9%). Superimposable rates were observed for Smax responders (13% vs. 21%; HR: 0.55; moderate 10%). In conclusion, elderly patients with severe PAD empowered by better rehabilitation outcomes showed lower rates of peripheral revascularizations and deaths that were comparable to patients with moderate PAD.
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Low, borderline and normal ankle-brachial index as a predictor of incidents outcomes in the Mediterranean based-population ARTPER cohort after 9 years follow-up. PLoS One 2019; 14:e0209163. [PMID: 30673706 PMCID: PMC6343871 DOI: 10.1371/journal.pone.0209163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/02/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Guidelines recommended adopting the same cardiovascular risk modification strategies used for coronary disease in case of low Ankle-brachial index (ABI), but here exist few studies on long-term cardiovascular outcomes in patients with borderline ABI and even fewer on the general population. AIM The aim of the present study was to analyze the relationship between long-term cardiovascular events and low, borderline and normal ABI after a 9-year follow up of a Mediterranean population with low cardiovascular risk. DESIGN AND SETTING A population-based prospective cohort study was performed in the province of Barcelona, Spain. METHOD A total of 3,786 subjects >49 years were recruited from 2006-2008. Baseline ABI was 1.08 ± 0.16. Subjects were followed from the time of enrollment to the end of follow-up in 2016 via phone calls every 6 months, systematic reviews of primary-care and hospital medical records and analysis of the SIDIAP (Information System for Primary Care Research) database to confirm the possible appearance of cardiovascular events. RESULTS 3146 individuals participated in the study. 2,420 (77%) subjects had normal ABI, 524 (17%) had borderline ABI, and 202 (6.4%) had low ABI. In comparison with normal and borderline subjects, patients with lower ABI had more comorbidities, such as hypertension, hypercholesterolemia and diabetes. Cumulative MACE incidence at 9 years was 20% in patients with low ABI, 6% in borderline ABI and 5% in normal ABI. The annual MACE incidence after 9 years follow-up was significantly higher in people with low ABI (26.9/1000py) (p<0.001) than in borderline (6.6/1000py) and in normal ABI (5.6/1000py). Subjects with borderline ABI are at significantly higher risk for coronary disease (HR: 1.58; 95% CI: 1.02-2, 43; p = 0,040) compared to subjects with normal ABI, after adjustment. CONCLUSION The results of the present study support that low ABI was independently associated with higher incidence of MACE, ICE, cardiovascular and no cardiovascular mortality; while borderline ABI had significantly moderate risk for coronary disease than normal ABI.
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Herráiz-Adillo Á, Piñar-Serrano O, Mariana-Herráiz JÁ, Martínez-Vizcaíno V, Pozuelo-Carrascosa DP, Notario-Pacheco B. Physical examination to screen for peripheral artery disease in a defined Primary Care population: A diagnostic accuracy study. Int J Clin Pract 2018; 72:e13253. [PMID: 30222240 DOI: 10.1111/ijcp.13253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/10/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Peripheral arterial disease (PAD) is an underdiagnosed prevalent disease which implies high cardiovascular risk. Professionals usually depend on physical examination to screen for PAD. OBJECTIVE To assess the diagnostic accuracy of physical examination to screen for PAD in a rural Primary Care population and to evaluate the nurse-physician level of agreement in pedal pulse palpation. METHODS Diagnostic accuracy study in which two experienced professionals (physician-nurse) prospectively performed pedal pulse palpation (grading as absent, reduced, normal, or bounding), femoral bruit auscultation and calf circumference (index tests) comparing with Doppler ABI (reference test, positive cut-off: 0.9 ≥ ABI ≥ 1.4) in 158 consecutive subjects. INCLUSION CRITERIA presence of diabetes, dyslipidaemia, hypertension, smoking habit (current or former), or age ≥ 65. RESULTS Of 315 legs included, PAD was confirmed in 38 (12.1%) legs. Absent dorsalis pedis (DP) and posterior tibial (PT) pulses were found in 37 (11.7%) and 67 (21.3%) legs, respectively. Regarding nurse evaluation, when a positive test was set if DP or PT were absent (more sensitive cut-off), sensitivity was = 86.8 (95% CI: 74.8-98.9), specificity = 82.7 (95% CI: 78.0-87.3), likelihood ratio+ = 5.01 (95% CI: 3.77-6.67), likelihood ratio- = 0.16 (95% CI: 0.07-0.36), and diagnostic odds ratio (dOR) = 31.5 (95% CI: 11.7-84.8). Age, diabetes, and calcification (ABI ≥ 1.4) influenced the rate of a false negative finding in pedal palpation. Physician-nurse weighted kappa coefficient was = 0.649 (95% CI: 0.599-0.699). The presence of a femoral bruit auscultation had a dOR = 3.8 (95% CI: 1.1-13.1), and a calf circumference <34.55 cm had a dOR = 3.2 (95% CI: 1.6-6.4). CONCLUSIONS AND RELEVANCE In a mainly asymptomatic Primary Care population, pedal pulse palpation was by far the best diagnostic test, with good diagnostic accuracy and inter-rater agreement. In view of a high sensitivity and capacity to rule out the disease, pedal pulse palpation could be performed as a screening test for PAD and individuals at high cardiovascular risk.
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Affiliation(s)
- Ángel Herráiz-Adillo
- Department of Primary Care, Health Service of Castilla-La Mancha (SESCAM), Tragacete, Cuenca, Spain
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Olga Piñar-Serrano
- Department of Primary Care, Health Service of Castilla-La Mancha (SESCAM), Tragacete, Cuenca, Spain
| | | | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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Galas N, Becker I, Ficon T, Sakrauski M, Reichert R, Ahmad W, Mylonas S, Brunkwall J, Majd P. Prescription rate of anti-atherosclerotic drugs in German nursing homes and its impact on outcome. VASA 2018; 48:158-166. [PMID: 30376415 DOI: 10.1024/0301-1526/a000754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is one of the major manifestations of general atherosclerosis and strongly associated with increased cardiovascular morbidity and mortality. Because only few epidemiologic studies are available concerning the prevalence of PAD in inhabitants ≥ 80 years of age, we screened inhabitants of nursing care homes in Germany for PAD and cardiovascular diseases and to assess the one year mortality. PATIENTS AND METHODS We conducted a prospective cohort study, screening inhabitants of 42 nursing homes for PAD. Demographic data, comorbidities, cardiovascular risk factors and daily medication were collected. PAD was defined as ankle-brachial index < 0.9. During a follow up period of one year, cardio- and cerebrovascular events and mortality were recorded, as well as the rate of falls and major amputation. RESULTS 1,329 probands (391 men, 938 women) > 60 years were eligible for further analysis. The mean age was 84.1 years (range 61-107 years) and the prevalence of PAD was 31.5 % . Media sclerosis was found in up to 17 %, and an existing diagnosis of PAD (in case of pathological ABI) and undertreatment was common. Probands with PAD were less likely to be treated according to guideline recommendations (antiplatelet therapy, beta blockers, statins) than probands with coronary artery disease (CAD). The overall one-year mortality was 19.8 % (n = 236), significantly higher than for a gender and age matched German population (p < 0.001). CONCLUSIONS The current study shows a high prevalence of PAD in German nursing care homes. The one year mortality was not significantly different between probands with PAD and those with severe PAD (defined as an ABI of ≤ 0.5), whereas a media sclerosis was associated with an increased risk in probands with CAD in comparison to those without. Use of anti-diabetic agents and aspirin in monotherapy was associated with a reduced one-year mortality risk.
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Affiliation(s)
- Noemi Galas
- 1 Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
| | - Ingrid Becker
- 2 Institute for statistics and epidemiology, Mathematician University of Cologne, Cologne, Germany
| | | | | | | | - Wael Ahmad
- 1 Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany.,3 University of Cologne, Cologne, Germany
| | - Spyridon Mylonas
- 1 Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
| | - Jan Brunkwall
- 1 Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
| | - Payman Majd
- 1 Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
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Liang KW, Lee WJ, Lee IT, Lin SY, Wang JS, Lee WL, Sheu WHH. Regaining body weight after weight reduction further increases pulse wave velocity in obese men with metabolic syndrome. Medicine (Baltimore) 2018; 97:e12730. [PMID: 30290684 PMCID: PMC6200464 DOI: 10.1097/md.0000000000012730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Subjects with metabolic syndrome (MetS) or obesity have worse arterial stiffness. However, there have been no studies addressing time-sequential changes in pulse wave velocity (PWV) after weight loss and then regaining weight in obese non-diabetic men with MetS.We prospectively enrolled 40 obese, non-diabetic men with MetS undergoing a 3-month weight reduction program. Another 26 lean and healthy men were recruited for comparisons. Oral glucose tolerance test and brachial ankle (ba) PWV were assessed in study subjects. Eighteen obese non-diabetic MetS and 15 lean control subjects had follow-ups at the 60th month.The body weight of obese MetS decreased from 94.8 ± 7.6 to 86.1 ± 9.0 (N = 18, P < .001) after a 3-month weight reduction program but regained gradually thereafter to 93.6 ± 11.6 kg at the 60th month (P < .001 versus 3rd month). baPWV decreased after weight loss slightly (P = .240) while weight regain significantly increased the baPWV (from 3rd month, 1358 ± 168 to 60th month 1539 ± 264 cm/sec, P < .001). Systolic and diastolic blood pressure increments correlated with the increment of baPWV after weight regain. At the 60th month, lean controls (N = 15) had increases in body weight while their baPWV increased non-significantly. The increments of baPWV after weight regain in obese MetS were significantly higher than the increment of baPWV in lean controls after weight gain.In conclusion, regaining body weight after weight reduction worsened arterial stiffness with significant increase of baPWV in obese non-diabetic MetS.
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Affiliation(s)
- Kae-Woei Liang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Cardiovascular Research Center, Department of Medicine, National Yang Ming University School of Medicine, Taipei
| | - Wen-Jane Lee
- Department of Medical Research, Taichung Veterans General Hospital
- Tung-Hai University
| | - I-Te Lee
- Cardiovascular Research Center, Department of Medicine, National Yang Ming University School of Medicine, Taipei
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital
- Department of Medicine, Chung Shan Medical University
| | - Shih-Yi Lin
- Cardiovascular Research Center, Department of Medicine, National Yang Ming University School of Medicine, Taipei
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital
- Center of Geriatrics and Gerontology, Taichung Veterans General Hospital
| | - Jun-Sing Wang
- Cardiovascular Research Center, Department of Medicine, National Yang Ming University School of Medicine, Taipei
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Cardiovascular Research Center, Department of Medicine, National Yang Ming University School of Medicine, Taipei
| | - Wayne H-H Sheu
- Cardiovascular Research Center, Department of Medicine, National Yang Ming University School of Medicine, Taipei
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
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Si S, Golledge J, Norman P, Nelson M, Chew D, Ademi Z, Bhatt DL, Steg GP, Reid CM. Prevalence and Outcomes of Undiagnosed Peripheral Arterial Disease Among High Risk Patients in Australia: An Australian REACH Sub-Study. Heart Lung Circ 2018; 28:939-945. [PMID: 29843973 DOI: 10.1016/j.hlc.2018.04.292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 03/21/2018] [Accepted: 04/22/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Compared with other manifestations of cardiovascular disease, peripheral arterial disease (PAD) is under-diagnosed. This study aims to investigate the prevalence, risk profile and cardiovascular outcomes of undiagnosed PAD in Australian general practices. METHOD A sub-study of the Australian Reduction of Atherothrombosis for Continued Health (REACH) Registry, a prospective cohort study of patients at high risk of atherothrombosis recruited from Australian general practices. Eligible patients for this study had no previous clinical diagnosis of PAD and had an ankle-brachial index (ABI) ≤1.4 at recruitment. RESULTS Peripheral arterial disease was undiagnosed in 34% Australian REACH participants, 28% patients had low ABI (ABI<0.9) and 11% had intermittent claudication (IC) based on responses to the Edinburgh Claudication Questionnaire (ECQ). We found no significant differences in risk factor control between patient with or without PAD. Intermittent claudication patients had higher risks of non-fatal cardiovascular events and PAD interventions at one year, whereas all-cause mortality rate was higher among patients with ABI<0.9, especially in those who also reported IC. Finally, an ABI<0.9, together with poorly controlled risk factors were independent predictors of incident IC at one year. CONCLUSIONS This study suggests a high rate of undiagnosed PAD among high risk patients in Australian primary health care. These patients are at high risk of events and therefore would potentially benefit from better secondary prevention measures.
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Affiliation(s)
- Si Si
- NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Perth, WA, Australia; CCRE Therapeutics, Monash University, Melbourne, Vic, Australia.
| | - Jonathan Golledge
- School of Medicine and Dentistry, James Cook University, Brisbane, Qld, Australia
| | - Paul Norman
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Mark Nelson
- Discipline of General Practice, University of Tasmania, Hobart, Tas, Australia
| | - Derek Chew
- Flinders University, Adelaide, SA, Australia
| | - Zanfina Ademi
- CCRE Therapeutics, Monash University, Melbourne, Vic, Australia
| | - Deepak L Bhatt
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, the US
| | | | - Christopher M Reid
- NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Perth, WA, Australia; CCRE Therapeutics, Monash University, Melbourne, Vic, Australia
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Vogiatzi G, Oikonomou E, Deftereos S, Siasos G, Tousoulis D. Peripheral artery disease: a micro-RNA-related condition? Curr Opin Pharmacol 2018; 39:105-112. [PMID: 29679926 DOI: 10.1016/j.coph.2018.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/06/2017] [Accepted: 04/02/2018] [Indexed: 01/20/2023]
Abstract
Peripheral artery disease (PAD) is a vascular problem of diffuse atherosclerosis and is a major cause of cardiovascular morbidity and mortality. Many studies have tried to gain insight into the molecular mechanisms involved in PAD. Lately, highly stable circulating small noncoding RNAs, microRNAs (miRNAs), seem to have disease-specific expression. Thus, miRNAs are emerging as new measurable diagnostic biomarkers and a start point for individualized treatment. To date, the association of miRNA regulation in angiogenesis and maintenance of vascular integrity in PAD has attracted little interest. In this review, we will provide an overview of studies regarding the roles of specific miRNAs in PAD and their potential to act as a minimally invasive tool for diagnosis and risk stratification.
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Affiliation(s)
- Georgia Vogiatzi
- 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Evangelos Oikonomou
- 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Spyridon Deftereos
- 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Gerasimos Siasos
- 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece.
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Stojkovic S, Jurisic M, Kopp CW, Koppensteiner R, Huber K, Wojta J, Gremmel T. Circulating microRNAs identify patients at increased risk of in-stent restenosis after peripheral angioplasty with stent implantation. Atherosclerosis 2018; 269:197-203. [PMID: 29366993 DOI: 10.1016/j.atherosclerosis.2018.01.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 12/24/2017] [Accepted: 01/12/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Target lesion restenosis is the most frequent complication after angioplasty and stenting for peripheral artery disease (PAD). MicroRNAs (miRs) regulate crucial pathophysiological processes leading to in-stent restenosis and thrombosis. The aim of this study was to investigate the predictive value of 11 miRs for the composite endpoint of target lesion restenosis and atherothrombotic events (primary endpoint), and target vessel revascularization (TVR, secondary endpoint) in 62 consecutive PAD patients after infrainguinal angioplasty with stent implantation. METHODS Circulating miRs were assessed using quantitative real-time polymerase chain reactions. RESULTS Within the 2 years of follow-up, the primary endpoint occurred in 26 patients (41.9%), and 21 patients (33.9%) underwent TVR. miR-92a and miR-195 were identified as independent predictors of the primary endpoint after adjustment for age, sex and clinical risk factors with respective HR per 1 increase of standard deviation (1-SD) of 0.55 (95% CI: 0.34-0.88, p = 0.013) and HR per 1-SD of 0.40 (95% CI: 0.23-0.68, p = 0.001). MiR-195 independently predicted TVR with HR per 1-SD of 0.40 (95% CI: 0.22-0.75, p = 0.005). Adding miR-195 to clinical risk factors improved Harrell's C-index to 0.75 (95% CI: 0.66-0.85, p = 0.03) and was superior to a model with miR-92a (C-index: 0.70, 95% CI: 0.60-0.80, p for comparison =0 .012). Assessment of both miR-92a and miR-195 had no incremental value when compared to miR-195 alone (C-index: 0.79, 95% CI: 0.69-0.88, p = 0.313). CONCLUSIONS Circulating miR-195 predicts adverse ischemic events and TVR after infrainguinal angioplasty with stent implantation. MiR-195 could improve risk stratification after peripheral endovascular revascularizations.
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Affiliation(s)
- Stefan Stojkovic
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Magdalena Jurisic
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christoph W Kopp
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Renate Koppensteiner
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Kurt Huber
- 3rd Medical Department for Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria; Sigmund Freud Private University, Medical School, Vienna, Austria
| | - Johann Wojta
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria; Core Facilities, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - Thomas Gremmel
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
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Kronlage M, Wassmann M, Vogel B, Müller OJ, Blessing E, Katus H, Erbel C. Short vs prolonged dual antiplatelet treatment upon endovascular stenting of peripheral arteries. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:2937-2945. [PMID: 29062225 PMCID: PMC5638576 DOI: 10.2147/dddt.s143226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Peripheral artery disease (PAD) is a highly prevalent disorder with a substantial economical burden. Dual antiplatelet treatment (DAPT) upon endovascular stenting to prevent acute thrombotic reocclusions is an universally accepted practice for postinterventional management of PAD patients. However, the optimal period of time for DAPT upon endovascular stenting is not known. METHODS In the current nonrandomized, retrospective monocentric study, we evaluated the duration of DAPT upon endovascular stenting. A total of 261 endovascular SFA and iliac stenting procedures were performed on 214 patients and these patients were subdivided into a short (4-6 weeks) or a prolonged (8-12 weeks) DAPT regime group. More than 65% of the patients included were male, approximately 35% were diabetic, and 61% had a history of smoking. Of all the patients, 90% exhibited a Rutherford stage 2-3, and approximately half of the patients had a moderate-to-severe calcified target lesion with a length of >13 cm. Major safety end points were defined as any bleeding, compartment syndrome, and ischemic events. In addition to this, patency, all-cause mortality, as well as amputation were followed up over a period of 12 months upon intervention. RESULTS Twelve months after endovascular stenting, primary patency in our cohort was comparable between the groups (83.94% short vs 79.8% long DAPT, P>0.05). Major bleeding occurred in 18 cases without any difference between the groups (P>0.05). In addition, during the 12-month follow-up, 6 (3.4%) patients in the short and 3 (3.5%) in the prolonged DAPT regime suffered a stroke/transient ischemic attack (P>0.05). In addition, there was no difference regarding mortality and amputation rate comparing short vs prolonged DAPT regime in a 12-month follow-up. CONCLUSION In the current cohort, prolonged DAPT after endovascular stenting had no beneficial effect on the outcome in a 12-month follow-up.
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Affiliation(s)
- Mariya Kronlage
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg
| | - Maximilian Wassmann
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg
| | - Britta Vogel
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg
| | - Oliver J Müller
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg
| | | | - Hugo Katus
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg.,DZHK German Center for Cardiovascular Research, Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Christian Erbel
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg
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Amrock SM, Abraham CZ, Jung E, Morris PB, Shapiro MD. Risk Factors for Mortality Among Individuals With Peripheral Arterial Disease. Am J Cardiol 2017; 120:862-867. [PMID: 28734461 DOI: 10.1016/j.amjcard.2017.05.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/08/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Abstract
Morbidity and mortality from peripheral arterial disease (PAD) continues to increase. Traditional cardiovascular risk factors are implicated in the development of PAD, yet the extent to which those risk factors correlate with mortality in such patients remains insufficiently assessed. Using data from the 1999 to 2004 National Health and Nutrition Examination Survey, Cox proportional hazards models were used to examine the association of cardiovascular risk factors and all-cause and cardiovascular mortality. A total of 647 individuals ≥40 years old with PAD (i.e., ankle-brachial index [ABI] ≤ 0.9) were followed for a median of 7.8 years. There were 336 deaths, of which 98 were attributable to cardiovascular disease. Compared with never smokers, current (hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.62 to 3.71) and former (HR 1.62, 95% CI 1.14 to 2.29) smokers with PAD had higher rates of death. Moderate or vigorous physical activity of ≥10 minutes monthly was associated with lower death rates (HR 0.63, 95% CI 0.44 to 0.91). Also associated with increased rates of cardiovascular death were an ABI of <0.5 (HR 2.56, 95% CI 1.28 to 5.15, compared with those with an ABI of 0.7 to 0.9) and diabetes mellitus (HR 2.50, 95% CI 1.33 to 4.73). Neither C-reactive protein nor body mass index was associated with mortality. In conclusion, tobacco use increased the risk of all-cause and cardiovascular death, whereas physical activity was associated with a decreased mortality risk. A low ABI and diabetes were also predictive of cardiovascular death.
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Mirault T, Galloula A, Cambou JP, Lacroix P, Aboyans V, Boulon C, Constans J, Bura-Riviere A, Messas E. Impact of betablockers on general and local outcome in patients hospitalized for lower extremity peripheral artery disease: The COPART Registry. Medicine (Baltimore) 2017; 96:e5916. [PMID: 28151868 PMCID: PMC5293431 DOI: 10.1097/md.0000000000005916] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lower extremity peripheral artery disease (PAD) is one manifestation of atherosclerosis. Patients with PAD have an increased rate of mortality due to concurrent coronary artery disease and hypertension. Betablockers (BB) may, therefore, be prescribed, especially in case of heart failure. However, BB safety in PAD is controversial, because of presumed peripheral hemodynamic consequences of BB that could lead to worsening of symptoms in patients with PAD. In this context, we aimed to determine the impact of BB on all-cause and cardiovascular mortality and amputation rate at 1 year after hospitalization for PAD from the COPART Registry population. This is a prospective multicenter observational study collecting data from consecutive patients hospitalized for PAD in vascular medicine departments of 4 academic hospitals in France. Patients with, either claudication, critical limb ischemia or acute lower limb ischemia related to a documented PAD were included. We compared the outcomes of patients with BB versus those without BB in their prescription list at hospital discharge. The mean age of the study population was 70.9 years, predominantly composed of males (71%). Among the 1267 patients at admission, 28% were treated by BB for hypertension, prior myocardial infarction or heart failure. During their hospital stay, 40% underwent revascularization (including bypass surgery 29% and angioplasty 74%), 17% required an amputation, and 5% died. In a multivariate analysis, only prior myocardial infarction was found associated with BB prescription with an odds ratio (OR) of 3.11, P < 0.001. Conversely, chronic obstructive pulmonary disease or PAD with ulcer impeded BB prescription (OR: 0.57 and 0.64, P = 0.007; P = 0.001, respectively). One-year overall mortality of patients with BB did not differ from those without (23% vs. 23%, P = 0.95). The 1-year amputation rate did not differ either (4% vs. 6%, P = 0.14). Patients hospitalized for PAD with a BB in their prescription did not worsen their outcome at 1 year compared to patients without BB. Based on these safety data, prospective study could be conducted to assess the effect of BB on long-term mortality and amputation rate in patients with mild, moderate, and severe PAD.
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Affiliation(s)
- Tristan Mirault
- Department of Vascular Medicine, Hôpital européen Georges-Pompidou, assistance publique hôpitaux de Paris, APHP, Paris Descartes University, Sorbonne Paris Cite, PARCC, INSERM U970, Paris
| | - Alexandre Galloula
- Department of Vascular Medicine, Hôpital européen Georges-Pompidou, assistance publique hôpitaux de Paris, APHP, Paris Descartes University, Sorbonne Paris Cite, PARCC, INSERM U970, Paris
| | - Jean-Pierre Cambou
- Department of Vascular Medicine, Rangueil Hospital, Institute of Molecular Medicine of Rangueil, INSERM U858
- Department of Biostatistics, Rangueil Hospital, Toulouse
| | - Philippe Lacroix
- Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital, Limoges
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, INSERM U1094, Limoges
| | - Carine Boulon
- Department of Vascular Medicine, Rangueil Hospital, Institute of Molecular Medicine of Rangueil, INSERM U858
| | - Joel Constans
- Department of Vascular Medicine, Saint-André Hospital, Bordeaux, France
| | - Alessandra Bura-Riviere
- Department of Vascular Medicine, Rangueil Hospital, Institute of Molecular Medicine of Rangueil, INSERM U858
| | - Emmanuel Messas
- Department of Vascular Medicine, Hôpital européen Georges-Pompidou, assistance publique hôpitaux de Paris, APHP, Paris Descartes University, Sorbonne Paris Cite, PARCC, INSERM U970, Paris
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McMasters J, Panitch A. Collagen-binding nanoparticles for extracellular anti-inflammatory peptide delivery decrease platelet activation, promote endothelial migration, and suppress inflammation. Acta Biomater 2017; 49:78-88. [PMID: 27840254 PMCID: PMC5253112 DOI: 10.1016/j.actbio.2016.11.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/26/2016] [Accepted: 11/10/2016] [Indexed: 11/16/2022]
Abstract
Peripheral artery disease is an atherosclerotic stenosis in the peripheral vasculature that is typically treated via percutaneous transluminal angioplasty. Deployment of the angioplasty balloon damages the endothelial layer, exposing the underlying collagen and allowing for the binding and activation of circulating platelets which initiate an inflammatory cascade leading to eventual restenosis. Here, we report on collagen-binding sulfated poly(N-isopropylacrylamide) nanoparticles that are able to target to the denuded endothelium. Once bound, these nanoparticles present a barrier that reduces cellular and platelet adhesion to the collagenous surface by 67% in whole blood and 59% in platelet-rich plasma under biologically relevant shear rates. In vitro studies indicate that the collagen-binding nanoparticles are able to load and release therapeutic quantities of anti-inflammatory peptides, with the particles reducing inflammation in endothelial and smooth muscle cells by 30% and 40% respectively. Once bound to collagen, the nanoparticles increased endothelial migration while avoiding uptake by smooth muscle cells, indicating that they may promote regeneration of the damaged endothelium while remaining anchored to the collagenous matrix and locally releasing anti-inflammatory peptides into the injured area. Combined, these collagen-binding nanoparticles have the potential to reduce inflammation, and the subsequent restenosis, while simultaneously promoting endothelial regeneration following balloon angioplasty. STATEMENT OF SIGNIFICANCE In this manuscript, we present our work on the development and characterization of a novel temperature sensitive collagen-binding nanoparticle system. We demonstrate that when bound to a collagenous matrix, the nanoparticles are able to promote endothelial migration while avoiding cellular uptake. We also show that the nanoparticles are able to reduce inflammation via the release of anti-inflammatory peptides which, when combined with its ability to inhibit platelet binding, could lead to reduced intimal hyperplasia following balloon angioplasty. The drug delivery platform presented represents a unique dual therapy biomaterial wherein the nanoparticle itself plays a crucial role in the system's overall therapeutic potential while simultaneously releasing anti-inflammatory peptides.
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Affiliation(s)
- James McMasters
- Weldon School of Biomedical Engineering, Purdue University, 206 South Martin Jischke Drive, West Lafayette, IN 47906, United States
| | - Alyssa Panitch
- Weldon School of Biomedical Engineering, Purdue University, 206 South Martin Jischke Drive, West Lafayette, IN 47906, United States.
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Cauley JA, Kassem AM, Lane NE, Thorson S. Prevalent peripheral arterial disease and inflammatory burden. BMC Geriatr 2016; 16:213. [PMID: 27938334 PMCID: PMC5148838 DOI: 10.1186/s12877-016-0389-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 12/06/2016] [Indexed: 12/20/2022] Open
Abstract
Background Strong evidence implicates inflammation in the development of atherosclerotic heart disease but less is known about peripheral arterial disease (PAD). Our objective was to test the hypothesis that a composite index of inflammatory burden is associated with PAD. Methods Cross-sectional analysis of a randomly-selected group of 903 community-dwelling men in the MrOS cohort recruited between 2000 and 2002. Using blood samples, we measured seven cytokines and related these levels to prevalent PAD (ankle-brachial index (ABI) <0.9) both individually and as part of an “inflammatory burden score” (a composite sum of the number of pro-inflammatory cytokines in the highest quartile). Results Overall, 6.75% of men had ABI <0.9. The odds of prevalent PAD were higher in men with the highest quartile (Q4) levels of interleukin-6 multivariable (MV) adjusted (odds ratio (OR) =3.95 (95% CI, 1.4–11.3), tumor necrosis factor alpha OR = 4.44 (95% confidence interval (CI), 1.5–12.8), and C-reactive protein OR = 3.63 (95% CI, 1.4–9.4) compared to men in Q1. The magnitude of the association of these cytokines with PAD was similar to the effect of being 10 years older, OR = 2.41 (95% CI, 1.16–3.7). These significant effects persisted after additional MV adjustment for smoking except for CRP. Men with the highest inflammatory burden score (≥3) had 3.6 (95% CI, 1.5–8.7) increased odds of PAD, p trend = 0.03. After smoking adjustment the linear trend was borderline statistically significant (p trend = 0.10). Conclusion Inflammatory burden is associated with prevalent PAD, an association similar to aging 10 years. The inflammatory effects of smoking contributes to the underlying association between inflammation and PAD.
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Affiliation(s)
- Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, A510 Crabtree Hall, Pittsburgh, PA, 15261, USA.
| | - Ahmed M Kassem
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, A510 Crabtree Hall, Pittsburgh, PA, 15261, USA
| | - Nancy E Lane
- University of California Davis Health System, 4625 2nd Avenue, Suite 2006, Sacramento, CA, 95817, USA
| | - Sara Thorson
- Family Medicine of Southwest, Peacehealth Southwest Medical Center, 400 NE Mother Joseph Place, Vancouver, WA, 986664, USA
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Hashimoto H, Fukushima Y, Kumita SI, Miyamoto M, Takagi G, Yamazaki J, Ikeda T. Prognostic value of lower limb perfusion single-photon emission computed tomography-computed tomography in patients with lower limb atherosclerotic peripheral artery disease. Jpn J Radiol 2016; 35:68-77. [DOI: 10.1007/s11604-016-0602-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/09/2016] [Indexed: 02/07/2023]
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Signorelli SS. Peripheral Artery Disease: To Screen or Not Screen, That Is the Question! Angiology 2016; 68:749-751. [DOI: 10.1177/0003319716677667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Salvatore Santo Signorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- 3rd Internal Medicine Division, University Hospital “G. Rodolico,” Catania, Italy
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Pasqualini L, Ministrini S, Macura A, Marini E, Leli C, Siepi D, Lombardini R, Kararoudi MN, Scarponi AM, Schillaci G, Pirro M, Mannarino E. Increased Bone Resorption: A Possible Pathophysiological Link Between Hypovitaminosis D and Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2016; 52:352-9. [PMID: 27432480 DOI: 10.1016/j.ejvs.2016.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 04/24/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE/BACKGROUND Vitamin D deficiency has been associated with the prevalence and severity of peripheral arterial disease (PAD); nevertheless, data on bone turnover in patients with PAD is lacking. The present study investigates a possible relationship between the markers of bone turnover and the presence and severity of PAD. METHODS The study examined 143 patients, with a mean ± SD age of 75.3 ± 8.5 years (range 50.0-93.0 years), of both sexes, admitted to a department of internal medicine. All patients underwent ankle brachial index (ABI) assessment by Doppler velocimetry. Serum levels of 25(OH) vitamin D and two markers of bone turnover, C-terminal telopeptide of type I collagen (sCTX) and bone isoenzyme of alkaline phosphatase, were measured. The differences between patients with normal ABI and patients with PAD were analyzed. Pearson and Spearman correlation coefficients were calculated and independent predictors were identified through a stepwise linear regression analysis. Odds ratios were calculated with a logistic regression model. RESULTS Compared with patients with a normal ABI (≥0.90), patients with PAD (ABI < 0.90) presented with significantly lower levels of 25(OH) vitamin D (12.2 ± 9.6 ng/mL vs. 16.7 ± 8.7 ng/mL; p = .006) and a significantly higher concentration of sCTX (1.1 ± 0.7 ng/mL vs. 0.6 ± 0.4 ng/mL; p < .001). There was a positive correlation between ABI and serum concentration of 25 (OH) vitamin D (r = 0.3; p < .001), whereas ABI was inversely correlated with the concentration of sCTX (r = -0.358; p < .001). At logistic regression analysis, age, cigarette smoking, and both vitamin D and sCTX were independent predictors of an ABI < 0.90. CONCLUSION These results support the hypothesis that hypovitaminosis D and increased bone turnover are risk factors for the presence and severity of PAD. Furthermore, the presence of PAD, even if asymptomatic and diagnosed by a reduced ABI, could identify a population at risk for osteoporosis and osteomalacia.
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Affiliation(s)
- L Pasqualini
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy.
| | - S Ministrini
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - A Macura
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - E Marini
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - C Leli
- Department of Experimental Medicine, Division of Microbiology, University of Perugia, Perugia, Italy
| | - D Siepi
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - R Lombardini
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - M N Kararoudi
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - A M Scarponi
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - G Schillaci
- Department of Medicine, Division of Internal Medicine, University of Perugia, Terni, Italy
| | - M Pirro
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - E Mannarino
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
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Bendermacher BLW, Teijink JAW, Willigendael EM, Bartelink ML, Peters RJG, de Bie RA, Büller HR, Boiten J, Langenberg M, Prins MH. A clinical prediction model for the presence of peripheral arterial disease — the benefit of screening individuals before initiation of measurement of the ankle—brachial index: an observational study. Vasc Med 2016; 12:5-11. [PMID: 17451087 DOI: 10.1177/1358863x07076827] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Measurement of the ankle—brachial index (ABI) can provide important information about the presence of subclinical atherosclerosis. Performing the ABI in the overall population is not feasible, but it can be used in a selected population. A simple prediction rule could be of much use to estimate the risk of an abnormal ABI. This was designed as an observational study in the setting of 955 general practices in The Netherlands. A total of 7454 patients aged ≥ 55 years presenting with at least one vascular risk factor (smoking, hypertension, diabetes, and hypercholesterolemia) and no complaints of intermittent claudication were included. Patients were selected by the general practitioner during visiting hours and from medical records. Main outcome measures included the prevalence of PAD, defined as an ABI below 0.9, which was related to vascular risk factors using regression analyses on which the PREVALENT clinical prediction model was developed. The overall prevalence of PAD was 18.4%. Since the treatment of individuals with a history of coronary heart disease and cerebrovascular disease will not be influenced by the finding of asymptomatic PAD, these individuals were not taken into account for the development of the clinical prediction model. Analyses showed a significantly increased risk for PAD with increasing age, smoking, and hypertension. The clinical prediction model giving risk factor points per factor (age: 1 point per 5 years starting at 55 years; ever smoked: 2 points; currently smoking: 7 points; and hypertension: 3 points), showed a proportional increase of the PAD prevalence with each increasing risk profile (range: 7.0—40.6%). In conclusion, based on the PREVALENT clinical prediction model, the general practitioner is able to identify a high-risk population in which measurement of ABI is useful.
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Affiliation(s)
- Bianca L W Bendermacher
- Department of Surgery, Division of Vascular Surgery, Atrium Medical Centre, Heerlen, The Netherlands
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