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Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1313-e1410. [PMID: 38743805 DOI: 10.1161/cir.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
AIM The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
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Miah MMR, Avabde D, Ghahramani I, Hemanth R, Abbas R, Maha Q, Beech A, Salem M. Graft Failure After Revascularization for Chronic Limb-Threatening Ischaemia (CLTI) Patients: The Role of Graft Surveillance. Cureus 2024; 16:e53036. [PMID: 38410345 PMCID: PMC10895559 DOI: 10.7759/cureus.53036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Failure of infrainguinal bypass grafts remains a major problem tackled by vascular surgeons despite a meticulous surgical technique. All infrainguinal bypasses should go under routine surveillance to pick the grafts at risk for the prevention of graft failure. Objectives The aim was to find out if we were adhering to the European Society of Vascular Surgery (ESVS) guidelines in the management of chronic limb-threatening ischaemia (CLTI) patients, including postoperative follow-up and to monitor whether the patients were having postoperative duplex surveillance scans to pick any graft at risk. Methods All patients who underwent infra-inguinal bypass procedures for CLTI during the last eight months (from mid-January to mid-September 2023) in our vascular unit were included. Retrospective data were collected. Results A total of 38 patients had lower limb bypass procedures over the last eight months (from 15 January till 14 September 2023). However, two femoral-femoral (fem-fem) crossovers, one Ilio-popliteal, and one pedal bypass were excluded. Thus, a total of 36 patients were included in the study (n=34). The vast majority (n=27, 79.4%) had femoro popliteal bypass anastomosing distally to above knee (AK) or below knee (BK) popliteal artery, and the rest (n=7, 20.5%) had distal bypass (fem-distal or pop-distal bypass). Moreover, 18% of patients had amputation, 15% of patients died, and 61% of the remaining patients were on surveillance. Of those, who were not on surveillance, 44% of them had graft occlusion. Conclusion Surveillance can predict graft at risk, and the graft occlusion can be prevented by appropriate intervention. Every vascular unit should have its own post-procedural follow-up strategies.
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Affiliation(s)
| | - Dani Avabde
- Vascular Surgery, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | | | - Raehan Hemanth
- Surgery, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | - Ridda Abbas
- Vascular Surgery, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | - Quratulain Maha
- Vascular Surgery, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | - Andrew Beech
- Vascular Surgery, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | - Murtaza Salem
- Vascular Surgery, Nottingham University Hospitals NHS Trust, Nottingham, GBR
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Wang X, Yang Y, Yu L, Pang C, Sun W, Zang S, Li C. Association between fibrinogen level and length of stay in patients with lower extremity atherosclerotic disease: a retrospective cohort study. Sci Rep 2023; 13:11872. [PMID: 37481624 PMCID: PMC10363167 DOI: 10.1038/s41598-023-39219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 07/21/2023] [Indexed: 07/24/2023] Open
Abstract
The level of fibrinogen in patients with lower extremity atherosclerosis (LEAD) has been widely identified as a risk factor contributing to adverse outcomes. However, some knowledge gaps remain regarding fibrinogen levels and downstream adverse outcomes, such as length of stay (LOS). We conducted this study to examine the association between fibrinogen level and LOS in LEAD patients. The retrospective cohort study included 1428 LEAD patients between January 2014 and November 2021 in China. Several generalized linear models with a negative binomial link function were used to evaluate the association between fibrinogen level and LOS. The area under the curve (AUC) was used to evaluate the predicting effect of fibrinogen level on a LOS greater than 10 days (median LOS). The median age of the patients was 70 years old, and 1153 (80.74%) were males. Fibrinogen level was positively associated with LOS (β = 1.14; 95% CI, 0.42-1.86; p = 0.002) in LEAD patients after controlling for age, gender, number of historical hospitalizations, surgical history, vascular disease history, drinking history, smoking history, insurance type, surgical approach, lesion site, weight loss, Fontaine classification, age-adjusted Charlson comorbidity index, urea, total protein, activated partial thromboplastin time, thrombin time, prothrombin time-international normalized ratio, calcium, triglyceride, albumin/globulin ratio, phosphorus, and D-dimer. The fibrinogen-added prediction model demonstrated good discrimination and calibration, with an AUC value of 0.807. Fibrinogen level was positively associated with LOS in LEAD patients. The fibrinogen level is a widely available and easy-to-measure biochemical indicator, and it could be used as a suitable indicator for the prognosis and prophylaxis of prolonged LOS in patients with LEAD during hospitalization.
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Affiliation(s)
- Xue Wang
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Yu Yang
- Department of Vascular Surgery, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning, China
| | - Ling Yu
- Phase I Clinical Trails Center, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning, China
| | - Chang Pang
- Department of General Practice, The Second Affiliated Hospital of Shenyang Medical College, No. 20 Bei Jiu Road, Heping District, Shenyang, 110002, Liaoning, China
| | - Wei Sun
- Department of Ultrasound, The Second Affiliated Hospital of Shenyang Medical College, No. 20 Bei Jiu Road, Heping District, Shenyang, 110002, Liaoning, China
| | - Shuang Zang
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China.
| | - Cong Li
- Department of Vascular Surgery, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning, China.
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4
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Gherasie FA, Popescu MR, Bartos D. Acute Coronary Syndrome: Disparities of Pathophysiology and Mortality with and without Peripheral Artery Disease. J Pers Med 2023; 13:944. [PMID: 37373933 DOI: 10.3390/jpm13060944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023] Open
Abstract
There are a number of devastating complications associated with peripheral artery disease, including limb amputations and acute limb ischemia. Despite the overlap, atherosclerotic diseases have distinct causes that need to be differentiated and managed appropriately. In coronary atherosclerosis, thrombosis is often precipitated by rupture or erosion of fibrous caps around atheromatous plaques, which leads to acute coronary syndrome. Regardless of the extent of atherosclerosis, peripheral artery disease manifests itself as thrombosis. Two-thirds of patients with acute limb ischemia have thrombi associated with insignificant atherosclerosis. A local thrombogenic or remotely embolic basis of critical limb ischemia may be explained by obliterative thrombi in peripheral arteries of patients without coronary artery-like lesions. Studies showed that thrombosis of the above-knee arteries was more commonly due to calcified nodules, which are the least common cause of luminal thrombosis associated with acute coronary events in patients with acute coronary syndrome. Cardiovascular mortality was higher in peripheral artery disease without myocardial infarction/stroke than in myocardial infarction/stroke without peripheral artery disease. The aim of this paper is to gather published data regarding the disparities of acute coronary syndrome with and without peripheral artery disease in terms of pathophysiology and mortality.
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Affiliation(s)
| | - Mihaela-Roxana Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila," 050474 Bucharest, Romania
- Department of Cardiology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 011461 Bucharest, Romania
| | - Daniela Bartos
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila," 050474 Bucharest, Romania
- Department of Internal Medicine, Clinical University Emergency Hospital, 014461 Bucharest, Romania
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Wang X, Yang Y, Zhang J, Zang S. Development and validation of a prediction model for the prolonged length of stay in Chinese patients with lower extremity atherosclerotic disease: a retrospective study. BMJ Open 2023; 13:e069437. [PMID: 36759024 PMCID: PMC9923290 DOI: 10.1136/bmjopen-2022-069437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES This study aims to develop and internally validate a prediction model, which takes account of multivariable and comprehensive factors to predict the prolonged length of stay (LOS) in patients with lower extremity atherosclerotic disease (LEAD). DESIGN This is a retrospective study. SETTING China. PARTICIPANTS, PRIMARY AND SECONDARY OUTCOMES Data of 1694 patients with LEAD from a retrospective cohort study between January 2014 and November 2021 were analysed. We selected nine variables and created the prediction model using the least absolute shrinkage and selection operator (LASSO) regression model after dividing the dataset into training and test sets in a 7:3 ratio. Prediction model performance was evaluated by calibration, discrimination and Hosmer-Lemeshow test. The effectiveness of clinical utility was estimated using decision curve analysis. RESULTS LASSO regression analysis identified age, gender, systolic blood pressure, Fontaine classification, lesion site, surgery, C reactive protein, prothrombin time international normalised ratio and fibrinogen as significant predictors for predicting prolonged LOS in patients with LEAD. In the training set, the prediction model showed good discrimination using a 500-bootstrap analysis and good calibration with an area under the receiver operating characteristic of 0.750. The Hosmer-Lemeshow goodness of fit test for the training set had a p value of 0.354. The decision curve analysis showed that using the prediction model both in training and tests contributes to clinical value. CONCLUSION Our prediction model is a valuable tool using easily and routinely obtained clinical variables that could be used to predict prolonged LOS in patients with LEAD and help to better manage these patients in routine clinical practice.
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Affiliation(s)
- Xue Wang
- Department of Community Nursing, School of Nursing, China Medical University, Shenyang, Liaoning, China
| | - Yu Yang
- Department of Vascular Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jian Zhang
- Department of Vascular Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuang Zang
- Department of Community Nursing, School of Nursing, China Medical University, Shenyang, Liaoning, China
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Aly K, Sabet S, Elkiey A, Fakhry H. The Complexity of Peripheral Arterial Disease and Coronary Artery Disease in Diabetic Patients: An Observational Study. Cardiol Res 2023; 14:54-62. [PMID: 36896224 PMCID: PMC9990548 DOI: 10.14740/cr1463] [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: 01/03/2023] [Accepted: 02/02/2023] [Indexed: 02/27/2023] Open
Abstract
Background Atherosclerosis is a systemic disease that causes luminal narrowing. Patients with peripheral arterial disease (PAD) also exhibit an increased risk of death from cardiovascular complications. This risk is the same for symptomatic or asymptomatic patients. Over a 5-year period, patients with PAD have a 20% chance of suffering from a stroke or myocardial infarction. Additionally, their mortality rate is 30%. This study aimed to assess the relationship between coronary artery disease (CAD) complexity using SYNTAX score and PAD complexity using Trans-Atlantic Inter-Society Consensus II (TASC II) score. Methods The study was designed as single-center cross-sectional observational and included 50 diabetic patients referred for elective coronary angiography and peripheral angiography was done. Results Most of the patients were males (80%) and smokers (80%) with mean age of 62 years. The mean SYNTAX score was 19.88. There was a significant negative correlation between SYNTAX score and ankle brachial index (ABI) (r = -0.48, P = 0.001) and a significant positive correlation with glycated hemoglobin (HbA1c) level (R2 = 26, P = 0.004). Complex PAD was found in nearly half of the patients with 48% having TASC II C or D classes. Those with TASC II classes C and D had higher SYNTAX scores (P = 0.046). Conclusions Diabetic patients with more complex CAD had more complex PAD. In diabetic patients with CAD, those with worse glycemic control had higher SYNTAX scores and the higher the SYNTAX score, the lower the ABI.
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Affiliation(s)
- Khaled Aly
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sameh Sabet
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Alaa Elkiey
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hany Fakhry
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Abstract
Chronic limb-threatening ischemia requires aggressive risk factor management and a thoughtful approach to the complex decision of best strategy for revascularization. Patients often have multilevel disease amenable to endovascular, open surgical, or hybrid approaches. Limited high-quality evidence is available to support a specific strategy; randomized trials are ongoing. Acute limb ischemia is associated with a high risk of limb loss and mortality. Catheter-directed thrombolysis is mainstay of therapy in patients with marginally threatened limbs, whereas those immediately threatened with motor deficits require more rapid restoration of flow with open or endovascular techniques that can establish flow in single setting.
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Affiliation(s)
- Jocelyn M Beach
- Section of Vascular Surgery, Heart and Vascular Institute, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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Ying L, Shen Y, Zhang Y, Wang Y, Liu Y, Yin J, Wang Y, Yin J, Zhu W, Bao Y, Zhou J. Association of Advanced Glycation End Products With Lower-Extremity Atherosclerotic Disease in Type 2 Diabetes Mellitus. Front Cardiovasc Med 2021; 8:696156. [PMID: 34568445 PMCID: PMC8460767 DOI: 10.3389/fcvm.2021.696156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/10/2021] [Indexed: 01/17/2023] Open
Abstract
Aims: Advanced glycation end products (AGEs) were reported to be correlated with the development of diabetes, as well as diabetic vascular complications. Therefore, this study aimed at investigating the association between AGEs and lower-extremity atherosclerotic disease (LEAD). Methods: A total of 1,013 type 2 diabetes patients were enrolled. LEAD was measured through color Doppler ultrasonography. The non-invasive skin autofluorescence method was performed for AGEs measurement. Considering that age plays an important role in both AGEs and LEAD, age-combined AGEs, i.e., AGEage index (define as AGEs × age/100) was used for related analysis. Results: The overall prevalence of LEAD was 48.9% (495/1,013). Patients with LEAD showed a significantly higher AGEage (p < 0.001), and the prevalence of LEAD increased with ascending AGEage levels (p for trend < 0.001). Logistic regression analysis revealed that AGEage was significantly positively associated with risk of LEAD, and the odds ratios of presence of LEAD across quartiles of AGEage were 1.00, 1.72 [95% confidence interval (CI) = 1.14-2.61], 2.72 (95% CI = 1.76-4.22), 4.29 (95% CI = 2.69-6.85) for multivariable-adjusted model (both p for trend < 0.001), respectively. The results were similar among patients of different sexes, body mass index, and with or without diabetes family history. Further, AGEage presented a better predictive value for LEAD than glycated hemoglobin A1c (HbA1c), with its sensitivity, specificity, and area under the curve of 75.5% (95% CI = 71.6-79.2%), 59.3% (95% CI = 54.9-63.6%), and 0.731 (0.703-0.758), respectively. Conclusion: AGEage, the non-invasive measured skin AGEs combined with age, seems to be a more promising approach than HbA1c in identifying patient at high risk of LEAD.
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Affiliation(s)
- Lingwen Ying
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yun Shen
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yang Zhang
- Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China.,Science Island Branch, Graduate School of USTC, Hefei, China
| | - Yikun Wang
- Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Yong Liu
- Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Jun Yin
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yufei Wang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Jingrong Yin
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Wei Zhu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
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9
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Criqui MH, Matsushita K, Aboyans V, Hess CN, Hicks CW, Kwan TW, McDermott MM, Misra S, Ujueta F. Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement From the American Heart Association. Circulation 2021; 144:e171-e191. [PMID: 34315230 PMCID: PMC9847212 DOI: 10.1161/cir.0000000000001005] [Citation(s) in RCA: 222] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Lower extremity peripheral artery disease (PAD) affects >230 million adults worldwide and is associated with increased risk of various adverse clinical outcomes (other cardiovascular diseases such as coronary heart disease and stroke and leg outcomes such as amputation). Despite its prevalence and clinical importance, PAD has been historically underappreciated by health care professionals and patients. This underappreciation seems multifactorial (eg, limited availability of the first-line diagnostic test, the ankle-brachial index, in clinics; incorrect perceptions that a leg vascular disease is not fatal and that the diagnosis of PAD would not necessarily change clinical practice). In the past several years, a body of evidence has indicated that these perceptions are incorrect. Several studies have consistently demonstrated that many patients with PAD are not receiving evidence-based therapies. Thus, this scientific statement provides an update for health care professionals regarding contemporary epidemiology (eg, prevalence, temporal trends, risk factors, and complications) of PAD, the present status of diagnosis (physiological tests and imaging modalities), and the major gaps in the management of PAD (eg, medications, exercise therapy, and revascularization). The statement also lists key gaps in research, clinical practice, and implementation related to PAD. Orchestrated efforts among different parties (eg, health care providers, researchers, expert organizations, and health care organizations) will be needed to increase the awareness and understanding of PAD and improve the diagnostic approaches, management, and prognosis of PAD.
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Tan BK, Chalouni M, Ceron DS, Cinaud A, Esterle L, Loko MA, Katlama C, Poizot-Martin I, Neau D, Chas J, Morlat P, Rosenthal E, Lacombe K, Naqvi A, Barange K, Bouchaud O, Gervais A, Lascoux-Combe C, Garipuy D, Alric L, Goujard C, Miailhes P, Aumaitre H, Duvivier C, Simon A, Lopez-Zaragoza JL, Zucman D, Raffi F, Lazaro E, Rey D, Piroth L, Boué F, Gilbert C, Bani-Sadr F, Dabis F, Sogni' P, Wittkop L, Boccara F. Atherosclerotic Cardiovascular Events in Patients Infected With Human Immunodeficiency Virus and Hepatitis C Virus. Clin Infect Dis 2021; 72:e215-e223. [PMID: 32686834 DOI: 10.1093/cid/ciaa1014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND An increased risk of cardiovascular disease (CVD) was reported in patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), without identifying factors associated with atherosclerotic CVD (ASCVD) events. METHODS HIV-HCV coinfected patients were enrolled in the Agence Nationale de Recherches sur le Sida et les hépatites virales (ANRS) CO13 HEPAVIH nationwide cohort. Primary outcome was total ASCVD events. Secondary outcomes were coronary and/or cerebral ASCVD events, and peripheral artery disease (PAD) ASCVD events. Incidences were estimated using the Aalen-Johansen method. Factors associated with ASCVD were identified using cause-specific Cox proportional hazards models. RESULTS At baseline, median age of the study population (N = 1213) was 45.4 (interquartile range [IQR] 42.1-49.0) years and 70.3% were men. After a median follow-up of 5.1 (IQR 3.9-7.0) years, the incidence was 6.98 (95% confidence interval [CI], 5.19-9.38) per 1000 person-years for total ASCVD events, 4.01 (2.78-6.00) for coronary and/or cerebral events, and 3.17 (2.05-4.92) for PAD ASCVD events. Aging (hazard ratio [HR] 1.06; 95% CI, 1.01-1.12), prior CVD (HR 8.48; 95% CI, 3.14-22.91), high total cholesterol (HR 1.43; 95% CI, 1.11-1.83), high-density lipoprotein cholesterol (HR 0.22; 95% CI, 0.08-0.63), statin use (HR 3.31; 95% CI, 1.31-8.38), and high alcohol intake (HR 3.18; 95% CI, 1.35-7.52) were independently associated with total ASCVD events, whereas undetectable baseline viral load (HR 0.41, 95% CI, 0.18-0.96) was associated with coronary and/or cerebral events. CONCLUSIONS HIV-HCV coinfected patients experienced a high incidence of ASCVD events. Some traditional cardiovascular risk factors were the main determinants of ASCVD. Controlling cholesterol abnormalities and maintaining undetectable HIV RNA are essential to control cardiovascular risk.
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Affiliation(s)
- Boun Kim Tan
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Department of Internal Medicine, Hôpital Cochin, Paris, France.,Unité des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Paris, France
| | - Mathieu Chalouni
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Dominique Salmon Ceron
- Unité des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Paris, France
| | - Alexandre Cinaud
- Université Paris Descartes, Paris, France.,Assistance Publique des Hôpitaux de Paris, Hypertension and Cardiovascular Prevention Unit, Diagnosis and Therapeutic Center, Hôtel-Dieu Hospital, Paris, France
| | - Laure Esterle
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Marc Arthur Loko
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Christine Katlama
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Service des Maladies Infectieuses et Tropicales, Paris, France.,Inserm Institut Pierre Louis Epidémiologie et Santé Publique, UPMC, Sorbonne Université, Paris, France
| | - Isabelle Poizot-Martin
- Assistance Publique des Hôpitaux de Marseille, Hôpital Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France.,Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Didier Neau
- Centre Hospitalier Universitaire de Bordeaux, Service des Maladies Infectieuses et Tropicales, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, Bordeaux, France
| | - Julie Chas
- France Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Philippe Morlat
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France.,Université de Bordeaux, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Service de Médecine Interne, Hôpital Saint-André, Bordeaux, France
| | - Eric Rosenthal
- Centre Hospitalier Universitaire de Nice, Service de Médecine Interne et Cancérologie, Hôpital l'Archet, Nice, France.,Université de Nice-Sophia Antipolis, Nice, France
| | - Karine Lacombe
- Inserm Institut Pierre Louis Epidémiologie et Santé Publique, UPMC, Sorbonne Université, Paris, France.,Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Alissa Naqvi
- Centre Hospitalier Universitaire de Nice, Service d'Infectiologie, Hôpital l'Archet, Nice, France
| | - Karl Barange
- Centre Hospitalier Universitaire de Toulouse, Service d'Hépatologie, Hôpital Purpan, Toulouse, France
| | - Olivier Bouchaud
- Assistance Publique des Hôpitaux de Paris, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, Bobigny, France.,Université Sorbonne Paris Nord, Bobigny, France
| | - Anne Gervais
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Caroline Lascoux-Combe
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Louis, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Daniel Garipuy
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Services des Maladies Infectieuses et Tropicales, Toulouse, France
| | - Laurent Alric
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Service de Médecine Interne-Pôle Digestif, Toulouse, France.,Université Toulouse III, UMR 152, IRD, Toulouse, France
| | - Cécile Goujard
- Assistance Publique des Hôpitaux de Paris, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Service de Médecine Interne et Immunologie Clinique, Le Kremlin-Bicêtre, Parris, France.,Université Paris-Saclay, Le Kremlin-Bicêtre, Parris, France
| | - Patrick Miailhes
- Centre Hospitalier Universitaire de Lyon, Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix Rousse, Lyon, France
| | - Hugues Aumaitre
- Centre Hospitalier de Perpignan, Service des Maladies Infectieuses et Tropicales, Perpignan, France
| | - Claudine Duvivier
- Assistance Publique des Hôpitaux de Paris, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants malades, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Paris, France
| | - Anne Simon
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Département de Médecine Interne et Immunologie Clinique, Paris, France
| | - Jose-Luis Lopez-Zaragoza
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service d'Immunologie Clinique et de Maladies Infectieuses, Créteil, France
| | | | - François Raffi
- Centre Hospitalier Universitaire de Nantes, Department of Infectious Diseases, Nantes, France.,Université de Nantes, CIC 1413, INSERM, Nantes, France
| | - Estibaliz Lazaro
- Université de Bordeaux, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, hôpital Haut-Lévèque, Service de Médecine Interne et Maladies Infectieuses, Pessac, France
| | - David Rey
- Centre Hospitalier Universitaire de Strasbourg, Le Trait d'Union, HIV Infection Care Center, Strasbourg, France
| | - Lionel Piroth
- Centre Hospitalier Universitaire de Dijon, Département d'Infectiologie, Dijon, France.,Université de Bourgogne, Dijon, France
| | - François Boué
- Université Paris-Saclay, Le Kremlin-Bicêtre, Parris, France.,Assistance Publique des Hôpitaux de Paris, Hôpital Antoine Béclère, Service de Médecine Interne et d'Immunologie clinique, Clamart, France
| | - Camille Gilbert
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Firouzé Bani-Sadr
- Centre Hospitalier Universitaire de Reims, Unité des Maladies Infectieuses et Tropicales, Hôpital Robert Debré, Reims, France.,Université Reims Champagne Ardenne, EA-4684/SFR CAP-SANTE, Reims, France
| | - François Dabis
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Philippe Sogni'
- Université Paris Descartes, Paris, France.,Assistance Publique des Hôpitaux de Paris, Hôpital Cochin, Service d'Hépatologie, Paris, France.,Inserm U-1223, Institut Pasteur, Paris, France
| | - Linda Wittkop
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Pôle de Santé Publique, Bordeaux, France
| | - Franck Boccara
- Assistance Publique des Hôpitaux de Paris, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Faculty of Medicine, Sorbonne Paris University, Paris, France.,National Institute of Health and Medical Research, INSERM, UMR_S 938, UPMC, Paris, France
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11
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Mori M, Sakamoto A, Kawakami R, Sato Y, Jinnouchi H, Kawai K, Cornelissen A, Virmani R, Finn AV. Paclitaxel- and Sirolimus-coated Balloons in Peripheral Artery Disease Treatment: Current Perspectives and Concerns. VASCULAR AND ENDOVASCULAR REVIEW 2021. [DOI: 10.15420/ver.2020.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Drug-coated balloons (DCBs) have become an established therapy for the treatment of above-the-knee peripheral artery disease. The paclitaxel DCB has shown clinical benefit in terms of patency and freedom from re-intervention in multiple randomised trials. However, a recent meta-analysis has suggested an association between mortality and the use of paclitaxel-coated devices. Sirolimus is another potential choice of anti-proliferative agent for use in DCBs because of its wider therapeutic index and lower risk for dose-dependent toxicity. More recently, encapsulating sirolimus in micro-reservoirs or polymers has facilitated the development of effective sirolimus DCBs, some of which are available in Europe and Asia. In this review, the authors focus on paclitaxel and sirolimus DCB technologies from the standpoint of drug characteristics and clinical trials.
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Affiliation(s)
| | | | | | - Yu Sato
- CVPath Institute, Gaithersburg, MD, US
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12
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Bozkurt B, Hershberger RE, Butler J, Grady KL, Heidenreich PA, Isler ML, Kirklin JK, Weintraub WS. 2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure). Circ Cardiovasc Qual Outcomes 2021; 14:e000102. [PMID: 33755495 PMCID: PMC8059763 DOI: 10.1161/hcq.0000000000000102] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is available in the text.
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13
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Watson RA, Johnson DM, Dharia RN, Merli GJ, Doherty JU. Anti-coagulant and anti-platelet therapy in the COVID-19 patient: a best practices quality initiative across a large health system. Hosp Pract (1995) 2020; 48:169-179. [PMID: 32429774 PMCID: PMC7441801 DOI: 10.1080/21548331.2020.1772639] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/19/2020] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged health-care systems and physicians worldwide to attempt to provide the best care to their patients with an evolving understanding of this unique pathogen. This disease and its worldwide impact have sparked tremendous interest in the epidemiology, pathogenesis, and clinical consequences of COVID-19. This accumulating body of evidence has centered around case series and often empiric therapies as controlled trials are just getting underway. What is clear is that patients appear to be at higher risk for thrombotic disease states including acute coronary syndrome (ACS), venous thromboembolism (VTE) such as deep vein thrombosis (DVT) or pulmonary embolism (PE), or stroke. Patients with underlying cardiovascular disease are also at higher risk for morbidity and mortality if infected. These patients are commonly treated with anticoagulation and/or antiplatelet medications and less commonly thrombolysis during hospitalization, potentially with great benefit but the management of these medications can be difficult in potentially critically ill patients. In an effort to align practice patterns across a large health system (Jefferson Health 2,622 staffed inpatient beds and 319 intensive care unit (ICU) beds across 14 facilities), a task force was assembled to address the utilization of anti-thrombotic and anti-platelet therapy in COVID-19 positive or suspected patients. The task force incorporated experts in Cardiology, Vascular Medicine, Hematology, Vascular Surgery, Pharmacy, and Vascular Neurology. Current guidelines, consensus documents, and policy documents from specialty organizations were used to formulate health system recommendations. OBJECTIVE Our goal is to provide guidance to the utilization of antithrombotic and antiplatelet therapies in patients with known or suspected COVID-19.
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Affiliation(s)
- Ryan A. Watson
- Division of Cardiology, Department of Medicine, At Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Drew M. Johnson
- Division of Cardiology, Department of Medicine, At Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Robin N. Dharia
- Division of Cerebrovascular Disease, Department of Neurology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Geno J. Merli
- Division of Vascular Medicine, Department of Surgery and Medicine, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - John U. Doherty
- Division of Cardiology, Department of Medicine, At Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia, PA, USA
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14
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Dehmer GJ, Badhwar V, Bermudez EA, Cleveland JC, Cohen MG, D'Agostino RS, Ferguson TB, Hendel RC, Isler ML, Jacobs JP, Jneid H, Katz AS, Maddox TM, Shahian DM. 2020 AHA/ACC Key Data Elements and Definitions for Coronary Revascularization: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Coronary Revascularization). Circ Cardiovasc Qual Outcomes 2020; 13:e000059. [PMID: 32202924 DOI: 10.1161/hcq.0000000000000059] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Robert C Hendel
- Former Task Force Chair during this writing effort.,Task Force Liaison
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15
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Gamal El Dein AI, Ebeed AE, Ahmed HM, Razek AAKA. Comparative study between duplex ultrasound and 160-multidetectors CT angiography in assessment of chronic lower limb ischemia. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0010-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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16
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Raikou VD, Kyriaki D. Factors related to peripheral arterial disease in patients undergoing hemodialysis: the potential role of monocyte chemoattractant protein-1. Hypertens Res 2019; 42:1528-1535. [PMID: 30988503 DOI: 10.1038/s41440-019-0259-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/09/2019] [Accepted: 03/11/2019] [Indexed: 02/07/2023]
Abstract
Peripheral arterial disease (PAD) is substantially prevalent among patients in the end stage of renal disease (ESRD). We considered factors related to peripheral arterial disease in patients undergoing hemodialysis including the important role of monocyte chemoattractant protein-1 (MCP-1) serum concentrations. We studied 150 patients in on-line-predilution hemodiafiltration. Dialysis sufficiency was defined by Kt/V for urea. PAD was defined using clinical criteria, ankle-brachial index and Doppler ultrasound in the lower limbs. MCP-1 serum concentrations were measured using enzyme-linked immunoabsorbed assay (ΕLISA). We performed chi-square tests and logistic regression analysis to investigate risk factors for the prevalence of PAD in these patients including MCP-1 serum concentrations. The patients with manifested PAD had elevated MCP-1, higher BP, higher arterial stiffness markers, higher markers of malnutrition, uncontrolled metabolic acidosis, bone disease and lower obtained dialysis adequacy than the patients without PAD. The association between PAD manifestation and high MCP-1 was found significant (x2 = 9.6, p = 0.001). The built logistic regression analysis showed that the high MCP-1 increased the risk for PAD 3.2 (95% C.I 1.3-8.2) folds after adjustment for confounders. PAD was also significantly associated with non-administration of vitamin D agents during dialysis (x2 = 3.5, p = 0.04).Malnutrition, low-grade inflammation mainly defined by high MCP-1 serum concentrations, metabolic acidosis and bone disease were included in significant predictors for peripheral arterial disease in patients undergoing hemodiafiltration. The obtained dialysis sufficiency and the therapy during dialysis sessions seem to play an additional role in the demonstration of peripheral vascular disease in these patients.
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Affiliation(s)
- Vaia D Raikou
- 1st Department of Medicine - Propaedaetic, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - Despina Kyriaki
- Department of Nuclear Medicine, General Hospital "LAΪKO", Athens, Greece
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17
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Smolderen KG, Gosch K, Patel M, Jones WS, Hirsch AT, Beltrame J, Fitridge R, Shishehbor MH, Denollet J, Vriens P, Heyligers J, Stone MEd N, Aronow H, Abbott JD, Labrosciano C, Tutein-Nolthenius R, A Spertus J. PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories): Overview of Design and Rationale of an International Prospective Peripheral Arterial Disease Study. Circ Cardiovasc Qual Outcomes 2019; 11:e003860. [PMID: 29440123 DOI: 10.1161/circoutcomes.117.003860] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/21/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health status outcomes, including symptoms, functional status, and quality of life, are critically important outcomes from patients' perspectives. The PORTRAIT study (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) was designed to prospectively define health status outcomes and examine associations between patients' characteristics and care to these outcomes among those presenting with new-onset or worsened claudication. METHODS AND RESULTS PORTRAIT screened 3637 patients with an abnormal ankle-brachial index and new, or worsened, claudication symptoms from 16 peripheral arterial disease (PAD) specialty clinics in the United States, the Netherlands, and Australia between June 2, 2011, and December 3, 2015. Of the 1608 eligible patients, 1275 (79%) were enrolled. Before treatment, patients were interviewed to obtain their demographics, PAD symptoms and health status, psychosocial characteristics, preferences for shared decision-making, socioeconomic, and cardiovascular risk factors. Patients' medical history, comorbidities, and PAD diagnostic information were abstracted from patients' medical records. Serial information about patients' health status, psychosocial, and lifestyle factors was collected at 3, 6, and 12 months by a core laboratory. Follow-up rates ranged from 84.2% to 91%. Clinical follow-up for PAD-related hospitalizations and major cardiovascular events is ongoing. CONCLUSIONS PORTRAIT systematically collected serial PAD-specific health status data as a foundation for risk stratification, comparative effectiveness studies, and clinicians' adherence to quality-based performance measures. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01419080.
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Affiliation(s)
- Kim G Smolderen
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.).
| | - Kensey Gosch
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Manesh Patel
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - W Schuyler Jones
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Alan T Hirsch
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - John Beltrame
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Rob Fitridge
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Mehdi H Shishehbor
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Johan Denollet
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Patrick Vriens
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Jan Heyligers
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Nancy Stone MEd
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Herbert Aronow
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - J Dawn Abbott
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Clementine Labrosciano
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - Rudolf Tutein-Nolthenius
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
| | - John A Spertus
- From the Department of Biomedical & Health Informatics, University of Missouri Kansas City (K.G.S., J.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.G., N.S., J.S.); Department of Cardiology, Duke University School of Medicine, Durham, NC (M.P., S.J.); Department of Cardiology, University of Minnesota, Minneapolis (A.T.H.); Departments of Cardiology and Vascular Surgery, Queen Elisabeth Hospital, Adelaide, Australia (J.B., R.F., C.L.); Department of Cardiology, University Hospitals of Cleveland, OH (M.H.S.); Department of Medical Psychology, Tilburg University, The Netherlands (J.D.); Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (P.V., J.H.); and Department of Cardiology, Rhode Island Hospital, Providence (H.A., D.A.)
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18
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Torii S, Kolodgie FD, Virmani R, Finn AV. IN.PACT™ Admiral™ drug-coated balloons in peripheral artery disease: current perspectives. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:53-64. [PMID: 30858737 PMCID: PMC6385763 DOI: 10.2147/mder.s165620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Endovascular therapy has evolved as a main treatment option especially in patients with short (<25 cm) femoropopliteal lesion. The latest guideline recommends the use of drug-eluting devices (both drug-coated balloons [DCBs] and drug-eluting stents) in short femoro-popliteal lesions as class IIb recommendation. DCB usage is also recommended for in-stent restenosis lesions (class IIb). DCBs are a more attractive treatment option because the lack of metal prosthesis allows for more flexibility in future treatment options including the option of treating nonstenting zones, previously DCB-treated zones with DCBs again. The IN.PACT™ Admiral™ DCB has shown promising clinical performance in several randomized control trials and global registries, and is currently the market DCB leader for the treatment of femoropopliteal lesions with more than 200,000 patients treated thus far. Currently, more than 10 DCBs have received Conformité Européene mark for the treatment of femoropopliteal atherosclerotic disease. Three of these (including IN.PACT Admiral DCBs) have also received Food and Drug Administration approval in the USA. However, some Conformité Européene-marked DCBs have failed to show consistent results in their clinical studies suggesting all DCBs are not created equal. Each DCB is unique (ie, drug type, drug dose, crystallinity, and excipient) with different clinical outcomes. In the current review, we will focus on the preclinical and clinical results of not only IN.PACT Admiral DCB, but also the other currently available DCBs.
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Affiliation(s)
- Sho Torii
- Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, MD, USA,
| | - Frank D Kolodgie
- Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, MD, USA,
| | - Renu Virmani
- Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, MD, USA,
| | - Aloke V Finn
- Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, MD, USA,
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19
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Wang SK, Murphy MP, Gutwein AR, Drucker NA, Dalsing MC, Motaganahalli RL, Lemmon GW, Akingba AG. Perioperative Outcomes are Adversely Affected by Poor Pretransfer Adherence to Acute Limb Ischemia Practice Guidelines. Ann Vasc Surg 2018; 50:46-51. [DOI: 10.1016/j.avsg.2017.11.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/26/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
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20
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He X, Hu X, Ma X, Su H, Ying L, Peng J, Pan X, Bao Y, Zhou J, Jia W. Elevated serum fibroblast growth factor 23 levels as an indicator of lower extremity atherosclerotic disease in Chinese patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2017; 16:77. [PMID: 28619026 PMCID: PMC5472967 DOI: 10.1186/s12933-017-0559-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/05/2017] [Indexed: 02/06/2023] Open
Abstract
Background Recently, basic and clinical studies have provided evidence supporting the relationship between circulating levels of fibroblast growth factor (FGF) 23 and the development of atherosclerosis. Given that diabetes is an established risk factor for lower extremity atherosclerotic disease (LEAD), the goal of the present study was to explore the relationship between serum FGF23 levels and LEAD, as well as the related factors, in Chinese patients with type 2 diabetes mellitus (T2DM). Methods A total of 401 hospitalized T2DM patients (201 subjects with LEAD and 200 subjects without LEAD) were enrolled in this study. Serum FGF23 levels were determined by a sandwich enzyme-linked immunosorbent assay. Femoral intima-media thickness (F-IMT) and lower limb atherosclerotic plaque were assessed through color Doppler ultrasound. Results The median (interquartile range) serum FGF23 levels in the entire study population was 42.08 (35.59–49.17) pg/mL. Subjects with LEAD had significantly higher serum FGF23 levels compared with those without LEAD (44.00 [37.54–51.30] pg/mL versus 40.42 [32.61–48.23] pg/mL, P < 0.001). Logistic regression showed that serum FGF23 levels were independently and positively correlated with the presence of LEAD (odds ratio 1.039, 95% confidence interval 1.012–1.067, P = 0.004). In addition, multiple liner regression analysis revealed that serum FGF23 levels were positively associated with F-IMT (standardized β = 0.175, P < 0.001). Furthermore, this relationship remained significant after additional adjustment for gender and factors potentially affecting serum FGF23 levels (serum calcium, serum phosphorus, and glomerular filtration rate), respectively (both P < 0.01). Conclusions In Chinese patients with T2DM, serum FGF23 levels were independently and positively correlated with the presence of LEAD.
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Affiliation(s)
- Xingxing He
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
| | - Xiang Hu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
| | - Xiaojing Ma
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China.
| | - Hang Su
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
| | - Lingwen Ying
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
| | - Jiahui Peng
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
| | - Xiaoping Pan
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China.
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
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21
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Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135:e686-e725. [PMID: 27840332 PMCID: PMC5479414 DOI: 10.1161/cir.0000000000000470] [Citation(s) in RCA: 362] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health. These guidelines, based on systematic methods to evaluate and classify evidence, provide a cornerstone of quality cardiovascular care. In response to reports from the Institute of Medicine1 ,2 and a mandate to evaluate new knowledge and maintain relevance at the point of care, the ACC/AHA Task Force on Clinical Practice Guidelines (Task Force) modified its methodology.3 –5 The relationships among guidelines, data standards, appropriate use criteria, and performance measures are addressed elsewhere.5
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Affiliation(s)
| | - Heather L Gornik
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Coletta Barrett
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Neal R Barshes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Matthew A Corriere
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Douglas E Drachman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Lee A Fleisher
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Francis Gerry R Fowkes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Naomi M Hamburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Scott Kinlay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Robert Lookstein
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Sanjay Misra
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Leila Mureebe
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Jeffrey W Olin
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Rajan A G Patel
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Judith G Regensteiner
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Andres Schanzer
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Mehdi H Shishehbor
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Kerry J Stewart
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Diane Treat-Jacobson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - M Eileen Walsh
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
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22
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Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135:e726-e779. [PMID: 27840333 PMCID: PMC5477786 DOI: 10.1161/cir.0000000000000471] [Citation(s) in RCA: 373] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health. These guidelines, based on systematic methods to evaluate and classify evidence, provide a cornerstone of quality cardiovascular care. In response to reports from the Institute of Medicine1 ,2 and a mandate to evaluate new knowledge and maintain relevance at the point of care, the ACC/AHA Task Force on Clinical Practice Guidelines (Task Force) modified its methodology.3 –5 The relationships among guidelines, data standards, appropriate use criteria, and performance measures are addressed elsewhere.5
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Affiliation(s)
| | - Heather L Gornik
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Coletta Barrett
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Neal R Barshes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Matthew A Corriere
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Douglas E Drachman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Lee A Fleisher
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Francis Gerry R Fowkes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Naomi M Hamburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Scott Kinlay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Robert Lookstein
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Sanjay Misra
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Leila Mureebe
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Jeffrey W Olin
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Rajan A G Patel
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Judith G Regensteiner
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Andres Schanzer
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Mehdi H Shishehbor
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Kerry J Stewart
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Diane Treat-Jacobson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - M Eileen Walsh
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
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Improving the therapeutic efficacy of mesenchymal stromal cells to restore perfusion in critical limb ischemia through pulsed focused ultrasound. Sci Rep 2017; 7:41550. [PMID: 28169278 PMCID: PMC5294408 DOI: 10.1038/srep41550] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/21/2016] [Indexed: 12/13/2022] Open
Abstract
Mesenchymal stem cells (MSC) are promising therapeutics for critical limb ischemia (CLI). Mechanotransduction from pulsed focused ultrasound (pFUS) upregulates local chemoattractants to enhance homing of intravenously (IV)-infused MSC and improve outcomes. This study investigated whether pFUS exposures to skeletal muscle would improve local homing of iv-infused MSCs and their therapeutic efficacy compared to iv-infused MSCs alone. CLI was induced by external iliac arterial cauterization in 10–12-month-old mice. pFUS/MSC treatments were delayed 14 days, when surgical inflammation subsided. Mice were treated with iv-saline, pFUS alone, IV-MSC, or pFUS and IV-MSC. Proteomic analyses revealed pFUS upregulated local chemoattractants and increased MSC tropism to CLI muscle. By 7 weeks post-treatment, pFUS + MSC significantly increased perfusion and CD31 expression, while reducing fibrosis compared to saline. pFUS or MSC alone reduced fibrosis, but did not increase perfusion or CD31. Furthermore, MSCs homing to pFUS-treated CLI muscle expressed more vascular endothelial growth factor (VEGF) and interleukin-10 (IL-10) than MSCs homing to non-pFUS-treated muscle. pFUS + MSC improved perfusion and vascular density in this clinically-relevant CLI model. The molecular effects of pFUS increased both MSC homing and MSC production of VEGF and IL-10, suggesting microenvironmental changes from pFUS also increased potency of MSCs in situ to further enhance their efficacy.
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Senthong V, Wu Y, Hazen SL, Tang WHW. Predicting long-term prognosis in stable peripheral artery disease with baseline functional capacity estimated by the Duke Activity Status Index. Am Heart J 2017; 184:17-25. [PMID: 27892883 DOI: 10.1016/j.ahj.2016.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 10/16/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The ability of a simple self-assessment tool for estimated functional capacity to predict long-term prognosis in patients with established peripheral artery disease (PAD) is unknown. We investigate whether subjective measurement of functional capacity estimated by using the Duke Activity Status Index (DASI) questionnaire predicts long-term prognosis in patients with established PAD. METHODS We administered the DASI questionnaire to 771 stable patients with established PAD who underwent elective diagnostic coronary angiography with 5-year follow-up all-cause mortality. RESULTS Two hundred ten patients (27%) died over a 5-year follow-up. The lowest DASI score was associated with a 3.2-fold increased risk of 5-year all-cause mortality (unadjusted hazard ratio 3.23, 95% CI 2.19-4.75, P<.001). After adjustments for traditional risk factors, estimated glomerular filtration rate, high-sensitivity C-reactive protein, and lowest DASI score remained predictive of 5-year all-cause mortality (adjusted hazard ratio 2.09, 95% CI 1.36-3.23, P<.001). Interestingly, the lowest DASI score remained to predict 5-year all-cause mortality regardless of each PAD diagnosis subtype (including lower extremity, non-lower extremity, or carotid artery PAD), although the mortality risk was attenuated when incorporating heart disease severity in the non-lower extremity group. CONCLUSIONS A simple self-assessment tool of functional capacity provides an independent and incremental prognosis value for long-term adverse clinical events in stable patients with established PAD beyond each PAD diagnostic subtype.
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Senthong V, Wang Z, Fan Y, Wu Y, Hazen SL, Tang WHW. Trimethylamine N-Oxide and Mortality Risk in Patients With Peripheral Artery Disease. J Am Heart Assoc 2016; 5:e004237. [PMID: 27792653 PMCID: PMC5121520 DOI: 10.1161/jaha.116.004237] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/09/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Production of the proatherogenic metabolite, trimethylamine N-oxide (TMAO), from dietary nutrients by intestinal microbiota enhances atherosclerosis development in animal models and is associated with atherosclerotic coronary artery disease in humans. The utility of studying plasma levels of TMAO to risk stratify in patients with peripheral artery disease (PAD) has not been reported. METHODS AND RESULTS We examined the relationship between fasting plasma TMAO and all-cause mortality (5-year), stratified by subtypes of PAD and presence of coronary artery disease in 935 patients with PAD who underwent elective angiography for cardiac evaluation at a tertiary care hospital. Median plasma TMAO was 4.8 μmol/L (interquartile range, 2.9-8.0 μmol/L). Elevated TMAO levels were associated with 2.7-fold increased mortality risk (fourth versus first quartiles, hazard ratio 2.86, 95% CI 1.82-3.97, P<0.001). Following adjustments for traditional risk factors, inflammatory biomarkers, and history of coronary artery disease, the highest TMAO quartile remained predictive of 5-year mortality (adjusted hazard ratio 2.06, 95% CI 1.36-3.11, P<0.001). Similar prognostic value for elevated TMAO was seen for subjects with carotid artery, non-carotid artery, or lower extremity PAD. TMAO provided incremental prognostic value for all-cause mortality (net reclassification index, 40.22%; P<0.001) and improvement in area under receiver operator characteristic curve (65.7% versus 69.4%; P=0.013). CONCLUSIONS TMAO, a pro-atherogenic metabolite formed by gut microbes, predicts long-term adverse event risk and incremental prognostic value in patients with PAD. These findings point to the potential for TMAO to help improve selection of high-risk PAD patients with or without significant coronary artery disease, who likely need more aggressive and specific dietary and pharmacologic therapy.
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Affiliation(s)
- Vichai Senthong
- Cleveland Clinic, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, OH Faculty of Medicine, Department of Medicine, Queen Sirikit Heart Center of the Northeast, Khon Kaen University, Khon Kaen, Thailand
| | - Zeneng Wang
- Cleveland Clinic, Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland, OH
| | - Yiying Fan
- Department of Mathematics, Cleveland State University, Cleveland, OH
| | - Yuping Wu
- Department of Mathematics, Cleveland State University, Cleveland, OH
| | - Stanley L Hazen
- Cleveland Clinic, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, OH Cleveland Clinic, Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland, OH
| | - W H Wilson Tang
- Cleveland Clinic, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, OH Cleveland Clinic, Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland, OH
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Sanghavi M, Gulati M. Cardiovascular Disease in Women: Primary and Secondary Cardiovascular Disease Prevention. Obstet Gynecol Clin North Am 2016; 43:265-85. [PMID: 27212092 DOI: 10.1016/j.ogc.2016.01.001] [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: 12/17/2022]
Abstract
Cardiovascular disease remains the leading cause of death in the United States. Primary prevention of cardiovascular disease requires involvement of an extended health care team. Obstetricians and gynecologists are uniquely positioned within the health care system because they are often the primary or only contact women have with the system. This review article discusses initial assessment, treatment recommendations, and practical tips regarding primary and secondary prevention of cardiovascular disease in women with a focus on coronary heart disease; discussion includes peripheral and cerebrovascular disease.
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Affiliation(s)
- Monika Sanghavi
- Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9047, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona-Phoenix, 1300 North 12th Street, Suite 407, Phoenix, AZ 85006, USA.
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Silva Junior JAD, Souza DÚF, Ferreira DR, Valeriano MCP, Santos RF, Britto RR, Pereira DAG. Avaliação da saturação tecidual de oxigênio durante o sintoma claudicante em pacientes com doença arterial periférica. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.002115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Contexto O relato de sintoma claudicante em pacientes com doença arterial periférica é utilizado como modulador da intensidade de exercício físico para o tratamento clínico, entretanto os valores de oxigenação tecidual nesse momento são desconhecidos. Objetivo Descrever o suprimento tecidual de oxigênio por meio da espectroscopia de luz próxima ao infravermelho ou Near-Infrared Spectroscopy (NIRS) nos momentos em que o paciente relata sintoma claudicante inicial e máximo em testes de exercício. Métodos Nove pacientes, oito homens com 65,63 ± 6,02 anos de idade, previamente diagnosticados com doença arterial periférica, realizaram teste de exercício de carga constante e de carga incremental com monitorização do nível de oxigenação tecidual através da NIRS. As saturações de oxigênio obtidas no momento em que o paciente relata sintoma claudicante inicial e no momento em que relata sintoma claudicante máximo foram comparadas com os valores de saturação da manobra de oclusão arterial por meio do intervalo de confiança de 95% da diferença. Resultados Verificou-se que os valores de saturação nos momentos de sintoma claudicante inicial e máximo são estatisticamente distintos quando comparados àqueles obtidos na manobra de oclusão arterial, entretanto, através da análise percentual do quão distante esses valores encontram-se é possível observar que, do ponto de vista clínico, eles estão próximos. Conclusões A saturação no momento em que o paciente relata sintomas claudicantes inicial e máximo é bastante próxima do valor de saturação no momento de oclusão e do ponto de vista clínico o relato subjetivo de sintoma do paciente é adequado como parâmetro para a prescrição do exercício físico.
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Wallace EL, Tasan E, Cook BS, Charnigo R, Abdel-Latif AK, Ziada KM. Long-Term Outcomes and Causes of Death in Patients With Renovascular Disease Undergoing Renal Artery Stenting. Angiology 2015; 67:657-63. [PMID: 26430136 DOI: 10.1177/0003319715609013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Renovascular disease (RVD) can lead to hypertension and chronic kidney disease (CKD). Patients with advanced peripheral arterial disease (PAD) have a 5-year mortality of ∼30%. Rate and causes of death in patients with significant RVD, who share similar risk factors with patients having PAD, are not well defined. We assessed consecutive patients with RVD who underwent renal artery stenting at our institution over 6 years. Specific causes of death were ascertained, and the probability of survival was estimated. Cox models were fit to identify predictors of outcomes. We identified 281 patients with RVD who underwent renal stenting. Follow-up was available for all patients (median 5.1 years). All-cause mortality was 24.2% at 5 years and 33.7% at 7 years (compounded annualized death rate: 5.5%). Of the 68 deaths, 36 (52.9%) were cardiovascular (13.2% acute myocardial infarction, 13.2% stroke, 11.8% sudden death, and 10.3% congestive heart failure) and 32 (47.1%) deaths had noncardiovascular causes. In patients with RVD undergoing stenting, cardiovascular events are the most common causes of death. Compared to patients with advanced PAD, RVD may have a lower 5-year mortality.
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Affiliation(s)
- Eric L Wallace
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Veterans Affairs Medical Center, Lexington, KY, USA
| | - Ediz Tasan
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Bryon S Cook
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Richard Charnigo
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Ahmed K Abdel-Latif
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Veterans Affairs Medical Center, Lexington, KY, USA
| | - Khaled M Ziada
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Veterans Affairs Medical Center, Lexington, KY, USA
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Hicks KA, Tcheng JE, Bozkurt B, Chaitman BR, Cutlip DE, Farb A, Fonarow GC, Jacobs JP, Jaff MR, Lichtman JH, Limacher MC, Mahaffey KW, Mehran R, Nissen SE, Smith EE, Targum SL. 2014 ACC/AHA Key Data Elements and Definitions for Cardiovascular Endpoint Events in Clinical Trials: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Cardiovascular Endpoints Data Standards). J Nucl Cardiol 2015; 22:1041-144. [PMID: 26204990 DOI: 10.1007/s12350-015-0209-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Hicks KA, Tcheng JE, Bozkurt B, Chaitman BR, Cutlip DE, Farb A, Fonarow GC, Jacobs JP, Jaff MR, Lichtman JH, Limacher MC, Mahaffey KW, Mehran R, Nissen SE, Smith EE, Targum SL. 2014 ACC/AHA Key Data Elements and Definitions for Cardiovascular Endpoint Events in Clinical Trials. Circulation 2015; 132:302-61. [DOI: 10.1161/cir.0000000000000156] [Citation(s) in RCA: 186] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Drozd NN, Kuznetsova SA, Savchik EY, Miftakhova NT, Vasil’eva NY. Effects of Subcutaneous Microcrystalline Cellulose Sulfate Extracted from the Wood of the Siberian Fir (Abies sibirica Ledeb) on the Clotting of Rabbit Plasma. Pharm Chem J 2015. [DOI: 10.1007/s11094-015-1246-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Demir O, Tasci I, Acikel C, Saglam K, Gezer M, Acar R, Yildiz B, Bulucu F, Kabul HK, Dogan MI, Koc B. Individual variations in ankle brachial index measurement among Turkish adults. Vascular 2015; 24:53-8. [PMID: 25925905 DOI: 10.1177/1708538115584506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Variability of ankle brachial index (ABI) measured by the same observer in the same individual on three different occasions was examined. BASIC METHODS A single morning ABI was initially determined (measurement 1) with handheld Doppler device. One to four weeks apart, another morning (measurement 2) and afternoon (measurement 3) ABI was measured on the same day. PRINCIPAL FINDINGS A total of 161 adults were enrolled. Mean ABI was similar among the three measurements. ABI differed more than ≥0.15 in 15 individuals between measurement 1 and 3, in 10 subjects between measurement 1 and 2, and in 12 individuals between measurement 2 and 3. Intra-group correlation coefficients of reproducibility of ABI were 0.808 for single measurements (coefficient of the values lacking association with each other), and 0.927 for average measurements (coefficient of the values that were associated with each other). CONCLUSIONS Although reproducibility of ABI values was found satisfactory, up to 12% of participants displayed more than 0.15 alternations between measurements, either on the same day or more than a week apart.
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Affiliation(s)
- Orhan Demir
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Ilker Tasci
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Cengizhan Acikel
- Department of Epidemiology, Gulhane School of Medicine, Ankara, Turkey
| | - Kenan Saglam
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Mustafa Gezer
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Ramazan Acar
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Birol Yildiz
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Fatih Bulucu
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Hasan Kutsi Kabul
- Department of Cardiology, Gulhane School of Medicine, Ankara, Turkey
| | | | - Bayram Koc
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
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Rantner B, Pohlhammer J, Stadler M, Peric S, Hammerer-Lercher A, Klein-Weigel P, Fraedrich G, Kronenberg F, Kollerits B. Left ventricular ejection fraction is associated with prevalent and incident cardiovascular disease in patients with intermittent claudication – results from the CAVASIC Study. Atherosclerosis 2015; 239:428-35. [DOI: 10.1016/j.atherosclerosis.2014.12.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/15/2014] [Accepted: 12/31/2014] [Indexed: 01/08/2023]
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Abstract
Improvements in the design of endovascular devices and technical skills of interventionalists have opened new possibilities for patients with a wide range of peripheral vascular diseases. In lower extremity peripheral artery disease, percutaneous treatments have become the predominant revascularization strategy for simple and complex lesions. Newer generations of stents and drug-coated balloons have demonstrated strong potential in the treatment of femoropopliteal and infrainguinal diseases. One of the most dramatic advances in the recent past has been endovascular repair of thoracic and abdominal aortic aneurysms, which has become the preferred approach in lieu of open surgical repair. Contemporary trials have established the safety and effectiveness of carotid stenting in selected patients with severe stenosis. Endovascular treatments for venous occlusive disease have long been underutilized, but their effectiveness is being increasingly recognized. This review covers new endovascular procedures performed by interventional cardiologists for peripheral vascular diseases.
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Hedberg P, Hammar C, Selmeryd J, Viklund J, Leppert J, Hellberg A, Henriksen E. Left ventricular systolic dysfunction in outpatients with peripheral atherosclerotic vascular disease: prevalence and association with location of arterial disease. Eur J Heart Fail 2014; 16:625-32. [DOI: 10.1002/ejhf.95] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/06/2014] [Accepted: 03/14/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Pär Hedberg
- Department of Clinical Physiology; Västmanland County Hospital; Västerås Sweden
- Center for Clinical Research; University of Uppsala, Västmanland County Hospital; Västerås Sweden
| | - Charlotta Hammar
- Division of Internal Medicine, Department of Cardiology; Västmanland County Hospital; Västerås Sweden
| | - Jonas Selmeryd
- Department of Clinical Physiology; Västmanland County Hospital; Västerås Sweden
- Center for Clinical Research; University of Uppsala, Västmanland County Hospital; Västerås Sweden
| | - Josefin Viklund
- Division of Internal Medicine, Department of Cardiology; Västmanland County Hospital; Västerås Sweden
| | - Jerzy Leppert
- Center for Clinical Research; University of Uppsala, Västmanland County Hospital; Västerås Sweden
| | - Anders Hellberg
- Department of Vascular Surgery; Västmanland County Hospital; Västerås Sweden
| | - Egil Henriksen
- Department of Clinical Physiology; Västmanland County Hospital; Västerås Sweden
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Jones WS, Dolor RJ, Hasselblad V, Vemulapalli S, Subherwal S, Schmit K, Heidenfelder B, Patel MR. Comparative effectiveness of endovascular and surgical revascularization for patients with peripheral artery disease and critical limb ischemia: systematic review of revascularization in critical limb ischemia. Am Heart J 2014; 167:489-498.e7. [PMID: 24655697 DOI: 10.1016/j.ahj.2013.12.012] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 12/22/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND For patients with critical limb ischemia (CLI), the optimal treatment to enhance limb preservation, prevent death, and improve functional status is unknown. We performed a systematic review and meta-analysis to assess the comparative effectiveness of endovascular revascularization and surgical revascularization in patients with CLI. METHODS We systematically searched PubMed, Embase, and the Cochrane Database of Systematic Reviews for relevant English-language studies published from January 1995 to August 2012. Two investigators screened each abstract and full-text article for inclusion, abstracted the data, and performed quality ratings and evidence grading. Random-effects models were used to compute summary estimates of effects, with endovascular treatment as the control group. RESULTS We identified a total of 23 studies, including 1 randomized controlled trial, which reported no difference in amputation-free survival at 3 years (odds ratio [OR] 1.22, 95% CI 0.84-1.77) and all-cause mortality (OR 1.07, 0.73-1.56) between the 2 treatments. Meta-analysis of the observational studies showed a statistically nonsignificant reduction in all-cause mortality at 6 months (11 studies, OR 0.85, 0.57-1.27) and amputation-free survival at 1 year (2 studies, OR 0.76, 0.48-1.21) in patients treated with endovascular revascularization. There was no difference in overall death, amputation, or amputation-free survival at ≥2 years. CONCLUSIONS The currently available literature suggests that there is no difference in clinical outcomes for patients with CLI treated with endovascular or surgical revascularization. There is a paucity of high-quality data available to guide clinical decision making, especially as it pertains to patient subgroups or anatomical considerations.
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Sanborn TA, Tcheng JE, Anderson HV, Chambers CE, Cheatham SL, DeCaro MV, Durack JC, Everett AD, Gordon JB, Hammond WE, Hijazi ZM, Kashyap VS, Knudtson M, Landzberg MJ, Martinez-Rios MA, Riggs LA, Sim KH, Slotwiner DJ, Solomon H, Szeto WY, Weiner BH, Weintraub WS, Windle JR. ACC/AHA/SCAI 2014 health policy statement on structured reporting for the cardiac catheterization laboratory: a report of the American College of Cardiology Clinical Quality Committee. Circulation 2014; 129:2578-609. [PMID: 24682349 DOI: 10.1161/cir.0000000000000043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Peripheral artery disease (PAD) usually refers to ischemia of the lower limb vessels. Currently, the estimated number of cases in the world is 202 million. PAD is the third leading cause of atherosclerotic cardiovascular morbidity. The measurement of the ankle-brachial index (ABI) is recommended as a first-line noninvasive test for screening and diagnosis of PAD. An ABI <0.90 is an independent predictor of cardiovascular events and this measurement is useful to identify patients at moderate to high risk of cardiovascular disease. However, there is insufficient evidence to assess the benefits and harms of screening for PAD with the ABI in asymptomatic adults. Lifestyle modifications, including smoking cessation, dietary changes and physical activity, are currently the most cost-effective interventions. Inverse associations with PAD have been reported for some subtypes of dietary fats, fiber, antioxidants (vitamins E and C), folate, vitamins B6, B12 and D, flavonoids, and fruits and vegetables. A possible inverse association between better adherence to the Mediterranean diet and the risk of symptomatic PAD has also been reported in a large randomized clinical trial. Therefore, a Mediterranean-style diet could be effective in the primary and secondary prevention of PAD, although further experimental studies are needed to better clarify this association. (Circ J 2014; 78: 553-559).
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Affiliation(s)
- Miguel Ruiz-Canela
- Department of Preventive Medicine and Public Health, University of Navarra
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Keo HH, Duval S, Baumgartner I, Oldenburg NC, Jaff MR, Goldman J, Peacock JM, Tretinyak AS, Henry TD, Luepker RV, Hirsch AT. The FReedom from Ischemic Events-New Dimensions for Survival (FRIENDS) registry: design of a prospective cohort study of patients with advanced peripheral artery disease. BMC Cardiovasc Disord 2013; 13:120. [PMID: 24354507 PMCID: PMC3878262 DOI: 10.1186/1471-2261-13-120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/02/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Advanced lower extremity peripheral artery disease (PAD), whether presenting as acute limb ischemia (ALI) or chronic critical limb ischemia (CLI), is associated with high rates of cardiovascular ischemic events, amputation, and death. Past research has focused on strategies of revascularization, but few data are available that prospectively evaluate the impact of key process of care factors (spanning pre-admission, acute hospitalization, and post-discharge) that might contribute to improving short and long-term health outcomes. METHODS/DESIGN The FRIENDS registry is designed to prospectively evaluate a range of patient and health system care delivery factors that might serve as future targets for efforts to improve limb and systemic outcomes for patients with ALI or CLI. This hypothesis-driven registry was designed to evaluate the contributions of: (i) pre-hospital limb ischemia symptom duration, (ii) use of leg revascularization strategies, and (iii) use of risk-reduction pharmacotherapies, as pre-specified factors that may affect amputation-free survival. Sequential patients would be included at an index "vascular specialist-defined" ALI or CLI episode, and patients excluded only for non-vascular etiologies of limb threat. Data including baseline demographics, functional status, co-morbidities, pre-hospital time segments, and use of medical therapies; hospital-based use of revascularization strategies, time segments, and pharmacotherapies; and rates of systemic ischemic events (e.g., myocardial infarction, stroke, hospitalization, and death) and limb ischemic events (e.g., hospitalization for revascularization or amputation) will be recorded during a minimum of one year follow-up. DISCUSSION The FRIENDS registry is designed to evaluate the potential impact of key factors that may contribute to adverse outcomes for patients with ALI or CLI. Definition of new "health system-based" therapeutic targets could then become the focus of future interventional clinical trials for individuals with advanced PAD.
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Affiliation(s)
- Hong H Keo
- Division of Angiology, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Sue Duval
- Vascular Medicine Program, Lillehei Heart Institute and Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Iris Baumgartner
- Swiss Cardiovascular Center, Division of Angiology, University Hospital Bern, Bern, Switzerland
| | - Niki C Oldenburg
- Vascular Medicine Program, Lillehei Heart Institute and Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michael R Jaff
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - JoAnne Goldman
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - James M Peacock
- Minnesota Department of Health, Heart Disease and Stroke Prevention Unit, Saint Paul, MN, USA
| | - Alexander S Tretinyak
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Timothy D Henry
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Russell V Luepker
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Alan T Hirsch
- Vascular Medicine Program, Lillehei Heart Institute and Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
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Melzer J, Saller R. [Clinical studies in peripheral arterial occlusive disease: update from the aspects of a meta-narrative review]. ACTA ACUST UNITED AC 2013; 20 Suppl 2:17-21. [PMID: 23860108 DOI: 10.1159/000351720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Atherosclerosis is a systemic disease. Its association with the metabolic syndrome requires a multimodal therapy setting, to alleviate symptoms and for primary and secondary prevention. In the planning of the therapy, information about evidence of the interventions and a rationale for reasonable combinations are important. METHOD For compiling a meta-narrative review (MNR) on the evidence of complementary and conventional pharmaco-therapy in peripheral arterial occlusive disease (PAOD), the literature was searched for meta-analyses of randomized controlled trials (RCTs). These were evaluated taking into account network-pharmacological aspects and research parameters. RESULTS 4 suitable meta-analyses were found. In comparison to placebo, treatments with verum showed a significant improvement of the maximum walking distance of 63.5 m (95% confidence interval (CI) 27.11-99.91 m; Padma 28, Tibetan Formula), 41.3 m (95% CI -7.1-89.7 m; cilostazol, phosphodiesterase IIl inhibitor), 43.8 m (95% CI 14.1-73.6 m; pentoxifylline, rheological drug), and 71.2 m (95% CI 13.3-129.0 m; naftidrofuryl, rheological drug). Only for Padma 28, clinical relevance, defined as an increase of the maximum walking distance by >100 m, was analyzed and reached by 18.2% of the verum and 2.1% of the placebo patients (odds ratio 10; 95% CI 3.03-33.33). 1 conventional and 1 complementary drug additionally showed to have significant pleiotropic effects (Padma 28 and cilostazol (e.g. reduction of triglycerides)). CONCLUSIONS According to meta-analytic evidence, naftidrofuryl and Padma 28 show clinically relevant efficacy for the treatment of early stages of PAOD. The extent to which the theoretically possible combination of different drugs contributes to improve the systemic disease under a network-pharmacological rationale remains to be shown in a multi-armed RCT.
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Affiliation(s)
- Jörg Melzer
- Institut für Naturheilkunde, Universitätsspital Zürich, Schweiz.
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Cannon CP, Brindis RG, Chaitman BR, Cohen DJ, Cross JT, Drozda JP, Fesmire FM, Fintel DJ, Fonarow GC, Fox KA, Gray DT, Harrington RA, Hicks KA, Hollander JE, Krumholz H, Labarthe DR, Long JB, Mascette AM, Meyer C, Peterson ED, Radford MJ, Roe MT, Richmann JB, Selker HP, Shahian DM, Shaw RE, Sprenger S, Swor R, Underberg JA, Van de Werf F, Weiner BH, Weintraub WS. 2013 ACCF/AHA Key Data Elements and Definitions for Measuring the Clinical Management and Outcomes of Patients With Acute Coronary Syndromes and Coronary Artery Disease. Circulation 2013; 127:1052-89. [DOI: 10.1161/cir.0b013e3182831a11] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | | | | | | | - J. Thomas Cross
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | - Joseph P. Drozda
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | - Francis M. Fesmire
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | - Dan J. Fintel
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | | | | | - Darryl T. Gray
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | | | - Karen A. Hicks
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | - Judd E. Hollander
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | | | - Darwin R. Labarthe
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | - Janet B. Long
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | - Alice M. Mascette
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | - Connie Meyer
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | | | | | | | - James B. Richmann
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | - Harry P. Selker
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | - David M. Shahian
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | | | - Sharon Sprenger
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | - Robert Swor
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | - James A. Underberg
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
| | | | - Bonnie H. Weiner
- American College of Physicians Representative. American Medical Association Representative. American College of Emergency Physicians Representative. American College of Chest Physicians Representative. Agency for Healthcare Research and Quality Representative. The findings and conclusions in this report are those of the author and do not necessarily represent the official positions of the Agency for Healthcare Research and Quality. Food and Drug Administration Representative. The findings and
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Peripheral artery occlusive disease in chronic phase chronic myeloid leukemia patients treated with nilotinib or imatinib. Leukemia 2013; 27:1316-21. [PMID: 23459449 DOI: 10.1038/leu.2013.70] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Several retrospective studies have described the clinical manifestation of peripheral artery occlusive disease (PAOD) in patients receiving nilotinib. We thus prospectively screened for PAOD in patients with chronic phase chronic myeloid leukemia (CP CML) being treated with tyrosine kinase inhibitors (TKI), including imatinib and nilotinib. One hundred and fifty-nine consecutive patients were evaluated for clinical and biochemical risk factors for cardiovascular disease. Non-invasive assessment for PAOD included determination of the ankle-brachial index (ABI) and duplex ultrasonography. A second cohort consisted of patients with clinically manifest PAOD recruited from additional collaborating centers. Pathological ABI were significantly more frequent in patients on first-line nilotinib (7 of 27; 26%) and in patients on second-line nilotinib (10 of 28; 35.7%) as compared with patients on first-line imatinib (3 of 48; 6.3%). Clinically manifest PAOD was identified in five patients, all with current or previous nilotinib exposure only. Relative risk for PAOD determined by a pathological ABI in first-line nilotinib-treated patients as compared with first-line imatinib-treated patients was 10.3. PAOD is more frequently observed in patients receiving nilotinib as compared with imatinib. Owing to the severe nature of clinically manifest PAOD, longitudinal non-invasive monitoring and careful assessment of risk factors is warranted.
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Alvarez CE, Verdú G, Ena J. [Use of pulse oximetry as screening method for peripheral arterial disease in patients admitted to a general medicine service]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2013; 25:1-7. [PMID: 23522275 DOI: 10.1016/j.arteri.2012.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 12/04/2012] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Ankle-brachial index measured by a continuous wave Doppler device remains as the reference method for office diagnosis of peripheral arterial disease. This method is time consuming, requires an appropriate device and training of the examiner. We evaluated the usefulness of pulse oximetry as an easier method to screen for peripheral arterial disease. METHODS A total of 110 subjects were selected by opportunistic sampling among patients admitted to a general medicine service. Entry criteria were age older than 50 years and having an additional cardiovascular risk factor. Patients with known cardiovascular disease were excluded. We measured oxygen saturation (SaO2) by means of a pocket finger tip pulse oximeter at 4 limbs. SaO2 was measured at right and left index fingers and great toes with patient lying and after elevating the foot 30 cm above the bed. We considered as abnormal a difference in SaO2 greater than 2% between fingers and toes. Brachial index was estimated by means of a handheld Doppler device. RESULTS The prevalence of peripheral arterial disease was 10% (95% confidence interval [CI], 6%-14%). Pulse oximetry has sensitivity 12% (95%CI, 4%-37%), specificity 67% (95%CI, 60%-74%), positive likelihood ratio 0.43 (95%CI, 0.11-1.19), negative likelihood ratio 1.27 (95%CI, 0.91-1.45) and area under the receiving operating characteristics curve 0.75 (95%CI, 0.67-0.82). CONCLUSIONS Pulse oximetry showed low accuracy as screening method for peripheral arterial disease. Simpler and more accurate devices than ankle-brachial index measured by Doppler are necessary to ease the screening of peripheral arterial disease.
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Affiliation(s)
- Carlos E Alvarez
- Servicio de Medicina Interna, Hospital Marina Baixa, Villajoyosa, Alicante, España
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