Paradox of the Relationship between Cardio-Ankle Vascular Index and Ankle-Brachial Index in Patients with Lower Extremity Artery Disease

Relationships between Cardio-Ankle Vascular Index and Peptides Related to Hypertensive Disorders of Pregnancy in Patients with Lower Extremity Arterial Disease

Introduction

Cardio-ankle vascular index (CAVI), a blood pressure-independent measure of heart-ankle pulse wave velocity, is a relatively new indicator of arterial stiffness. The absolute value of the difference in right CAVI and left CAVI (diff-CAVI) has been proposed as a new indicator of leg ischemia in patients with lower extremity arterial disease (LEAD). The aim of this study was to elucidate the relationships between diff-CAVI and peptides related to hypertensive disorders of pregnancy (HDP), which have been proposed as biomarkers for leg ischemia in patients with LEAD.

Methods

The participants were 165 outpatients with LEAD who had already received medication therapy for LEAD. The relationships between diff-CAVI and serum levels of the seven HDP-related peptides, which were measured by mass spectrometry, were investigated.

Results

HDP-related peptides with m/z 2091 (P-2091) and m/z 2378 (P-2378) showed significant positive correlations with diff-CAVI, and odds ratios (ORs) for large diff-CAVI (≥1.05) of the 3rd vs. 1st tertile groups of P-2091 (OR [99.3% confidence interval]: 3.71 [1.24-11.15]) and P-2378 (OR: 4.46 [1.39-14.30]) were significantly higher (p < 0.01) than the reference level. The associations of P-2091 and P-2378 with diff-CAVI were shown to be independent of age, gender, habit of smoking, history of diabetes, BMI, and blood pressure in multivariate analyses. The other peptides with m/z 2081, 2127, 2209, 2858, and 3156 did not show significant associations with diff-CAVI.

Conclusion

P-2091 and P-2378 were associated with diff-CAVI and are thought to be useful indicators of leg ischemia in patients with LEAD.

Early Diagnosis of Subclinical Atherosclerosis in Asymptomatic Type 2 Diabetic Normotensive Menopausal Women: A Global Pulse Wave Velocity Study

Arterial stiffness serves as a cardiovascular disease marker, aiding in the early identification of high-risk patients. We aimed to evaluate the prevalence of arterial stiffness, measured by global pulse wave velocity (gPWV), among diabetic normotensive menopausal women (DPMW) and its correlation with levels of glycosylated hemoglobin (HbA1c). We recruited 641 consecutive DPMW diagnosed with type 2 diabetes over 5 years. The control group (CG) consisted of 300 normotensive, normoglycemic menopausal women. Normal gPWV was defined as a velocity ≤7.1 m/s. We enrolled 641 DPMW with a mean age of 57 ± 12 years. The CG comprised 300 normotensive, normoglycemic postmenopausal women with a mean age of 56 ± 4 years. Among DPMW, 29 (4.5%) exhibited increased gPWV compared with 4 (1.3%) in the CG (p < 0.01). Of the 225 (35.1%) DPMW with HbA1c > 7.5%, 23 (10.2%) had increased gPWV. In contrast, among the 416 (64.9%) DPMW with HbA1c < 7.5%, only 6 (1.4%) had increased gPWV (p < 0.0001). Electrocardiographic (ECG) abnormalities were detected in 208 (32.4%) DPMW, with 11 (5.3%) of them exhibiting increased gPWV (p = 0.6). There was a higher prevalence of increased gPWV in asymptomatic normotensive DPMW, with a significant association between increased gPWV and elevated HbA1c levels. However, there was no correlation between increased gPWV and abnormal ECG findings, despite ECG being the sole test recommended by current guidelines for all diabetic patients. Early detection of elevated HbA1c levels and increased gPWV may identify asymptomatic DPMW at higher cardiovascular risk, highlighting the inadequacy of a simple ECG in assessing cardiovascular risk in this population.

Difference in right and left cardio-ankle vascular index as a useful marker for evaluation of leg ischemia in patients with lower extremity arterial disease

OBJECTIVES

Cardio-ankle vascular index (CAVI) is a blood pressure-independent measure of heart-ankle pulse wave velocity and is used as an indicator of arterial stiffness. However, there is a paradox that CAVI is inversely associated with leg ischemia in patients with lower extremity arterial disease (LEAD). The aim of this study was to clarify the significance of the absolute value of left and right difference in CAVI (diff-CAVI).

METHODS

The subjects were 165 patients with LEAD who had received medication therapy. Relationships between diff-CAVI and leg ischemia were investigated. Leg ischemia was evaluated by decrease in leg arterial flow using ankle-brachial index (ABI) and by symptoms using the Rutherford classification.

RESULTS

There was a significant inverse correlation between diff-CAVI and ABI. The odds ratio for low ABI of the 3rd versus 1st tertile groups of diff-CAVI was 7.03 with a 95% confidence interval of 2.71 ∼ 18.22. In ROC analysis, the cutoff value of diff-CAVI for low ABI was 1.05 with a sensitivity of 61.1% and a specificity of 87.1%. The median of diff-CAVI was significantly higher in subjects with grade 2 of the Rutherford classification than in subjects with its grade 1.

CONCLUSIONS

diff-CAVI showed an inverse association with ABI and a positive association with symptoms of leg ischemia. Thus, diff-CAVI is thought to be a useful indicator of leg ischemia in LEAD patients.