Association between adherence to home-based walking exercise with a pedometer and one-year adverse outcomes among lower extremity peripheral artery disease patients with endovascular treatment

Background

Home-based exercise after endovascular treatment (EVT) for lower extremity peripheral artery disease (LE-PAD) patients with intermittent claudication is suggested as an alternative therapy for supervised exercise; however, an association of adherence to home-based exercise with clinical adverse events has not been fully investigated.

Purpose

We aimed to investigate the association of adherence to home-based exercise with 1-year major adverse events (MAE), patency, and leg symptoms after EVT in a contemporary Japanese registry.

Methods

A total of 500 patients with LE-PAD within the Long Term Outcome of Endovascular Therapy for PAD with Intermittent Claudication Observational Prospective Multicenter (ASHIMORI-IC) registry (UMINCTR, UMINehab724.203718753) who underwent EVT between January 2016 and March 2019 were included in the analysis. After EVT, all patients were instructed to do home-based walking exercise with a pedometer. The study population was divided and compared between 2 groups according to adherence to home-based exercise: well-adherence and poor-adherence. The adherence of home-based exercise was as defined by step count derived from a pedometer on sites. The primary outcome was MAE defined as composite of all-cause death, myocardial infarction, stroke, target vessel revascularization, and major amputation of target lower limb for one year. The main secondary outcome was 1-year primary patency of the treated lesion, and the improvement of leg symptom (6-minute walk distance [6MWD] and claudication distance). The study followed the Consensus definitions from peripheral academic research consortium criteria.

Results

Overall, the mean age was 72.8 years, and 78% were men. At 1 year, MAE occurred in 45 patients (9.0%), and the primary patency rate was 85.3% (94.2% of EVT for aortoiliac and 71.9% of EVT for femoropopliteal). A significant difference in the incidence of MAE was observed between the well-adherence group and the poor-adherence group (10 of 233 patients [4.3%] vs. 35 of 267 patients [13.1%]; P<0.001). After multivariate Cox regression analysis, patients in the well-adherence group showed the lower hazard ratio for 1-year MAE (0.30; 95% confidence interval, 0.15–0.58; P<0.001) compared to those in the poor-adherence group. In the well-adherence group, compared with the poor-adherence group, higher primary patency rate (88.9% vs 81.5%; p=0.015), longer claudication onset distance (370 m [IQR 240–453 m] vs 240m [IQR 126–324 m]; P<0.001), and longer 6MWD (422 m [IQR 359–483 m] vs 325 m [IQR 213–400 m]; P<0.001) were observed even after adjusting for each baseline value.

Conclusion

Our study demonstrates the importance of adherence to home-based walking exercise after EVT in LE-PAD patients.

Funding Acknowledgement

Type of funding sources: None.

Involvement of Na+-Ca2+ exchanger in cAMP-mediated relaxation in mice aorta: evaluation using transgenic mice

BACKGROUND AND PURPOSE

Although vascular smooth muscle cells are known to express the Na+-Ca2+ exchanger (NCX), its functional role has remained unclear, mainly because of its relatively low expression. We thus investigated the involvement of NCX in the mechanism for the forskolin-induced vaso-relaxation, using wild type (WT) and transgenic (TG) mice that specifically over-express NCX1.3 in smooth muscle.

EXPERIMENTAL APPROACH

We examined the relaxing effect of forskolin during the pre-contraction induced by 100 nM U46619, a thromboxane A2 analogue in the mouse isolated thoracic aorta. We also measured the intracellular Ca2+ concentration ([Ca2+]i) in fura-PE3-loaded aortic strips.

KEY RESULTS

The forskolin-induced decreases in [Ca2+]i and tension were much greater in aortas from TG mice than in those from WT mice. In a low Na+ solution, forskolin-induced decreases in [Ca2+]i and tension were greatly inhibited in both groups of aortas. In WT aortas, the presence of 100 nM SEA0400, an NCX inhibitor, had only a little effect on the forskolin-induced decreases in [Ca2+]i, but inhibited the forskolin-induced relaxation. However, in TG aortas, the presence of SEA0400 greatly inhibited the forskolin-induced decreases in [Ca2+]i and tension.

CONCLUSIONS AND IMPLICATIONS

The NCX was involved in the forskolin-induced reduction of [Ca2+]i and tension in the mouse thoracic aorta. Measurement of [Ca2+]i and tension in aortas of the TG mouse is thus considered to be a useful tool for evaluating the role of NCX in vascular tissue.