Characterizing the relationship between flow-mediated vasodilation and radial artery tonometry in peripheral artery disease

Zahner, Greg J.; Spaulding, Kimberly A.; Schaller, Melinda S.; Hills, Nancy K.; Gasper, Warren J.; Grenon, S. Marlene

doi:10.1016/j.jss.2017.11.062

Cited by 7 publications

(7 citation statements)

References 60 publications

(71 reference statements)

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“…In addition to the macrovascular blood flow restriction, work from our group and others suggests that patients with PAD exhibit "microvascular disease" seen as a thickening of capillary basement membranes, perivascular fibrosis, and impaired endothelial reactivity. [16][17][18][19] This microvascular disease further impairs the delivery of oxygen and nutrients to the affected tissues. Moreover, studies of permeabilized myofibers have demonstrated a significant dysfunction in the mitochondria of affected muscle cells, decreasing the ability of the muscle to effectively use the delivered oxygen and nutrients.…”

Section: Discussionmentioning

confidence: 99%

A low-cost, wireless near-infrared spectroscopy device detects the presence of lower extremity atherosclerosis as measured by computed tomographic angiography and characterizes walking impairment in peripheral artery disease

Fuglestad

Hernandez

Gao

et al. 2020

Journal of Vascular Surgery

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Background: Patients with peripheral artery disease (PAD) who experience intermittent claudication report a range of symptoms. Patients with symptoms other than classically described intermittent claudication may be at the highest risk for functional decline and mobility loss. Therefore, technologies allowing for characterization of PAD severity are desirable. Near-infrared spectroscopy (NIRS) allows for measurements of muscle heme oxygen saturation (StO 2 ) during exercise. We hypothesized lower extremities affected by PAD would exhibit distinct NIRS profiles as measured by a lowcost, wireless NIRS device and that NIRS during exercise predicts walking limitation. Methods:We recruited 40 patients with PAD and 10 control participants. All patients with PAD completed a computed tomographic angiography, 6-minute walk test, and a standardized treadmill test. Controls completed a 540-second treadmill test for comparison. StO 2 measurements were continuously taken from the gastrocnemius during exercise.Variables were analyzed by Fischer's exact, c 2 , Wilcoxon rank-sum, and Kruskal-Wallis tests as appropriate. Correlations were assessed by partial Spearman correlation coefficients adjusted for occlusive disease pattern.Results: Patients with PAD experienced claudication onset at a median of 108 seconds with a median peak walking time of 288 seconds. The baseline StO 2 was similar between PAD and control. The StO 2 of PAD and control participants dropped below baseline at a median of 1 and 104 seconds of exercise, respectively (P < .0001). Patients with PAD reached minimum StO 2 earlier than control participants (119 seconds vs 522 seconds, respectively; P < .001) and experienced a greater change in StO 2 at 1 minute of exercise (À73.2% vs 8.3%; P < .0001) and a greater decrease at minimum exercise StO 2 (À83.4% vs À16.1%; P < .0001). For patients with PAD, peak walking time, and 6-minute walking distance correlated with percent change in StO 2 at 1 minute of exercise (r ¼ À0.76 and -0.67, respectively; P < .001) and time to minimum StO 2 (r ¼ 0.79 and 0.70, respectively; P < .0001). Conclusions:In this initial evaluation of a novel, low-cost NIRS device, lower extremities affected by PAD exhibited characteristic changes in calf muscle StO 2 , which differentiated them from healthy controls and were strongly correlated with walking impairment. These findings confirm and expand on previous work demonstrating the potential clinical value of NIRS devices and the need for further research investigating the ability of low-cost NIRS technology to evaluate, diagnose, and monitor treatment response in PAD. (J Vasc Surg 2020;71:946-57.)

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Section: Discussionmentioning

confidence: 99%

A low-cost, wireless near-infrared spectroscopy device detects the presence of lower extremity atherosclerosis as measured by computed tomographic angiography and characterizes walking impairment in peripheral artery disease

Fuglestad

Hernandez

Gao

et al. 2020

Journal of Vascular Surgery

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“…18 For patients with PAD, arterial stiffness has mainly been analyzed in claudicants, also with the objective of assisting cardiovascular risk analysis. 10 - 13 There are few studies evaluating patients with an advanced stage of PAD. 14…”

Section: Discussionmentioning

confidence: 99%

“…9 Almost all of these studies were performed in patients with early stage, asymptomatic PAD or claudication. 10 - 13 There is no consensus on whether patients with advanced PAD have increased arterial stiffness. Brand et al demonstrated that patients with CLI had high central aortic pulse pressures and AIx values, but a much reduced PWV.…”

Section: Introductionmentioning

confidence: 99%

Association between critical limb ischemia and arterial stiffness measured by brachial artery oscillometry

2019

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Background Elevated arterial stiffness is associated with increased cardiovascular mortality. The relationship between arterial stiffness and critical limb ischemia (CLI) is not well established. Objectives The objective of this study is to analyze the relationship between arterial stiffness indices and the degree of limb ischemia measured by the ankle-brachial index (ABI). Methods A cross-sectional study comparing patients with CLI and controls. Arterial stiffness was measured using brachial artery oscillometry. The arterial stiffness indices pulse wave velocity (PWV) and augmentation index normalized to 75 beats/min (AIx@75) were determined. Multiple linear regression was applied to identify predictors of arterial stiffness indices. Results Patients in the CLI group had higher PWV (12.1±1.9 m/s vs. 10.1±1.9 m/s, p < 0.01) and AIx@75 (31.8±7.8% vs. 17.5±10.8%, p < 0.01) than controls. Central systolic pressure was higher in the CLI group (129.2±18.4 mmHg vs. 115.2±13.1 mmHg, p < 0.01). There was an inverse relationship between AIx@75 and ABI (Pearson coefficient = 0.24, p = 0.048), but there was no relationship between ABI and PWV (Pearson coefficient = 0.19, p = 0.12). In multiple regression analysis, reduced ABI was a predictor of elevated levels of AIx@75 (β = -25.02, p < 0.01). Conclusions Patients with CLI have high arterial stiffness measured by brachial artery oscillometry. The degree of limb ischemia, as measured by the ABI, is a predictor of increased AIx@75. The increased AIx@75 observed in CLI may have implications for the prognosis of this group of patients with advanced atherosclerosis.

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“…Endothelial function was measured by brachial artery FMD using previously described methods. 21 A blood pressure cuff was placed on the upper arm, and B-mode ultrasound (Philips HD11; Philips Healthcare, Andover, Mass) with a broadband linear array transducer with a 3-12 MHz range (Philips L12-3) was used to locate the brachial artery. The mean diameter at baseline was then measured.…”

Section: Measurementsmentioning

confidence: 99%

Serum resistin is associated with impaired endothelial function and a higher rate of adverse cardiac events in patients with peripheral artery disease

Ramirez

Khetani

Spaulding

et al. 2019

Journal of Vascular Surgery

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Objective: Resistin is a hormone that has been associated with metabolic syndrome and cardiovascular disease. The role of resistin in patients with peripheral artery disease (PAD) has not been fully explored. This study seeks to understand the relationship between serum resistin, vascular function, and cardiovascular outcomes in patients with PAD.Methods: There were 106 patients with PAD who were recruited between 2011 and 2016. Patients attended a baseline visit during which a comprehensive vascular physiology assessment including medical and surgical history, radial artery tonometry, and flow mediated-vasodilation (FMD) was completed. A blood sample was drawn, and serum resistin was assayed using enzyme-linked immunosorbent assay kits. Using the time of study enrollment as the time of origin, incident major adverse cardiac events (MACEs) were identified by subsequent chart review and defined as a composite end point of myocardial infarction, coronary revascularization, transient ischemic attack, stroke, or death from a cardiac cause.Results: Patients had a mean age of 68 6 8 years, were largely white (75%), and had comorbidities commonly associated with PAD including hypertension (92%), hyperlipidemia (87%), coronary artery disease (37%), and diabetes mellitus (38%). After stratification by resistin quartile, higher resistin quartiles were significantly associated with an older age, a greater number of pack-years smoked, and a lower estimated glomerular filtration rate. Despite similar comorbidities and medication use, endothelial function, as measured by FMD, was significantly lower with increasing resistin quartile (I, 9.1% 6 3.3%; II, 7.1% 6 3.5%; III, 5.8% 6 4.0%; IV, 5.6% 6 3.5%; P ¼ .002). In multivariable linear regression, higher resistin quartiles (III and IV) were associated with lower FMD relative to quartile I after adjusting for several patient characteristics, medications, and comorbidities (III, À2.26 [95% confidence interval (CI), À4.51 to À0.01; P ¼ .05]; IV, À2.53 [95% CI, À4.87 to À0.20; P ¼ .03]). During a median follow-up period of 36 months (interquartile range, 29-45 months), 21 patients experienced the primary end point. In a Cox proportional hazards model adjusted for smoking status, coronary artery disease, and age, each 1 ng/mL increase in resistin was associated with a 10% increased risk of MACEs (hazard ratio, 1.10; 95% CI, 1.00-1.20; P ¼ .04).Conclusions: In patients with PAD, higher levels of resistin were associated with impaired endothelial function and an increased rate of MACEs. These results suggest that resistin may be a marker or effector of impaired vascular physiology and adverse cardiac outcomes in patients with PAD. Further research is needed to determine the potential mechanisms by which resistin may impair endothelial function and increase MACEs in this population.

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Characterizing the relationship between flow-mediated vasodilation and radial artery tonometry in peripheral artery disease

Cited by 7 publications

References 60 publications

A low-cost, wireless near-infrared spectroscopy device detects the presence of lower extremity atherosclerosis as measured by computed tomographic angiography and characterizes walking impairment in peripheral artery disease

A low-cost, wireless near-infrared spectroscopy device detects the presence of lower extremity atherosclerosis as measured by computed tomographic angiography and characterizes walking impairment in peripheral artery disease

Association between critical limb ischemia and arterial stiffness measured by brachial artery oscillometry

Serum resistin is associated with impaired endothelial function and a higher rate of adverse cardiac events in patients with peripheral artery disease

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