Investigation of arterial claudication with transcutaneous oxygen pressure at exercise: Interests and limits

Ábrahám, Pierre; Ramondou, Pierre; Hersant, Jeanne; Sempore, Wendsèndaté Yves; Feuilloy, Mathieu; Henni, Samir

doi:10.1016/j.tcm.2020.03.003

Cited by 16 publications

(13 citation statements)

References 32 publications

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“…The relatively small sample size may appear as a limitation but in our opinion it is a force of this study to attain a highly selected group with proof of exercise-induced ischemia and absence of non-vascular limitation among which exercise-induced hypoxemia is observed in almost 15% of patients complaining claudication ( Abraham et al, 2021 ). Another limit is the number of metabolites explored by our targeted metabolomics approach.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of ischemia was defined as DROP < −15 mmHg ( Abraham et al, 2003 ; Bouyé et al, 2004 ). The presence of exercise-induced systemic hypoxemia was defined as a decrease in chest TcPO 2 > 5 mmHg ( Abraham et al, 2021 ). For further analysis, the sum of minimal DROPs of the six limb probes was used as an index of LEAD severity.…”

Section: Methodsmentioning

confidence: 99%

“…Transcutaneous oximetry (TcPO 2 ) allows for the evaluation of the severity and diffusion (buttocks, thighs, and calves) of exercise-induced lower limb ischemia (Abraham et al, 2003) and the detection of eventual systemic exercise-induced hypoxemia (Abraham et al, 2018(Abraham et al, , 2021.…”

Section: Introductionmentioning

confidence: 99%

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Exercise-Induced Plasma Metabolomic Profiles in Patients With Peripheral Arterial Disease

et al. 2021

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Aim: A better knowledge of the biological consequences in the blood of these exercise-induced ischemic events in lower extremity artery disease (LEAD) may improve the prospects of disease management. We explored the preminus postexercise metabolomic difference in 39 patients with LEAD referred for a treadmill oximetry test [transcutaneous oximetry (TcPO2)].Methods: Ischemia was estimated through the sum of decrease from rest of oxygen pressure (DROPs) (limb TcPO2 changes minus chest TcPO2 changes) at buttocks, thighs, and calves regions. Targeted metabolomic analyses measuring 188 metabolites were performed on a few microliters blood samples taken at the earlobe at rest and 3 min after exercise.Results: Maximum walking distance (MWD) was 290 m (120–652 m) and ankle brachial index (ABI) was 0.67 ± 0.17. Supervised paired partial least squares discriminant analysis based on 23,345 models showed good predictive performance for test sets with a median area under the receiver operating characteristic (AUROC) curve value of 0.99 and a p-value of 0.00049. The best discriminant metabolites contributing to the model included a subset of 71 (47%) of the 150 accurately measured metabolites in the plasma, comprising 3 acylcarnitines, 3 amino acids, 5 biogenic amines, 9 sphingomyelin, 7 lysophosphatidylcholines, and 44 phosphatidylcholines. In addition, 16 of these metabolites were found to correlate with one or more severity scores of the LEAD.Conclusion: Our results provide new insights into the biological changes that accompany exercise in LEAD and contribute to a better understanding of walking impairment pathophysiology in LEAD, highlighting new candidate biomarkers.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Exercise-Induced Plasma Metabolomic Profiles in Patients With Peripheral Arterial Disease

et al. 2021

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“…It would have been of major importance in exercise (as in gas inhalation) to account for systemic PO2 changes with a chest reference electrode and calculate the decrease from rest of oxygen pressure index. 5,6 A modest change in systemic PO2 controlled from a chest reference electrode could also be the cause for the slight decline in TcPO2 measurements that was recorded under hypercapnic conditions. If they were measured in the present experiments, it would be of great interest that the authors report the chest TcPO2 values.…”

Section: Dear Editormentioning

confidence: 99%

Muscle blood flow, oxygen pressure, and hemoglobin/myoglobin saturation: The infernal triad

Ábrahám

Ramondou

Hersant

et al. 2021

Magnetic Resonance in Med

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“…Exercise-oximetry can be used to detect exercise-induced ischemia for patients referred for claudication of unknown, debatable, or arterial-suspected origin [ 15 , 19 ]. Its specific interest is to detect isolated proximal ischemia (as can result from internal iliac artery lesions), or exercise-induced hypoxemia as a cause or worsening factor of walking impairment [ 15 , 18 , 19 ]. Exercise-oximetry has been used as a routine in the last 20 years in our service for patients complaining walking limitation.…”

Section: Introductionmentioning

confidence: 99%

Lower Extremity Arterial Disease and Lumbar Spinal Stenosis: A Study of Exercise-Induced Arterial Ischemia in 5197 Patients Complaining of Claudication

Lecoq

Hersant²,

Feuilloy³

et al. 2022

JCM

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Only few studies have analyzed the associations of lower extremity artery disease (LEAD) with lumbar spinal stenosis (LSS), although it is expected to be a frequent association. With exercise-oximetry, we determined the presence of exercise-induced regional blood flow impairment (ischemia) in 5197 different patients complaining of claudication and referred for treadmill testing. We recorded height, weight, age, sex, ongoing treatments, cardiovascular risk factor (diabetes, high blood pressure, current smoking habit), and history of suspected or treated LSS and/or lower limb revascularization. An ankle-brachial index at rest < 0.90 or >1.40 on at least one side was considered indicative of the presence of LEAD (ABI+). Ischemia was defined as a minimal DROP (Limb-changes minus chest-changes from rest) value < –15 mmHg during exercise oximetry. We analyzed the clinical factors associated to the presence of exercise-induced ischemia in patients without a history of LSS, using step-by-step linear regression, and defined a score from these factors. This score was then tested in patients with a history of LSS. In 4690 patients without a history of (suspected, diagnosed, or treated) LSS, we observed that ABI+, male sex, antiplatelet treatment, BMI< 26.5 kg//m2, age ≤ 64 years old, and a history of lower limb arterial revascularization, were associated to the presence of ischemia. The value of the score derived from these factors was associated with the probability of exercise-induced ischemia in the 507 patients with a history of LSS. This score may help to suspect the presence of ischemia as a factor of walking impairment in patients with a history of lumbar spinal stenosis.

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Investigation of arterial claudication with transcutaneous oxygen pressure at exercise: Interests and limits

Cited by 16 publications

References 32 publications

Exercise-Induced Plasma Metabolomic Profiles in Patients With Peripheral Arterial Disease

Exercise-Induced Plasma Metabolomic Profiles in Patients With Peripheral Arterial Disease

Muscle blood flow, oxygen pressure, and hemoglobin/myoglobin saturation: The infernal triad

Lower Extremity Arterial Disease and Lumbar Spinal Stenosis: A Study of Exercise-Induced Arterial Ischemia in 5197 Patients Complaining of Claudication

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