Toe Pressure and Toe Brachial Index are Predictive of Cardiovascular Mortality, Overall Mortality, and Amputation Free Survival in Patients with Peripheral Artery Disease

Abstract Background and introduction Endothelial dysfunction and associated cells are an important cornerstone in the development and progression of peripheral artery disease (PAD). Endothelial progenitor cells (EPC) are released from the bone marrow and have exhibited the potential for cardiovascular repair. Higher EPC levels have been linked to longer event-free survival in coronary artery disease. Similar evaluation of EPC on mortality in PAD is lacking. Purpose The current study aimed to evaluate the possible association between EPC levels and mortality in PAD patients. Methods EPC were measured in 367 PAD patients (age 69.22±10.3, 66.5% male, Fontaine stage I-II) by flow cytometry using the cell surface marker CD34+ and CD309+. Patients were followed for seven years to assess all cause and cardiovascular mortality. Patients were categorized into quartiles according to EPC levels for further analyses. Statistics included Kaplan-Meier and Cox regression. Results 89 patients died over the observation period. ICD-codes indicated a cardiovascular cause in 58 patients. The group with the highest count of EPC showed a trend towards higher all-cause mortality (p=0.070) and a significant association with cardiovascular mortality (p=0.002). Multivariable adjustment for age, c-reactive protein, systolic blood pressure, renal function (creatinine and urinary albumin), low density lipoprotein cholesterol, HbA1c, and smoking status revealed the EPC quartile to be an independent risk factor for cardiovascular mortality (p=0.016). Conclusion Increased levels of CD34+CD309+ cells are independently associated with long-term cardiovascular mortality in PAD patients.

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Trimethylamine (Tma) And Trimethylamine-N-Oxide (Tmao) As Predictors Of Cardiovascular Mortality In Peripheral Artery Disease

Atherosclerosis ◽

10.1016/j.atherosclerosis.2019.06.716 ◽

2019 ◽

Vol 287 ◽

pp. e233

Author(s):

C. Roncal ◽

E. Martínez-Aguilar ◽

J. Orbe ◽

S. Ravassa ◽

A. Fernandez-Montero ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Cardiovascular Mortality ◽

Peripheral Artery ◽

Artery Disease

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Body mass index and outcome in patients with coronary, cerebrovascular, or peripheral artery disease: findings from the FRENA registry

European Journal of Cardiovascular Prevention & Rehabilitation ◽

10.1097/hjr.0b013e32832b1818 ◽

2009 ◽

Vol 16 (4) ◽

pp. 457-463 ◽

Cited By ~ 29

Author(s):

Raquel Barba ◽

Josep Bisbe ◽

José Nicolas Alcalá Pedrajas ◽

Jesús Toril ◽

Rafael Monte ◽

...

Keyword(s):

Body Mass Index ◽

Cerebrovascular Disease ◽

Body Mass ◽

Peripheral Artery Disease ◽

Cardiovascular Mortality ◽

Inverse Correlation ◽

Limb Ischemia ◽

Arterial Disease ◽

Peripheral Artery ◽

Artery Disease

Background The relationship between body mass index (BMI) and mortality in patients with established arterial disease remains controversial. Methods FRENA is an ongoing, observational registry of consecutive outpatients with coronary artery disease (CAD), cerebrovascular disease, or peripheral artery disease (PAD). We examined the prognostic importance of accepted BMI categories on outcome among patients in the FRENA registry. Results In April 2008, 2274 patients (mean age, 66 years) had been enrolled, of whom 14 (0.6%) were underweight; 533 (23%) normal; 1051 (46%) overweight; and 676 (30%) were obese. Over a mean follow-up of 14 months, the incidence of major cardiovascular events (myocardial infarction, ischemic stroke, or critical limb ischemia) per 100 patient-years was: 7.1 [95% confidence interval (CI): 0.4–35]; 11 (95% CI: 8.4–14); 6.9 (95% CI: 5.6–8.5); and 8.5 (95% CI: 6.6–11), respectively. Their cardiovascular mortality was: 7.1 (95% CI: 0.4–35); 4.1 (95% CI: 5.9–11); 1.3 (95% CI: 0.9–2.3); and 1.5 (95% CI: 1.4–3.5), respectively. On multivariate analysis, the hazard ratio for cardiovascular mortality was: 2.2 (95% CI: 0.3–17); 1.0 (reference); 0.37 (95% CI: 0.20–0.69); and 0.37 (95% CI: 0.18–0.73), respectively. Survival benefit was only found in patients with CAD or PAD. Weight loss had little influence on outcome. Conclusion Patients with CAD or PAD (not those with cerebrovascular disease) have an inverse correlation between BMI and cardiovascular mortality, even after adjusting for confounding variables.

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Multiple Peri-Operative Complications are Associated with Reduced Long Term Amputation Free Survival Following Revascularisation for Lower Limb Peripheral Artery Disease: A Population Based Linked Data Study

Journal of Vascular Surgery ◽

10.1016/j.jvs.2020.01.070 ◽

2020 ◽

Vol 71 (4) ◽

pp. 1452

Author(s):

S.J. Aitken ◽

D.A. Randall ◽

N. Noguchi ◽

F.M. Blyth ◽

V. Naganathan

Keyword(s):

Peripheral Artery Disease ◽

Lower Limb ◽

Linked Data ◽

Population Based ◽

Peripheral Artery ◽

Free Survival ◽

Operative Complications ◽

Artery Disease

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Endovascular treatment of peripheral artery disease is associated with improved central hemodynamics and ventricular function

European Heart Journal ◽

10.1093/ehjci/ehaa946.2381 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D Messiha ◽

L Halfmann ◽

O Azizy ◽

M Steinmetz ◽

T Rassaf ◽

...

Keyword(s):

Arterial Stiffness ◽

Left Ventricular Function ◽

Endovascular Treatment ◽

Ventricular Function ◽

Peripheral Artery Disease ◽

Cardiovascular Mortality ◽

Left Ventricular ◽

Central Hemodynamics ◽

Peripheral Artery ◽

Artery Disease

Abstract Background Peripheral artery disease (PAD) is a major manifestation of atherosclerosis and a risk factor for morbidity and mortality. PAD itself is associated with increased arterial stiffness with impact on cardiac functions. Previous studies have demonstrated that augmentation index (AIx) and central blood pressure (CBP) correlate with increased cardiovascular mortality. This mechanism has been described as arterio-ventricular (AV) coupling with altered ventricular afterload and a depressed ventricular function, measured by global longitudinal strain (GLS). The impact of PAD-related endovascular treatment on arterial stiffness, central hemodynamics and potential impact on AV coupling has not been elucidated until now. Purpose Aim of the study was to investigate, if endovascular treatment of PAD improves cardiac function via enhanced central hemodynamics and AV coupling. Methods To this aim 77 patients with known symptomatic PAD who underwent interventions in the iliac and femoropopliteal arteries were included in a cross-sectional study. AIx, CBP and GLS were determined using dedicated waveform analysis and echocardiography before and after endovascular treatment. Results Mean age was 65.1±10.4 years with 66.2% male patients. Symptoms were classified by Fontaine classification (stage IIb 80.7%, stage III 5.8% and stage IV 13.5%). Iliac vessel intervention was performed in 16 and femoropopliteal intervention in 61 cases. A stentless approach was feasible in 55 patients with DCB treatment and atherectomy. After endovascular treatment, peripheral perfusion was enhanced (ABI 0.45±0.6 vs 0.81±0.5, p<0.0001). Moreover, central hemodynamics were improved (AIX 33.7±3% vs 27.9±2%, p=0.0008; AP 17.8±2 mmHg vs 14.0±2 mmHg, p=0.0004; central PP 52.4±6 mmHg vs 46.4±6 mmHg, p=0.0001). Impressively, left ventricular function was also significantly improved (GLS −15.7±2.3% vs −17.1±2.8%, p=0.005) with an improvement in AV coupling (PWV/GLS ratio −0.58m/sec% vs −0.56m/sec%, p<0.01). Conclusion Our results demonstrate that endovascular treatment of the peripheral vessels is associated with an improvement of central hemodynamics and left ventricular function via enhanced AV coupling. These prognostic relevant markers of cardiovascular disease could point to an overall potential mortality benefit through PAD treatment. Further investigation of the underlying mechanisms of AV coupling in the setting of endovascular treatment of PAD with impact on cardiovascular mortality is needed in this high-risk population. Funding Acknowledgement Type of funding source: None

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Detection of peripheral artery disease in patients with ischemic heart disease. A quick guide for medical practitioners

Kardiologiia ◽

10.18087/cardio.2020.12.n1380 ◽

2021 ◽

Vol 60 (12) ◽

pp. 125-132

Author(s):

D. P. Dundua ◽

I. D. Strazhesko

Keyword(s):

Peripheral Artery Disease ◽

Cardiovascular Events ◽

Functional Tests ◽

Peripheral Artery ◽

Critical Ischemia ◽

Medical Practitioners ◽

Artery Disease ◽

Extremity Amputation ◽

Diagnostic And Prognostic Value ◽

Overall Mortality

In this manual, the authors focused on the principal methods for diagnosis of peripheral artery disease in cardiological patients, from the interview and physical examination to functional tests and vascular visualization. Diagnostic and prognostic value of each method, its potentialities for reducing the risk of cardiovascular events (CVE), including myocardial infarction (MI), ischemic stroke (IS) or extremity amputation in critical ischemia, and overall mortality are discussed. The authors provided current information about a possibility of reducing the risk of CVE by intensifying the antithrombotic therapy according to results of the COMPASS study.

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