Toe pressure may be able to identify peripheral artery disease in patients with normal ankle-brachial index

We evaluated angiogenin as a prospective biomarker in peripheral artery disease (PAD) patients with and without claudication symptoms. A pilot study suggested an elevation of angiogenin in critical limb ischemia. However, in PAD patients, the predictive value of angiogenin has not yet been evaluated. For this purpose, 342 patients with PAD (age: 69 ± 10 years, 34.5% women) were followed-up for 7 years in a cross-sectional study. Angiogenin was measured by enzyme-linked immunosorbent assay. All-cause and cardiovascular mortality were analyzed by Cox regression. Angiogenin levels were higher in men ( P = .001) and were associated with patient waist-to-hip ratio ( P < .001), fasting triglycerides ( P = .011), and inversely with estimated glomerular filtration rate ( P = .009). However, angiogenin showed no association with age, characteristics of diabetes, markers of lipid metabolism, or C-reactive protein. Angiogenin did not correlate with markers of angiogenesis such as vascular endothelial growth factor, angiopoietin-2, or tie-2. Furthermore, angiogenin was not associated with PAD Fontaine stages or with patient ankle-brachial index in addition to all-cause mortality (hazard ratio [HR] = 1.09 [95% CI: 0.89-1.34]) or cardiovascular morality (HR = 1.05 [0.82-1.35]). These results suggest that angiogenin does not provide further information regarding outcome prediction in patients with PAD.

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Peripheral artery disease impairs myocardial perfusion through increasing pulse wave reflection: the Northern Shanghai study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2352 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Yu ◽

J Teliewubai ◽

X Fan ◽

C Chi ◽

H Ji ◽

...

Keyword(s):

Myocardial Perfusion ◽

Peripheral Artery Disease ◽

Wave Reflection ◽

Pulse Wave ◽

Ankle Brachial Index ◽

Community Dwelling ◽

Peripheral Artery ◽

Cardiac Damage ◽

Pulse Wave Reflection ◽

Artery Disease

Abstract Background Peripheral artery disease (PAD) is prevalent and substantially contributes to cardiovascular mortality particularly in the elderly, although the pathophysiological impact of PAD on heart itself still needs further investigation. In theory, PAD can increase pulse wave reflection which is an important determinant of subendocardial viability ratio (SEVR), a valuable estimate of myocardial perfusion as indicated by previous invasive studies. Thus, we hypothesize that PAD impairs myocardial perfusion through increasing pulse wave reflection. In this study, we aim to test this hypothesis in a large cohort from the Northern Shanghai Study. Methods A total of 2947 community-dwelling elderly Chinese (43.6% male, mean age: 71.3±5.9 years) were recruited. Ankle-brachial index were measured with the VP1000 device and used to diagnose PAD. Pulse wave reflection was estimated as aortic augmentation pressure (AP). Aortic BP, AP and SEVR were assessed by radial applanation tonometry. Multiple linear regression with SEVR and AP as dependent variable and PAD as independent variable, meanwhile adjusted for other covariates, were performed, respectively. Results 375 (12.7%) participants presented PAD. Compared to subjects without PAD, those with PAD showed significantly lower SEVR (126 vs. 132, P<0.001) but higher AP (19 vs. 17 mmHg, P<0.001). Multiple regression analysis revealed that both SEVR (regression coefficient [B] = −1.69, P=0.04, R2=0.61) and AP (B=1.19, P=0.04, R2=0.56) significantly associated with PAD, respectively. However, the association between SEVR and PAD was abolished when further adjusted for AP (B=−0.49, P=0.52). Similar results were obtained when inter-leg systolic BP difference was used to diagnose PAD. Conclusions PAD significantly and independently associates with myocardial perfusion; moreover, this association is mediated by increased pulse wave reflection. These findings provide a new dimension for understanding the pathophysiological mechanisms of cardiac damage of PAD. Funding Acknowledgement Type of funding source: None

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Cholesterol Efflux Capacity Associates with the Ankle-Brachial Index but Not All-Cause Mortality in Patients with Peripheral Artery Disease

Diagnostics ◽

10.3390/diagnostics11081407 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1407

Author(s):

Robert K. Clemens ◽

Monika Hunjadi ◽

Andreas Ritsch ◽

Lucia Rohrer ◽

Thomas O. Meier ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Cholesterol Efflux ◽

Ankle Brachial Index ◽

Mortality Rates ◽

High Density Lipoproteins ◽

Peripheral Artery ◽

Cholesterol Efflux Capacity ◽

Hdl Function ◽

All Cause Mortality ◽

Artery Disease

Background: Cholesterol efflux is an important mechanism by which high-density lipoproteins (HDLs) protect against cardiovascular disease. As peripheral artery disease (PAD) is associated with high mortality rates, mainly due to cardiovascular causes, we investigated whether cholesterol efflux capacity (CEC) of apolipoprotein B (apoB)-depleted plasma, a widely used surrogate of HDL function, may serve as a predictive marker for mortality in this patient population. Methods: In this prospective single-center study (median follow-up time: 9.3 years), apoB-containing lipoproteins were precipitated from plasma of 95 patients with PAD and incubated with J744-macrophages, which were loaded with radiolabeled cholesterol. CEC was defined as the fractional radiolabel released during 4 h of incubation. Results: Baseline CEC was lower in PAD patients that currently smoked (p = 0.015) and had a history of myocardial infarction (p = 0.011). Moreover, CEC showed a significant correlation with HDL-cholesterol (p = 0.003) and apolipoprotein A-I levels (p = 0.001) as well as the ankle-brachial index (ABI, p = 0.018). However, CEC did not differ between survivors and non-survivors. Neither revealed Kaplan–Meier and Cox regression analyses any significant association of CEC with all-cause mortality rates. Conclusion: Taken together, CEC is associated with ABI but does not predict all-cause mortality in patients with PAD.

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A Targeted Literature Review of the Disease Burden in Patients With Symptomatic Peripheral Artery Disease

Angiology ◽

10.1177/0003319719896477 ◽

2019 ◽

Vol 71 (4) ◽

pp. 303-314

Author(s):

Rupert Bauersachs ◽

Sebastian Debus ◽

Mark Nehler ◽

Maria Huelsebeck ◽

Janita Balradj ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Disease Burden ◽

Ankle Brachial Index ◽

Peripheral Artery ◽

Economic Burden Of Disease ◽

Surgical Interventions ◽

Treatment Practice ◽

Patient Profile ◽

Increased Risk ◽

Artery Disease

Patients with peripheral artery disease (PAD) have an increased risk of cardiovascular (CV) and limb events, but the disease is frequently underdiagnosed and treatment options are limited. This review examines the disease burden of symptomatic PAD as well as key guideline recommendations. Publications were identified using the ProQuest portal to access the Medline, Medline In-Process, and Embase databases. Search terms for symptomatic PAD were combined with terms relevant to epidemiology, burden, treatment practice, and physiopathology. Articles in English published between January 2001 and September 2016 were screened according to the population, interventions, comparator, outcomes, and study design criteria. Relevant publications (n = 200) were identified. The reported incidence and prevalence of PAD varied depending on the definitions used and the study populations. Patients generally had a poor prognosis, with an increased risk of mortality, CV, and limb events and decreased quality of life. Guideline recommendations included ankle–brachial index measurements, exercise testing, and angiography for diagnosis and risk factor modification, antiplatelets, cilostazol, exercise therapy, or surgical interventions for treatment, depending on the patient profile. The clinical, humanistic, and economic burden of disease in patients with symptomatic PAD is substantial and needs to be reduced through improved PAD management.

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Differences of Ankle-Brachial Index according to Ischemic Stroke Subtypes: The Peripheral Artery Disease in Korean Patients with Ischemic Stroke (PIPE) Study

European Neurology ◽

10.1159/000342892 ◽

2013 ◽

Vol 69 (3) ◽

pp. 179-184 ◽

Cited By ~ 8

Author(s):

Pil-Wook Chung ◽

Dae-Hyun Kim ◽

Hahn Young Kim ◽

Kwang-Yeol Park ◽

Tai Hwan Park ◽

...

Keyword(s):

Ischemic Stroke ◽

Peripheral Artery Disease ◽

Ankle Brachial Index ◽

Peripheral Artery ◽

Korean Patients ◽

Stroke Subtypes ◽

Artery Disease

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The prognosis of diabetic patients with high ankle-brachial index depends on the coexistence of occlusive peripheral artery disease

Journal of Vascular Surgery ◽

10.1016/j.jvs.2010.10.054 ◽

2011 ◽

Vol 53 (4) ◽

pp. 984-991 ◽

Cited By ~ 30

Author(s):

Victor Aboyans ◽

Philippe Lacroix ◽

Minh-Hoang Tran ◽

Claire Salamagne ◽

Sophie Galinat ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Ankle Brachial Index ◽

Diabetic Patients ◽

Peripheral Artery ◽

Artery Disease

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Diagnostic Validation Study. Relationship Between Optical Spectroscopy and Ankle Brachial Index Tests for Peripheral Artery Disease.

Annals of Vascular Surgery ◽

10.1016/j.avsg.2021.06.010 ◽

2021 ◽

Author(s):

Concepción Rodríguez Nieves Aleicel ◽

Riera del Moral Luis Felipe ◽

Gutiérrez Nistal Marta ◽

Zafra Angulo Juan ◽

Fernández Heredero Álvaro

Keyword(s):

Optical Spectroscopy ◽

Peripheral Artery Disease ◽

Validation Study ◽

Ankle Brachial Index ◽

Peripheral Artery ◽

Index Tests ◽

Diagnostic Validation ◽

Artery Disease

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Abstract 11: Effects of Canakinumab in Patients With Peripheral Artery Disease

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.37.suppl_1.11 ◽

2017 ◽

Vol 37 (suppl_1) ◽

Author(s):

Kerry S Russell ◽

Denise Yates ◽

Andrea Feller ◽

Tianke Wang ◽

Ping Chen ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Vascular Function ◽

Cardiovascular Events ◽

Ankle Brachial Index ◽

Unmet Need ◽

Walking Distance ◽

Plaque Progression ◽

Peripheral Artery ◽

Plaque Volume ◽

Artery Disease

Background: Peripheral artery disease (PAD) affects 8.5 million people in the US. PAD patients are at high risk for cardiovascular events, and their quality of life is often significantly impaired by decreased mobility. Interleukin-1β (IL-1β) may play an important role in this disease by promoting inflammatory responses that drive atherosclerotic plaque progression and impair vascular function. We sought to test whether interruption of IL-1β signaling would improve patient mobility and decrease plaque progression in the lower extremities. Methods: 38 patients (mean age 65; 71% male) with symptomatic PAD (confirmed by ankle-brachial index) were randomized 1:1 to receive Canakinumab (150 mg subcutaneously) or placebo monthly for up to 12 months. Plaque volume in the superficial femoral artery (SFA) was assessed serially using 3.0T MRI. Mobility was assessed serially using the 6-minute walk test (maximum and pain-free walking distance). Results: Canakinumab was safe and well-tolerated. 12 patients discontinued (8 placebo, 4 Canakinumab). MRI data (from 31 patients at 3 months; 21 patients at 12 months) showed no evidence of plaque progression in the SFA at either time point in placebo-treated patients; nor was there a change in plaque volume in the Canakinumab-treated group. There was a serial and significant improvement in placebo-adjusted maximum and pain-free walking distance observed as early as 3 months after treatment with Canakinumab (58-meter improvement over placebo in pain-free distance at 3 months, P=0.01). Two placebo-treated patients required peripheral vascular interventions due to progression of disease; however, no Canakinumab-treated patients required revascularization during the study. Canakinumab decreased markers of systemic inflammation (IL-6 and hsCRP). Conclusions: Treatment with Canakinumab may improve maximum and pain-free walk distance in patients with symptomatic PAD. In conjunction with results soon to be reported for the CANTOS trial of Canakinumab for secondary prevention of cardiovascular events, additional studies may provide support that inhibition of IL-1β signaling can improve symptoms and function in this patient population with high unmet need.

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