Fluorescence angiography compared to toe blood pressure in the evaluation of severe limb ischemia

VASA ◽  
2020 ◽  
Vol 49 (3) ◽  
pp. 230-234 ◽  
Author(s):  
Christophe Seinturier ◽  
Sophie Blaise ◽  
Théophile Tiffet ◽  
Cynthia Brousseau Provencher ◽  
Jean Luc Cracowski ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Prognostic Value ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Fluorescence Angiography ◽  
Cross Sectional ◽  
Transcutaneous Oxygen ◽  
Fluorescence Parameters ◽  
Toe Blood Pressure

Summary: Background: Severity of limb ischemia in peripheral arterial disease (PAD) patients is usually evaluated by clinical assessment and toe blood pressure (TBP) or transcutaneous oxygen pressures (TcPO 2). Indocyanin green angiography (IGA) is a promising tool generating a foot cartography of skin microvascular perfusion. However, there is no consensus about the fluorescence parameters that should be used to evaluate ischemia. The purpose of this cross-sectional evaluation and 3-month clinical follow-up was to determine the best fluorescence parameter for the evaluation of severe PAD, using TBP as reference. Patients and methods: IGA was realized in patients with clinical suspicion of CLI in addition to TBP and TcPO 2. Parameters from the time intensity fluorescence curve measured on the foot were compared with TBP (primary reference), and with TcPO2. Clinical outcomes (amputation, revascularization, death) were recorded at 3 months follow-up. Results: Thirty-four patients were included and IGA could be analysed in 29 of them. When all limbs were studied, no significant correlation was found between any of the measured fluorescence parameters (saturation time, ingress slope, amplitude, delay) and TBP pressure neither TCPO2. In the limbs with CLI, a significant correlation between the TBP and amplitude on the forefoot was found. According to the outcome, none of the fluorescence parameters showed a significant prognostic value in contrast to the significant results for TBP and TcPO2. Conclusions: In this study, quantitative analysis of IGA parameters did not show any prognostic value, nor was there any significant statistical association with well-established prognostic parameters such as TBP and TcPO 2 in patients with suspected CLI. A correlation was found between amplitude and TBP in patients with CLI. Topographical information such as perfusion heterogeneity was not evaluated and remains a valuable target to be investigated.

Abstract P262: Spot Urine Sodium to Potassium Ratio Predicts Increasing Blood Pressure Levels in a General Population: The Nagahama Study

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Yasuharu Tabara ◽  
Yoshimitsu Takahashi ◽  
Takeo Nakayama ◽  
Fumihiko Matsuda
Keyword(s):  
Blood Pressure ◽  
Salt Intake ◽  
Linear Regression Analysis ◽  
Prognostic Significance ◽  
Reverse Causality ◽  
Cross Sectional ◽  
Salt Loading ◽  
Available N ◽  
Spot Urine

Excessive salt intake is a risk factor for hypertension. The most reliable method for estimating daily salt intake is measurement of 24-h urinary sodium excretion, while it is inconvenient. Sodium-to-potassium ratio (Na/K) of a urine sample is another index of salt loading. We previously reported that a simple measure of spot urine Na/K might be a representative of salt loading in a cross-sectional setting. Here, we conducted a longitudinal study aiming to clarify a prognostic significance of spot urine Na/K for increasing blood pressure (BP) levels. Study subjects consists of 9,769 general individuals. Among them, individuals whose baseline Na/K was available (n=9,328), who were normotensive at baseline (n=6,392), and who participated in the follow-up measurement (n=5,209) were included in this analysis (51.8±12.9 years old, male: 29.2%). Mean follow-up duration was 5.0±0.5 years. Mean Na/K at baseline was 3.1±1.7, and showed step-wise increase with BP levels (optimal: 3.0±1.6, normal: 3.3±1.8, high normal: 3.4±1.8, P<0.001). Other major factors that were significantly associated with Na/K was fasting time (r=-0.220, P<0.001), and CKD (CKD (n=694): 2.7±1.6, control: 3.2±1.7, P<0.001). Mean SBP was significantly increased during follow-up period (baseline: 116±12, follow-up: 119±15 mmHg), and 805 individuals (15.5%) were newly diagnosed as hypertension (HT). These individuals were significantly older (HT: 60.3±9.9, NT: 50.3±12.8 years), were frequently male (36.4%, 27.9%), and had higher SBP (127±9, 115±11 mmHg) at baseline (P<0.001). In contrast, baseline spot urine Na/K was slightly lower in individuals who developed HT (3.0±1.6, 3.1±1.8, P=0.013), while that measured at follow-up investigation was oppositely higher in hypertensives (3.1±1.8, 2.8±1.5, P<0.001). Multiple linear regression analysis adjusted for the covariates identified baseline Na/K (β=0.108, P<0.001) and changes in Na/K during follow-up period (β=0.222, P<0.001) as independent determinants for future SBP levels. Higher spot urine Na/K, as well as increases in the Na/K levels, was significant determinant for future BP levels. The apparently lower baseline Na/K levels in individuals who developed HT might be due to reverse causality.

scholarly journals Cervical cancer: Renal complications and survival after percutaneous nephrostomy

2016 ◽  
Vol 62 (3) ◽  
pp. 255-261 ◽  
Author(s):  
Alzira Carvalho Paula de Souza ◽  
Alfredo Nunes Souza ◽  
Rubens Kirsztajn ◽  
Gianna Mastroianni Kirsztajn
Keyword(s):  
Blood Pressure ◽  
Cervical Cancer ◽  
Renal Function ◽  
Percutaneous Nephrostomy ◽  
Cross Sectional Study ◽  
Obstructive Nephropathy ◽  
Cross Sectional ◽  
Low Blood Pressure ◽  
Northern Brazil

SUMMARY Introduction: Obstructive nephropathy is a frequent complication in the course of advanced cervical cancer (CC), and ultrasonography-guided percutaneous nephrostomy (PCN) is a well established technique for fast ureteral desobstruction. Objective: To identify possible factors related to the survival and quality of life of patients with advanced CC presenting acute urinary obstructive complications that after desobstruction by PCN recovered urinary flux and renal function. Method: This is an analytical, descriptive, cross-sectional study that included 45 patients with CC who underwent PCN and were divided into 2 groups: “death” (DG) and “survival” (SG), in a public hospital that is reference for oncologic diseases in Northern Brazil. Results: The mean serum creatinine of the patients preceding PCN was >10 mg/dL, and after PCN <2 mg/dL. The cutoffs of 8.7 g/dL for Hb (p=0.0241) and 27% for Ht (p=0.0065) indicated the values that better discriminate the outcomes of the groups. The presence of low blood pressure was statistically correlated (p=0.0037) to the outcome “death”. Changes in glomerular filtration rate (already reduced in all cases) were not associated to the levels of Hb/Ht or to the outcome “death” during the nephrological follow-up. Conclusion: PCN was responsible for the recovery of renal function in 61.7% of the patients, leading to interruption of renal replacement therapy (RRT) in all of those patients. Hb levels >8.7g/dL and Ht >27% were associated to longer survival, and the presence of low blood pressure during follow-up was associated with progression to death.

The cuff width influences the toe blood pressure value

VASA ◽  
2004 ◽  
Vol 33 (4) ◽  
pp. 215-218 ◽  
Author(s):  
Påhlsson ◽  
Jörneskog ◽  
Wahlberg
Keyword(s):  
Blood Pressure ◽  
Limb Ischemia ◽  
Limb Ischaemia ◽  
Patients With Diabetes ◽  
History Of ◽  
Blood Pressures ◽  
Cuff Size ◽  
And Control ◽  
Toe Blood Pressure ◽  
Cuff Width

Background: Toe blood pressure is a valuable and often used parameter when lower limb ischaemia is evaluated in patients with diabetes, but little has been done to standardise the method. The aim of this study was to evaluate if the cuff size influences the toe blood pressure values obtained in patients with diabetes. Patients and methods: Eleven patients with diabetes without a history of peripheral vascular disease, and six age matched healthy subjects were investigated. Their blood pressures were measured in the upper arm and at the ankle level repetitively. For measurement of toe blood pressure two different cuff widths were used. Results: All blood pressures were similar in patients and control subjects, as well as over time. The toe blood pressure values were 18 mmHg higher (p < 0.01) if measured with a 2.0-cm compared to a 2.5-cm wide cuff. There was a relationship (r = 0.63, p < 0.05 for patients) between toe circumference and the toe blood pressure value, where smaller halluxes gave lower values. Conclusions: The cuff width influences the obtained toe blood pressure value and needs to be considered when evaluating limb ischemia in patients with diabetes.

Predictors of blood pressure in a cohort of school-aged children

2007 ◽  
Vol 14 (5) ◽  
pp. 624-629 ◽  
Author(s):  
Masoud Mirzaei ◽  
Richard Taylor ◽  
Stephen Morrell ◽  
Stephen R. Leeder
Keyword(s):  
Blood Pressure ◽  
Socioeconomic Status ◽  
Primary Schools ◽  
Longitudinal Change ◽  
Anthropometric Measures ◽  
Cross Sectional ◽  
School Aged Children ◽  
European Society Of Cardiology ◽  
Current Weight

Objectives To examine anthropometric measures and birthweight as predictors of blood pressure (BP) in a cohort of children. Design Cross-sectional and longitudinal study comprising baseline anthropometric and BP measurements conducted in 1994 ( n = 1230), with follow-up in 1997 ( n = 628). Setting Seventy-five inner-Sydney primary schools. Participants School children aged 8-9 years at baseline and 11-12 years at follow-up. Main outcome measures Systolic and diastolic BP (SBP and DBP). Study factors Current weight, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHR), weight gain since birth and birth weight. Potential confounders: age, sex and socioeconomic status (on the basis of the area of residence). Results Current weight was significantly associated with both SBP and DBP in boys and girls at baseline and follow-up. BMI and WC were similar predictors of SBP and DBP in each survey, but longitudinal BMI change has a stronger association with SBP ( r = 0.43, P <0.001) and DBP ( r = 0.26, P < 0.001) than changes in WC (r = 0.18, P < 0.001 for SBP and r = 0.16, P < 0.001 for DBP) and WHR in boys with the similar results for girls. The unadjusted associations between SBP and DBP and birthweight were nonsignificant. After adjustments for age, height and socioeconomic status, however, the association becomes negative and significant in boys (β = −1.47, P = 0.04 for SBP and β = −1.33, P = 0.03 for DBP). Conclusion Longitudinal change in BMI is a better predictor of BP than change in WC or the WHR, although cross-sectional measurements of BMI and WC are very similar predictors of BP. In preventing subsequent adverse effects on BP, attending to body weight during childhood is important. Eur J Cardiovasc Prev Rehabil 14:624-629 © 2007 The European Society of Cardiology

Two-year follow-up of bioresorbable vascular scaffolds in severe infra-popliteal arterial disease

Vascular ◽  
2020 ◽  
pp. 170853812095494
Author(s):  
AbdulRahman Dia ◽  
Joseph M Venturini ◽  
Rohan J Kalathiya ◽  
Stephanie Besser ◽  
Jeremy Raider Estrada ◽  
...  
Keyword(s):  
Clinical Status ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Primary Patency ◽  
Target Vessel ◽  
Recent Trial ◽  
Bioresorbable Vascular Scaffold ◽  
Scaffold Thrombosis ◽  
Vascular Scaffold

Objectives To assess the safety, efficacy, and durability of the Absorb bioresorbable vascular scaffold in predominantly complex, infra-popliteal lesions for the management of chronic limb ischemia at two-year clinical follow-up. Bioresorbable vascular scaffold are biodegradable scaffolds that provide short-term vascular support before undergoing intravascular degradation. A recent trial reported excellent 36-month vessel patency rates in simple infrapopliteal arterial lesions treated with Absorb bioresorbable vascular scaffold. Methods This single-center, retrospective study evaluated the use of the Absorb bioresorbable vascular scaffold (everolimus impregnated poly-L-lactic scaffold) in patients with infra-popliteal peripheral arterial disease (PAD) with respect to safety (thrombosis and TIMI bleeding), technical success, and freedom from clinically driven target vessel failure at 24 months. Results 31 patients (51.6% male) with a median age of 67 years with predominantly advanced infra-popliteal disease were treated with 49 bioresorbable vascular scaffold in 41 vessels. The mean stenosis was 94% (80–100), with 49% of lesions being chronic thrombotic occlusions. No scaffold thrombosis or peri-procedural bleeding was observed. Procedural success was achieved in all patients; 93.5% of patients experienced freedom from clinically driven target vessel failure at 24 months, driven by one revascularization and one amputation. Primary patency was 96.7% at 12 months and 87.1% at 24 months. All patients were alive at 12 and 24 months. Conclusions At 24 months, our study found that patients with predominantly advanced infra-popliteal PAD who were treated with Absorb bioresorbable vascular scaffold reported improved clinical status and a low and durable rate of clinically driven target vessel failure extending out to 24 months.

Prevalence, Characteristics and Predictive Factors of Microalbuminuria in Resistant Systemic Arterial Hypertension

2018 ◽  
Vol 69 (9) ◽  
pp. 2425-2429
Author(s):  
Carmen Gadau ◽  
Elena Ardeleanu ◽  
Roxana Folescu ◽  
Ioan Tilea ◽  
Andreea Varga ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Predictive Factors ◽  
Hdl Cholesterol ◽  
Arterial Disease ◽  
Left Ventricular ◽  
Cross Sectional ◽  
Systemic Arterial Hypertension ◽  
Peripheral Arterial ◽  
Made In

The present cross-sectional observational study was made in family medicine offices of Timi� County, Romania. The aim of the study was to investigate the prevalence of urinary microalbumin excretion (MAU) in resistant systemic arterial hypertension (RH), to analyze patients� biochemical and clinical characteristics, and the predictive factors for MAU. From a total number of 347 patients, MAU was detected in 76 cases (21.9%). The microalbuminuria positive patients were older, with significant higher office systolic blood pressure (BP) (155 � 13.50 vs 148 � 12.40 mmHg, p [ 0.0001) and diastolic blood pressure (94 � 12.20 vs 88 � 14.6 mmHg, p = 0.0013), higher prevalence of left ventricular hypertrophy, diabetes mellitus, obesity, ischemic and peripheral arterial disease. MAU positive patients presented statistical significant differences in biochemical data concerning: fasting plasma glucose (FPG) (118.80 � 32.02 vs 108.01 � 26.01 mg/dL, p = 0.003), impaired glucose tolerance (IGT) (10.52 % vs 4.94 %), glycated hemoglobin (HbA1c) (6.56 � 0.98% vs 5.96 � 0.91%, p [ 0.001), reduced estimated glomerular filtration rate (eGFR) (56.10 � 15.4 vs 69.30 � 17.5 ml/min/1.73m2, p [ 0.001) and higher potassium levels (4.71 � 0.43 vs 4.59 � 0.44 mg/dL, p = 0.0378). No significant differences were noticed regarding LDL- and HDL-cholesterol, triglycerides, uric acid and serum creatinine. In a logistic multivariate analysis independent predictors for MAU were: systolic BP (odds ratio, OR = 1.024, 95% confidence interval, CI:1.011-1.039, p [ 0.001), HbA1c (OR = 1.324, 95% CI: 1.078-1.724, p = 0.008) and eGFR (OR = 0.989, 95% CI: 0.977-0.999, p = 0.01). Our findings suggest that an important part of RH patients have microalbuminuria and highlight the importance of controlling its predictors, in order to improve patients� outcome.

scholarly journals Associations of TSH levels within the reference range with future blood pressure and lipid concentrations: 11-year follow-up of the HUNT study

2013 ◽  
Vol 169 (1) ◽  
pp. 73-82 ◽  
Author(s):  
Bjørn Olav Åsvold ◽  
Trine Bjøro ◽  
Lars J Vatten
Keyword(s):  
Blood Pressure ◽  
Thyroid Disease ◽  
Reference Range ◽  
Hdl Cholesterol ◽  
Population Based ◽  
Lipid Levels ◽  
Cross Sectional ◽  
Normal Thyroid Function ◽  
Tsh Levels

ObjectiveIn cross-sectional studies, TSH levels within the reference range have been positively associated with blood pressure and adverse serum lipid levels. In a prospective study, we aimed to determine whether differences in TSH levels within the reference range are associated with future levels of blood pressure and lipids.DesignWe conducted a prospective population-based study.MethodsIn 9709 women and 4644 men without previous thyroid disease who had a baseline TSH level of 0.45–4.5 mU/l, we studied the associations of baseline TSH levels with blood pressure and lipid levels at follow-up 11 years later.ResultsHigher TSH levels at baseline were associated with higher systolic (P=0.002 in women) and diastolic (P=0.03 in women) blood pressure, non-HDL cholesterol (P=0.01 in men) and triglyceride (P=0.008 in men) levels and lower HDL cholesterol levels (P<0.001 in women and men) at follow-up, but the associations were very modest and not consistent between the sexes. Among people who remained free of thyroid disease, changes in TSH levels during follow-up were associated with concomitant changes in systolic and diastolic blood pressure, non-HDL cholesterol and triglyceride levels (all P<0.001), with similar results being observed for women and men. Thus, blood pressure and lipid levels increased among people with an increase in TSH levels and decreased among people with a decrease in TSH levels compared with people with no change in TSH levels.ConclusionsHigh TSH levels within the reference range may be associated with modestly higher future levels of blood pressure and adverse serum lipids. TSH levels may co-vary with blood pressure and lipid levels among people with apparently normal thyroid function.

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