Measuring regional arterial stiffness in patients with peripheral artery disease: innovative technology

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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Association between arterial stiffness and peripheral artery disease as measured by radial artery tonometry

Journal of Vascular Surgery ◽

10.1016/j.jvs.2017.06.068 ◽

2017 ◽

Vol 66 (5) ◽

pp. 1518-1526 ◽

Cited By ~ 16

Author(s):

Greg J. Zahner ◽

Magdalena A. Gruendl ◽

Kimberly A. Spaulding ◽

Melinda S. Schaller ◽

Nancy K. Hills ◽

...

Keyword(s):

Arterial Stiffness ◽

Radial Artery ◽

Peripheral Artery Disease ◽

Peripheral Artery ◽

Artery Disease

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Oxidative Stress and Arterial Dysfunction in Peripheral Artery Disease

Antioxidants ◽

10.3390/antiox7100145 ◽

2018 ◽

Vol 7 (10) ◽

pp. 145 ◽

Cited By ~ 13

Author(s):

Ahmed Ismaeel ◽

Robert Brumberg ◽

Jeffrey Kirk ◽

Evlampia Papoutsi ◽

Patrick Farmer ◽

...

Keyword(s):

Oxidative Stress ◽

Endothelial Dysfunction ◽

Arterial Stiffness ◽

Peripheral Artery Disease ◽

Nicotinamide Adenine Dinucleotide Phosphate ◽

Current Evidence ◽

Peripheral Artery ◽

Potential Therapeutic Role ◽

Artery Disease ◽

And Oxidative Stress

Peripheral artery disease (PAD) is an atherosclerotic disease characterized by a narrowing of the arteries in the lower extremities. Disease manifestations are the result of more than just reduced blood flow, and include endothelial dysfunction, arterial stiffness, and inflammation. Growing evidence suggests that these factors lead to functional impairment and decline in PAD patients. Oxidative stress also plays an important role in the disease, and a growing amount of data suggest a link between arterial dysfunction and oxidative stress. In this review, we present the current evidence for the involvement of endothelial dysfunction, arterial stiffness, and inflammation in the pathophysiology of PAD. We also discuss the links between these factors and oxidative stress, with a focus on nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 2 (NOX2)-derived reactive oxygen species (ROS) and decreased nitric oxide (NO) bioavailability. Finally, the potential therapeutic role of NOX2 antioxidants for improving arterial function and functional status in PAD patients is explored.

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Factors Associated to Arterial Stiffness in Patients With Symptomatic Peripheral Artery Disease

Annals of Vascular Surgery ◽

10.1016/j.avsg.2019.04.036 ◽

2019 ◽

Vol 61 ◽

pp. 78-82 ◽

Cited By ~ 1

Author(s):

Antonio Henrique Germano-Soares ◽

Breno Quintella Farah ◽

Aluísio Andrade-Lima ◽

Wagner Ribeiro Domingues ◽

Bruno Remígio Cavalcante ◽

...

Keyword(s):

Arterial Stiffness ◽

Peripheral Artery Disease ◽

Peripheral Artery ◽

Factors Associated ◽

Artery Disease

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Impacts of aquatic walking on arterial stiffness, exercise tolerance, and physical function in patients with peripheral artery disease: a randomized clinical trial

Journal of Applied Physiology ◽

10.1152/japplphysiol.00209.2019 ◽

2019 ◽

Vol 127 (4) ◽

pp. 940-949 ◽

Cited By ~ 4

Author(s):

Song-Young Park ◽

Yi-Sub Kwak ◽

Elizabeth J. Pekas

Keyword(s):

Body Composition ◽

Exercise Training ◽

Arterial Stiffness ◽

Physical Function ◽

Peripheral Artery Disease ◽

Exercise Tolerance ◽

Muscular Strength ◽

Peripheral Artery ◽

Walking Exercise ◽

Artery Disease

Peripheral artery disease (PAD) is an atherosclerotic disease that is associated with attenuated vascular function, cardiorespiratory capacity, physical function, and muscular strength. It is essential to combat these negative effects on health by incorporating lifestyle interventions to slow disease progression, such as exercise. We sought to examine the effects of aquatic walking exercise on cardiovascular function, cardiorespiratory capacity [maximal volume of oxygen consumption (V̇o2max)], exercise tolerance [6-min walking distance (6MWD)], physical function, muscular strength, and body composition in patients with PAD. Patients with PAD ( n = 72) were recruited and randomly assigned to a 12-wk aquatic walking training group (AQ, n = 35) or a control group (CON, n = 37). The AQ group performed walking and leg exercises in waist-to-chest-deep water. Leg arterial stiffness [femoral-to-ankle pulse wave velocity (legPWV)], heart rate (HR), blood pressure (BP), ankle-to-brachial index (ABI), V̇o2max, 6MWD, physical function, muscular strength, body composition, resting metabolic rate (RMR), and flexibility were measured before and after 12 wk. There were significant group × time interactions ( P < 0.05) after 12 wk for legPWV and HR, which significantly decreased ( P < 0.05) in AQ, and V̇o2max, 6MWD, physical function, and muscular strength, which significantly increased ( P < 0.05) in AQ, compared with no changes in CON. There were no significant differences ( P > 0.05) for BP, ABI, RMR, or flexibility after 12 wk. Interestingly, there was relatively high adherence (84%) to the aquatic walking exercise program in this population. These results suggest that aquatic walking exercise is an effective therapy to reduce arterial stiffness and resting HR and improve cardiorespiratory capacity, exercise tolerance, physical function, and muscular strength in patients with PAD.NEW & NOTEWORTHY The results of this study reveal for the first time that aquatic walking exercise can decrease arterial stiffness and improve exercise tolerance, cardiorespiratory capacity, and muscular strength in patients with peripheral artery disease (PAD). Aquatic walking exercise training demonstrates relatively high exercise adherence in this population. Aquatic walking exercise training may be a useful therapeutic intervention for improving physical function in patients with PAD.

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