scholarly journals Circulating MicroRNA-4739 May Be a Potential Biomarker of Critical Limb Ischemia in Patients with Diabetes

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Ju-yi Li ◽  
Biao Cheng ◽  
Xiu-fang Wang ◽  
Zhong-jing Wang ◽  
Hong-mei Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critical Limb Ischemia ◽  
Area Under The Curve ◽  
Limb Ischemia ◽  
Circulating Microrna ◽  
Roc Curve Analysis ◽  
Altered Expression ◽  
Potential Biomarker ◽  
Patients With Diabetes ◽  
Noninvasive Biomarkers

Critical limb ischemia (CLI) is the most severe manifestation of peripheral artery disease, which is common but rarely diagnosed. Noninvasive biomarkers are urgently required to assist in the diagnosis of CLI. Accumulating evidence indicates that miRNAs play an important role in the development of various diseases. In this study, microarray profiling revealed 11 miRNAs with significantly altered expression in four T2DM patients with CLI compared with that in four sex- and age-matched T2DM patients without CLI. In independent cohorts, qRT-PCR validation confirmed the increased miRNA-4739 level in patients with CLI versus patients without CLI. miRNA-4739 levels increased with FPG and HbA1c (all P < 0.05). After adjusting for the risk factors, miRNA-4739 levels were found to be associated with an increased odds ratio (OR) of T2DM with CLI (OR =12.818, 95% confidence intervals (CI) 1.148 to 143.143, P = 0.038). ROC curve analysis revealed that the area under the curve (AUC) of miR-4739+confounding risk factors was 0.94 (95% CI 0.891 to 0.998, P < 0.001), which was higher than that of confounding risk factors (AUC 0.94 vs. 0.91, 95% CI -0.122 to 0.060, P > 0.05) and of miR-4739 (AUC 0.94 vs. 0.69, 95% CI -0.399 to -0.101, P < 0.001), respectively. We conclude that elevated plasma miRNA-4739 levels are independently associated with CLI in T2DM patients. miRNA-4739 is implicated as a novel diagnostic marker and a potential therapeutic target for CLI in diabetes.

Critical limb ischemia patients clinically improving with medical treatment have lower neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios

Vascular ◽  
2021 ◽  
pp. 170853812098629
Author(s):  
Sevinç B Erdoğan ◽  
Ümmühan N Selçuk ◽  
Murat Baştopçu ◽  
Gökhan Arslanhan ◽  
Arif Y Çakmak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Treatment ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Response To Treatment ◽  
Standard Regimen ◽  
Markers Of Inflammation ◽  
Endovascular Revascularization ◽  
Cardiovascular Center ◽  
Associated Risk Factors

Objectives Inflammation is a component in the pathogenesis of critical limb ischemia. We aimed to assess how inflammation affects response to treatment in patients treated for critical limb ischemia using neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocytes ratios (PLR) as markers of inflammation. Methods Patients in a single tertiary cardiovascular center with critical limb ischemia unsuitable for surgical or interventional revascularization were retrospectively identified. Data were collected on medical history for risk factors, previous surgical or endovascular revascularization, and outcome. A standard regimen of low molecular weight heparin, aspirin, statins, iloprost infusions, and a standard pain medication protocol were applied to each patient per hospital protocol. Patients with improvement in ischemic pain and healed ulcers made up the responders group and cases with no worsening pain or ulcer size or progression to minor or major amputations made up the non-responders group. Responders and Non-responders were compared for risk factors including pretreatment NLR and PLR. Results 268 included patients who were not candidates for surgical or endovascular revascularization were identified. Responders had significantly lower pretreatment NLR (4.48 vs 8.47, p < 0.001) and PLR (162.19 vs 225.43, p = 0.001) values. After controlling for associated risk factors NLR ≥ 4.63 (p < 0.001) and PLR ≥ 151.24 (p = 0.016) were independently associated with no response to treatment. Conclusions Neutrophil-to-lymphocyte ratio and platelet-to-lymphocytes ratio are markers of inflammation that are reduced in patients improving with medical treatment suggesting a decreased state of inflammation before treatment in responding patients.

scholarly journals Outcome After Leg Bypass Surgery for Critical Limb Ischemia Is Poor in Patients With Diabetes: A population-based cohort study

Diabetes Care ◽  
2008 ◽  
Vol 31 (5) ◽  
pp. 887-892 ◽  
Author(s):  
J. Malmstedt ◽  
K. Leander ◽  
E. Wahlberg ◽  
L. Karlstrom ◽  
L. Alfredsson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critical Limb Ischemia ◽  
Bypass Surgery ◽  
Limb Ischemia ◽  
Population Based ◽  
Patients With Diabetes

Isolated femoral artery revascularisation with or without iliac inflow improvement – a less invasive surgical option in critical limb ischemia

VASA ◽  
2021 ◽  
pp. 1-7
Author(s):  
Andreas S. Peters ◽  
Katrin Meisenbacher ◽  
Dorothea Weber ◽  
Theodosios Bisdas ◽  
Giovanni Torsello ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Negative Impact ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Lesion Length ◽  
Vascular Intervention ◽  
Selection Of Variables ◽  
Surgical Option

Summary: Background: Isolated femoral artery revascularisation (iFAR) represents a well-established surgical method in the treatment of peripheral arterial disease (PAD) involving common femoral artery disease. Data for iFAR in multilevel PAD are inconsistent, particularly in patients with critical limb ischemia (CLI). The aim of the study was to evaluate the outcome of iFAR in CLI regarding major amputation and reintervention and to identify associated risk factors for this outcome. Patients and methods: The data used have been derived from the German Registry of Firstline Treatment in Critical Limb Ischemia (CRITISCH). A total of 1200 patients were enrolled in 27 vascular centres. This sub-analysis included patients, which were treated with iFAR with/without concomitant iliac intervention. For detection of risk factors for the combined endpoint of major amputation and/or reintervention, selection of variables for multiple regression was conducted using stepwise forward/backward selection by Akaike’s information criterion. Results: 95 patients were included (mean age: 72 years ± 10.82; 64.2% male). Of those, 32 (33.7%) participants reached the combined endpoint. Risk factor analysis revealed continued tobacco use (odds ratio [OR] 2.316, confidence interval [CI] 0.832–6.674), TASC D-lesion (OR: 2.293, CI: 0.869–6.261) and previous vascular intervention in the trial leg (OR: 2.720, CI: 1.037–7.381) to be associated with reaching the combined endpoint. Conclusions: iFAR provides a reasonable, surgical option to treat CLI. Lesion length (TASC D) seems to have a negative impact on outcome. Further research is required to better define the future role of iFAR for combined femoro-popliteal lesions in CLI – best in terms of a randomised controlled trial.

scholarly journals Myocardial revascularization in diabetic patients presenting with critical limbischemia

2010 ◽  
Vol 13 (4) ◽  
pp. 25-29
Author(s):  
Ivan Ivanovich Dedov ◽  
Victor Yur'evich Kalashnikov ◽  
Konstantin Vladimirovich Melkozerov
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Critical Limb Ischemia ◽  
Myocardial Revascularization ◽  
Limb Ischemia ◽  
Diabetic Patients ◽  
Preoperative Risk Assessment ◽  
Therapeutic Modalities ◽  
Optimal Drug ◽  
Patients With Diabetes

The frequency of diabetic complications remains high despite the development of improved therapeutic modalities. Macroangiopathy continues to bethe predominant complication while coronary heart disease is the main cause of mortality.This paper considers clinical features of diabetic patientswith coronary heart disease and critical limb ischemia; various aspects of optimal drug therapy, preoperative examination and diagnostics precedingvascular non-cardiac surgery; preoperative risk assessment; indications for coronary angiography and myocardial revascularization. The authors emphasizethe importance of development of algorithms for the treatment of patients with diabetes, critical limb ischemia, and coronary heart disease.

scholarly journals Patients with Critical Limb Ischemia Requiring Intervention: Occurrence and Risk Factors for Reintervention

2020 ◽  
Vol 231 (4) ◽  
pp. S351-S352
Author(s):  
Muhammad N. Khan ◽  
Romeo B. Mateo ◽  
Faisal S. Jehan ◽  
Muhammad Zeeshan ◽  
Viraj Pandit ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critical Limb Ischemia ◽  
Limb Ischemia

scholarly journals Gender-related differences in critical limb ischemia due to peripheral arterial occlusive disease

2013 ◽  
Vol 12 (4) ◽  
pp. 278-283 ◽  
Author(s):  
Vanessa Prado dos Santos ◽  
Carlos Alberto Silveira Alves ◽  
Cicero Fidelis Lopes ◽  
Jose Siqueira de Araujo Filho
Keyword(s):  
Risk Factors ◽  
Critical Limb Ischemia ◽  
Peripheral Arterial Occlusive Disease ◽  
Clinical Characteristics ◽  
Limb Ischemia ◽  
Arterial Occlusive Disease ◽  
Occlusive Disease ◽  
Male And Female ◽  
Female Patients ◽  
Peripheral Arterial

BACKGROUND: Mortality from cardiovascular disease has declined among men and increased among North American women. Recent studies have revealed differences between genders in the epidemiology of atherosclerotic disease. OBJECTIVE: To study possible differences between male and female patients with critical limb ischemia (CLI) according to risk factors of atherosclerosis and clinical characteristics of lower limbs with peripheral arterial occlusive disease (PAOD). METHODS: The study included 171 male and female patients treated for CLI due to infrainguinal PAOD and compared clinical characteristics (Rutherford category and PAOD territory), risk factors for atherosclerosis (diabetes, age, smoking and hypertension) and number of opacified arteries on digital angiograms of the leg. The EPI-INFO software was used for statistical analysis, and the level of significance was set at p<0.05. RESULTS: Mean age was 70 years, and 88 patients were men (52%). For most patients (both genders), Rutherford category was 5 (82 % of men and 70% of women; p=0.16). The group of women had higher mean age (73 vs. 67 years; p=0.0002) and greater prevalence of diabetes (66% vs. 45%; p=0.003) and hypertension (90% vs. 56%; p=0.0000001). Among men, the prevalence of smoking was higher (76% vs. 53%; p=0.0008). The analysis of digital angiograms revealed that opacification of only one artery in the leg was found for 74% of women (vs. 50% of men). CONCLUSION: The prevalence of risk factors for atherosclerosis and the characteristics of PAOD are different between male and female patients with CLI.

Assessment of Critical Limb Ischemia in Patients with Diabetes: Comparison of MR Angiography and Digital Subtraction Angiography

2005 ◽  
Vol 185 (6) ◽  
pp. 1641-1650 ◽  
Author(s):  
Matthieu Lapeyre ◽  
Hicham Kobeiter ◽  
Pascal Desgranges ◽  
Alain Rahmouni ◽  
Jean-Pierre Becquemin ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Critical Limb Ischemia ◽  
Mr Angiography ◽  
Limb Ischemia ◽  
Digital Subtraction ◽  
Patients With Diabetes

scholarly journals Plasma NAP-2 levels are associated with critical limb ischemia in peripheral arterial disease patients

2019 ◽  
Vol 244 (1) ◽  
pp. 22-27
Author(s):  
Xiufang Wang ◽  
Juyi Li ◽  
Liming Gan ◽  
Qun Liu
Keyword(s):  
Confidence Intervals ◽  
Critical Limb Ischemia ◽  
Plasma Levels ◽  
Ankle Brachial Index ◽  
Area Under The Curve ◽  
Limb Ischemia ◽  
Limb Amputation ◽  
Diagnostic Biomarker ◽  
Elevated Plasma ◽  
Novel Target

Our study evaluates the relationship between plasma neutrophil-activating peptide-2 (NAP-2) levels and critical limb ischemia (CLI); 189 subjects were enrolled in this study: 59 subjects with CLI and type 2 diabetes mellitus (T2DM), 45 subjects with CLI and no T2DM, 43 patients with T2DM and no CLI, and 42 without both T2DM and CLI. Subjects with CLI had higher plasma levels of NAP-2 than those of the healthy group (2.04 ± 0.06 ng/mL vs. 1.75 ± 0.09 ng/mL, P = 0.011). Subjects with CLI and T2DM had higher plasma levels of NAP-2 than those of the T2DM group (2.08 ± 0.08 ng/mL vs. 1.73 ± 0.10 ng/mL, P = 0.007). However, subjects with CLI including CLI and T2DM+CLI had higher plasma levels of NAP-2 than those of the non-CLI group including healthy and T2DM group (2.06 ± 0.05 ng/mL vs. 1.74 ± 0.07 ng/mL, P < 0.001). The ankle brachial index (ABI) and total cholesterol (TC) were significantly and negatively correlated with plasma NAP-2 levels (rho = −0.250, P = 0.001; rho = −0.162, P = 0.026, respectively). Systolic blood pressure (SBP) positively correlated with plasma NAP-2 levels (rho = 0.187, P = 0.010). When adjusting for the factors, plasma NAP-2 levels were still significantly correlated with CLI (odds ratio = 11.543, 95% confidence intervals: 1.327–100.403, P = 0.027). The area under the curve (AUC) of NAP-2+confounders was 0.992 (95% confidence intervals 0.981 to 1.003, P < 0.001) and it was higher than those of NAP-2 alone (95% confidence intervals 0.241 to 0.407, P < 0.001) and confounders alone (AUC = 0.990, 95% confidence intervals −0.013 to 0.018, P = 0.797). In conclusion, elevated plasma NAP-2 was independently associated with CLI, but it was not correlated with T2DM. Plasma NAP-2 levels might be an early CLI diagnostic biomarker and might provide a novel target for CLI treatment. Impact statement Critical limb ischemia (CLI) is a serious arterial obstruction, resulting in serious reduction of blood flow to the extremities. CLI is a symptomatic disorder and is frequently not diagnosed in time. This results in a high mortality and elevated risk of limb amputation. Serum or plasma biomarkers play important roles in disease prevention, diagnosis, and prognosis. Elevated plasma neutrophil-activating peptide-2 (NAP-2) was found independently associated with CLI, but not with T2DM. Plasma NAP-2 levels might be an early CLI diagnostic biomarker and might provide a novel target for CLI treatment.

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