Abstract
Background Elevated arterial stiffness is associated with increased cardiovascular mortality. The relationship between arterial stiffness and critical limb ischemia (CLI) is not well established. Objectives The objective of this study is to analyze the relationship between arterial stiffness indices and the degree of limb ischemia measured by the ankle-brachial index (ABI). Methods A cross-sectional study comparing patients with CLI and controls. Arterial stiffness was measured using brachial artery oscillometry. The arterial stiffness indices pulse wave velocity (PWV) and augmentation index normalized to 75 beats/min (AIx@75) were determined. Multiple linear regression was applied to identify predictors of arterial stiffness indices. Results Patients in the CLI group had higher PWV (12.1±1.9 m/s vs. 10.1±1.9 m/s, p < 0.01) and AIx@75 (31.8±7.8% vs. 17.5±10.8%, p < 0.01) than controls. Central systolic pressure was higher in the CLI group (129.2±18.4 mmHg vs. 115.2±13.1 mmHg, p < 0.01). There was an inverse relationship between AIx@75 and ABI (Pearson coefficient = 0.24, p = 0.048), but there was no relationship between ABI and PWV (Pearson coefficient = 0.19, p = 0.12). In multiple regression analysis, reduced ABI was a predictor of elevated levels of AIx@75 (β = -25.02, p < 0.01). Conclusions Patients with CLI have high arterial stiffness measured by brachial artery oscillometry. The degree of limb ischemia, as measured by the ABI, is a predictor of increased AIx@75. The increased AIx@75 observed in CLI may have implications for the prognosis of this group of patients with advanced atherosclerosis.
Highlights
Lower limb peripheral artery disease (PAD) is common in the elderly and its worldwide incidence is increasing.[1]
The p-values refer to the following tests: MMann-Whitney; TStudent’s t test for independent samples; ankle-brachial index (ABI) = ankle/brachial index; AIx@75 = augmentation index normalized to 75 beats/min; DBPc = central diastolic blood pressure; DBPp = peripheral diastolic blood pressure; HR = heart rate; MAP = mean arterial pressure; PPc = central pulse pressure; PWV = pulse wave velocity; SBPc = central systolic blood pressure; SBPp = peripheral systolic blood pressure; TVR = total vascular resistance; CLI = critical limb ischemia group
This study showed that patients with CLI had higher values of arterial stiffness indices compared to controls, matched by gender and age
Summary
Lower limb peripheral artery disease (PAD) is common in the elderly and its worldwide incidence is increasing.[1]. An ankle/brachial index (ABI) ≤ 0.90 is considered abnormal and when associated with ischemic pain at rest or ischemic wounds it confirms a diagnosis of CLI.[3,4] The ABI quantifies limb ischemia and is a marker of cardiovascular mortality. Objectives: The objective of this study is to analyze the relationship between arterial stiffness indices and the degree of limb ischemia measured by the ankle-brachial index (ABI). Results: Patients in the CLI group had higher PWV (12.1±1.9 m/s vs 10.1±1.9 m/s, p < 0.01) and AIx@75 (31.8±7.8% vs 17.5±10.8%, p < 0.01) than controls. Conclusions: Patients with CLI have high arterial stiffness measured by brachial artery oscillometry. The degree of limb ischemia, as measured by the ABI, is a predictor of increased AIx@75. The increased AIx@75 observed in CLI may have implications for the prognosis of this group of patients with advanced atherosclerosis
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