Post-exercise pulsatility index indicates treatment effects in peripheral arterial occlusive disease (PAOD).

Andrej Udelnow,Zuhir Halloul,Ivo Buschmann,Maria Hawemann,Frank Meyer

doi:10.1007/s00508-021-01818-x

Andrej Udelnow, Zuhir Halloul + Show 3 more

Open Access

https://doi.org/10.1007/s00508-021-01818-x

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Abstract

BackgroundHypothesis: Post-exercise measurements better discriminate PAOD-patients from healthy persons and they more sensitively detect hemodynamic improvements after treatment procedures than resting measurements.MethodsA total of 19 healthy volunteers and 23 consecutive PAOD-patients underwent measurements of peak systolic velocity (PSV), end-diastolic velocity (EDV), minimal diastolic velocity (MDV), time-averaged maximum velocities (TAMAX), resistance index (RI) and pulsatility index (PI) before and after a standard exercise test (at 1, 2, 3, 4 and 5 min) before and after treatment (incl. epidemiological data, PAOD risk factors and comorbidities).ResultsIn resting values, healthy persons and PAOD-patients did not differ significantly in any of the hemodynamic parameters. PSV increased after treatment in PAOD-patients by 5 cm/s (paired t‑test, p: 0.025); however, when the amplitude of autoregulatory changes related to the resting values were calculated, PAOD-patients showed clearly less hemodynamic changes after exercise than healthy persons (p: 0.04; 0.002; <0.001 for PSV, TAMAX and PI, resp.). The time course after exercise was compared by repeated measures of ANOVA. Healthy persons differed significantly in PI, RI and PSV from PAOD patients before and after treatment (p<0.001 each). The PAOD-patients revealed a significantly improved PI after treatment (p: 0.042). The only factor contributing significantly to PI independently from grouping was direct arterial vascularization as compared to discontinuous effects by an obstructed arterial tree.ConclusionHealthy persons cannot be well differentiated from PAOD-patients solely by hemodynamics at rest but by characteristic changes after standard exercise. Treatment effects are reflected by higher PI-values after exercise.

Highlights

Vascular medicine depends heavily on non-invasive measuring hemodynamic parameters, such as anklebrachial index (ABI), peak systolic velocity (PSV), end diastolic velocity (EDV), minimum diastolic velocity (MD) and time averaged maximal velocity (TAMAX)
Healthy persons cannot be well differentiated from peripheral arterial obstructive disease (PAOD)-patients solely by hemodynamics at rest but by characteristic changes after standard exercise
Other non-invasive methods and parameters, such as transcutaneous partial oxygen pressure measurement, “transkutane Sauerstoffpartialdruckmessung”, contrast-enhanced ultrasonography (CEUS) and toe pressure measurements try to circumvent the methodological artifacts of Doppler ultrasonography by quantifying the perfusion or oxygenation at the periphery but again, available evidence is not sufficient to recommend these methods for standard diagnostics [3]

Summary

Introduction

Vascular medicine depends heavily on non-invasive measuring hemodynamic parameters, such as anklebrachial index (ABI), peak systolic velocity (PSV), end diastolic velocity (EDV), minimum diastolic velocity (MD) and time averaged maximal velocity (TAMAX). Calculated values, such as the resistance index (RI) and the pulsatility index (PI) are used commonly for interindividual and intraindividual comparisons. Other non-invasive methods and parameters, such as transcutaneous partial oxygen pressure measurement, “transkutane Sauerstoffpartialdruckmessung” (tcpO2), contrast-enhanced ultrasonography (CEUS) and toe pressure measurements try to circumvent the methodological artifacts of Doppler ultrasonography by quantifying the perfusion or oxygenation at the periphery but again, available evidence is not sufficient to recommend these methods for standard diagnostics [3]

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