Brachial Index Research Articles

Changes in the cardiovascular profile in patients 3 and 12 months after COVID-19 pneumonia: parameters of arterial stiffness, global longitudinal strain, and diastolic function of the left ventricle

Aim. To study changes in the brachial – ankle pulse wave velocity (baPWV), ankle – brachial index (ABI), diastolic function, and global longitudinal strain of the left ventricle (LV) 3 and 12 months after COVID-19 pneumonia.Materials and methods. The dynamics of vascular age and LV global longitudinal strain was studied in 154 patients 3 and 12 months after COVID-19 pneumonia (51 ± 12 years, 48% were women). The control group consisted of 55 sexand age-matched individuals.Results. During the follow-up, the average baPWV decreased (13.2 [11.8; 15.1] cm / sec vs. 13.0 [11.8; 14.1] cm/ s; p < 0.001), and the frequency of its elevated values declined (45.4 vs. 35.1%; p = 0.008). The average ABI increased (1.09 [1.04; 1.14] vs. 1.11 [1.06; 1.17]; p = 0.012), but remained within the normal range. LV global longitudinal strain (LV GLS) (–19.6 ± 2.2 and –19.7 ± 2.5%; p = 0.854) and the frequency of reduced LV GLS (21.4 and 26.6%; p = 0.268) did not change significantly and did not differ from values in the control group. Global longitudinal strain in the LV basal inferoseptal segment improved (–19.2 ± 3.6% vs. –20.1 ± 4.0%; p = 0.032). The early diastolic mitral annular velocity decreased (8.4 ± 3.0 cm / s vs. 8.0 ± 2.5 cm / s; p = 0.023). The LV isovolumic relaxation time was greater than in the control group (101.8 ± 22.3 ms at the 1st visit vs. 92.9 ± 21.5 ms; p = 0.012; 105.9 ± 21.9 ms vs. 92.9 ± 21.5 ms at the 2nd visit; p < 0.001). A positive correlation was found between baPWV (r = 0.209; p = 0.009) and ABI (r = 0.190; p = 0.021) and strain parameters of the LV basal segments 12 months after discharge.Conclusion. Patients with optimal visualization on echocardiography at 12 months after COVID-19 pneumonia, compared to the results of the examination 3 months after the disease, had deteriorated parameters of LV diastolic function. LV GLS was within the grey zone and did not change significantly. An improvement in arterial stiffness was noted, associated with an improvement in the strain of basal LV segments.

Outcomes of retrograde intervention for chronic lower extremity arterial disease at Hanoi Heart Hospital

Background: Chronic lower extremity arterial disease, mostly caused by atherosclerotic etiology, has been increasing in recent years. Currently, there has been a shift in the treatment of chronic lower extremity arterial disease from open surgical treatment to endovascular intervention, even with complex TASC, C, D lesions.
 Objectives: Evaluate the results of retrograde intervention for chronic occlusive lesions of lower limb arteries. 
 Methods: From April 2021 to August, the cross sectional, descriptive study was carried out on 27 patients with lower limb artery disease, treated by retrograde intervention in Interventional Department, Hanoi Heart hospital. All patients were evaluated characteristics by clinical symptoms, ankle- brachial index and lesion characteristics before and after the intervention, complications, short -term results.
 Results: Patients with severe claudication: 70.4%, severe limb ischemia: 29.6%, the average ABI was 0.59. The majority of lesions belong to TASC II C and D (96.3%). Retrograde vascular access was ATA: 33.3%, PTA: 22.2%, popliteal artery: 14.8% , distal SFA: 7.4%, CFA: 22.2%. Vascular access under ultrasound guidance is 92.6%, under DSA: 7.4%. Subinimal guide wire: 74.1%, intraluminal guide wire 25.9%. Technical success was 100%. There were 21 cases (77.8%) with stent placement, 6 cases (22.2%) with balloon dilatation alone. The post-procedure complication was pseudoaneurysm at the puncture site (7.4%). Target lesion revascularization (TLR) rate after 1 month was 100%, after 6 months was 83.3%.
 Conclusions: Retrograde intervention to treat chronic occlusive lesions of lower extremity arteries is an effective, safe, and minimally invasive method. The "key" to performing retrograde intervention is distal vascular access.

Иммунный статус в развитии рестеноза у пациентов с окклюзионно-стенотическим поражением бедренно-подколенного артериального сегмента после бедренно-подколенного шунтирования

Objective: to assess the immune status of systemic and local blood flow after femoral-popliteal bypass surgery in patients with and without restenosis. Materials and methods. The analysis of the treatment of 82 patients who underwent femoral-popliteal bypass surgery was carried out. Depending on the condition of the reconstruction zone after 12 months, the patients were divided into two groups: group I - 21 patients without restenosis, group II - 61 patients with the development of restenosis. The analysis of IgA, IgM, IgG, circulating immune complexes (CIC), interleukin (IL)-6, IL-1 in the systemic and local blood flow before and after surgery was performed. Results. In patients with the development of restenosis of the reconstruction zone, the level of IgA in the systemic and IgA, IgM in the local bloodstream was initially lower, the level of CIC, IL-1, IL-6 in the systemic and IgG, IL-1, IL-6 in the local bloodstream was higher, after surgery, the level of IgA in the local bloodstream was lower, higher - IgM in systemic and IL-6 in local blood flow in comparison with patients without restenosis. The correlation between the immune status and the development of restenosis was established: before surgery in the systemic circulation - IgA (r=-0.31, p<0.01), CIC (r=0.39, p<0.001), IL-6 (r=0.25, p<0.05), IL-1 (r=0.26, p<0.05), in the local bloodstream - IgA (r=-0.26, p<0.05), IgM (r=-0.30, p<0.01), IgG (r=0.26, p<0.05), IL-6 (r=0.30, p<0.01), IL-1 (r=0.29, p<0.01); after surgery in the systemic circulation - IgM (r=0.33, p<0.01), in the local - IgA (r=-0.24, p<0.05), IL-6 (r=0.40, p<0.001). The relationship between the degree of chronic arterial insufficiency (r=0.22, p<0.05), the ankle- brachial index after surgery (r=-0.27, p<0.05) with the development of restenosis was revealed. Conclusion. The interrelation of the immune status of the systemic and local blood flow before and after surgery and restenosis in the anastomosis zone after femur-popliteal bypass surgery has been shown. The study of the immune status will make it possible to develop an algorithm for restenosis prevention.

Characteristics of ulcerated and non-ulcerated necrobiosis lipoidica.

Necrobiosis lipoidica (NL) is complicated by ulceration in up to 35% of cases. Retrospective study of patients with NL seen at our institution between January 1, 1992, and May 25, 2021, was conducted. Ulcerated NL (UNL, n=83) and non-ulcerated NL (NUNL, n=233) groups were compared. Twenty-six percent (83/316) of patients with NL experienced ulceration. UNL was significantly more likely to be painful (52% vs. 36%, P=0.01), was more likely to have a lesion-associated cutaneous malignancy (7% vs. 0%, P < 0.001), and had a larger median size (7 vs. 5 cm, P=0.004) compared to NUNL. Vascular studies were performed on a subset of patients and revealed transcutaneous oxygen pressure (TcPO2) < 40 mm Hg in 53% and venous insufficiency in 62% with no significant differences between UNL and NUNL groups. In patients with unilateral ulceration, mean TcPO2 values (39.7 vs. 46.6 mm Hg), regional perfusion index <0.6 (29% vs. 14%), and TcPO2 < 40 mm Hg (43% vs. 14%) were worse in the ulcerated leg compared to the non-ulcerated leg, but these differences were not statistically significant. UNL was more likely to be painful, develop lesion-associated malignancy, and be larger in size compared to NUNL. There were no statistically significant differences in venous insufficiency, arterial Doppler/ankle brachial index, or TcPO2 values between UNL and NUNL patients, however, a significant portion of the cohort demonstrated abnormal vascular studies, particularly on TcPO2 and venous insufficiency testing.

ASSESSMENT OF PERIPHERAL VASCULAR DAMAGE IN PATIENTS WITH DIFFERENT DEGREES OF BLOOD PRESSURE INCREASE

Purpose – to investigate the frequency of peripheral arteries damage by determining theankle- brachial index (ABI) in patients with hypertension of 1-3 degrees of the older agecategory (&gt; 55 years) using automatic devices for measuring blood pressure.Material and methods. The object of the study were patients with hypertension olderthan 55 years, 150 people (50 patients with elevated blood pressure levels 1, 2 and3 degrees), as well as 20 healthy people of the same age. The study included only patientswho did not have obvious clinical symptoms of peripheral vascular disease. The studydid not include patients with persistent cardiac arrhythmias (atrial fibrillation, frequentventricular arrhythmias, etc.). Simultaneous measurement of blood pressure on the armwith a higher level of blood pressure and on the leg in a supine position was carriedout. After that, the ankle- brachial index was calculated as the ratio of the mean systolicblood pressure (SBP) separately on the right and left ankle to the mean SAT level on thebrachial of the arm with higher BP. If ABI less than 0.9 damage of peripheral arteries ona proper side was diagnosed. Results. For a detailed analysis, we divided all patients with hypertension dependingon the value of the ankle- shoulder index into two subgroups: subgroup A includedpatients (n = 141) with hypertension with an index value&gt; 0.9, and subgroup B (n = 9) –respectively &lt;0.9. The mean age of patients in subgroup A was 64.5 ± 1.1 years, subgroupB – 66.5 ± 2.1 years (p&gt; 0.05 between subgroups). SAT in subgroup A was 159.4 ± 2.9mm Hg, in subgroup B – 162.1 ± 4.2 mm Hg. (p&gt; 0.05 between subgroups). Patients inboth subgroups did not differ in age, sex, body mass index, smoking frequency. Patients inboth subgroups had significantly elevated serum total cholesterol of 6.5 ± 0.2 mmol / l and6.7 ± 0.5 mmol / l, respectively. The degree of increase in diastolic blood pressure (BP)in subgroup A was significantly higher than 103.2 ± 1.2 mm Hg. compared with subgroupB – 78 ± 4.6 mm Hg (p &lt;0.01). Serum creatinine levels in patients with signs of peripheralarterial lesions were higher than in patients without signs of lesions of 99.4 ± 3.6 μmol /l versus 88.2 ± 3.1 μmol / l (p &lt;0.05). Type 2 diabetes was found in 44 % in subgroup Band in 7 % in subgroup A.Conclusions. The most common signs of peripheral vascular disease were observed inpatients older than 55 years with isolated systolic hypertension, type 2 diabetes mellitusand elevated serum creatinine.

The Decreasing Trends of Pulse Wave Velocity and Ankle- Brachial Pressure Index in Japanese Medical Students: A Sixteen-Year Study

The Decreasing Trends of Pulse Wave Velocity and Ankle- Brachial Pressure Index in Japanese Medical Students: A Sixteen-Year Study

Prevalence and risk factors for peripheral arterial disease in adults with systemic hypertension in Southern Nigeria

Aims: Atherosclerotic peripheral arterial disease affects quality of life and is used as a marker for atherosclerosis in the coronary and cerebral arteries. The ankle brachial pressure index can be used for identifying persons with peripheral arterial disease. This study aims to determine the prevalence of peripheral arterial disease in a cohort of hypertensive patients using the ankle brachial pressure index as well as identify the risk factors associated with PAD. Methods: One hundred and sixty hypertensive subjects and a commensurate number of age and sex matched apparently healthy controls were evaluated. Assessment of PAD was made using the history, physical examination and measurement of the ankle brachial pressure index. Chi square (χ2) and Student t tests were used to assess statistically differences between categorical and continuous variables respectively. Correlation and regression analysis was used to assess the risk factors for PAD in hypertension. Results: The mean age of the cases with systemic hypertension was 56.3 ± 8.2 years with a range of 42-72 years. There was a female preponderance with a female: male ratio of 1.8:1 as 64.4% of the cases were females and 35.6% were males. The prevalence of PAD using the ABPI was 11% in hypertensives and risk factors were determined to be increasing age (p=0.026), duration of hypertension (p=0.011), and BMI (p=0.008). Conclusion: This study highlights the presence of PAD in adult hypertensive patients and identifies the risk factors associated with PAD.

Blood lipid spectrum and elastic properties of arteries in patients with chronic pancreatitis in combination with arterial hypertension

110 patients aged 45-65 years with chronic pancreatitis were examined. The first group consisted of patients with a combined course of chronic pancreatitis with arterial hypertension; the second group - patients with chronic pancreatitis without concomitant hypertension. All patients were examined for total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol. Arterial stiffness was determined by the pulse wave velocity. It was found that patients of the 1st group had significantly higher levels of triglycerides (37.2%), low-density lipoprotein cholesterol (13%), total cholesterol (25%), atherogenic ratio (19.6%) and significantly lower levels of high-density lipoprotein cholesterol (15.4%). Correlations between age and the level of atherogenic ratio, low-density lipoprotein cholesterol were established – r=0.35; p&lt;0.01; r=0.37; p&lt;0.01, respectively. The duration of chronic pancreatitis positively correlated with the level of triglycerides, low-density lipoprotein cholesterol – r=0.43; p&lt;0.01; r=0.34; p&lt;0.01, respectively. The level of brachial artery augmentation index was significantly lower by 43% in patients with chronic pancreatitis in combination with arterial hypertension, while the aortic augmentation index was significantly higher by 37.6% (p&lt;0.01). It was found that patients of the 1st group had a significantly higher pulse wave velocity in the carotid-femoral segment compared to the 2nd group – by 7.5% (p&lt;0.01). Significant correlations have been established between the brachial artery augmentation index and age, total cholesterol, atherogenic ratio, high and low density lipoprotein cholesterol, triglycerides, cardiovascular risk level by the SCORE scale in patients with a combined course of chronic pancreatitis with arterial hypertension. Conclusions. Patients with the combination of chronic pancreatitis and hypertension had significantly higher levels of triglycerides, low-density lipoprotein cholesterol and total cholesterol. Changes in the elastic properties of arteries in patients with chronic pancreatitis with comorbid hypertension were characterized by an increase in the augmentation index and the pulse wave velocity in the carotid-femoral segment.

Dialysis Treatment is an Independent Risk Factor for Foot Morbidity.

Aim: To determine the prevalence of foot morbidity among patients with ESRD on dialysis. Methods: A prospective, non-experimental, quantitative time series design was employed. Forty-seven participants were recruited in the study. Medical records were reviewed followed by non-invasive foot assessments which included: Neurological, Arterial, Biomechanical, and Dermatological Assessment. Participants were assessed twice during the study. Results: Foot morbidity was found to be high among participants with ESRD on dialysis. 95.74% of participants presented with foot deformities, 76.60% had skin and nail conditions. 15% of participants had a history of ulceration and amputation. Moreover, active ulceration and history of revascularisation were also observed. Findings demonstrated overall poor foot health and footcare behavior within this population with 40.43% of participants having inappropriate footwear. The majority of participants did not check feet regularly, did not attend to podiatry appointments, and were unable to reach their feet for self-care. The Toe Brachial Pressure Index (TBPI), Spectral Doppler Waveform Analysis, and the Quantitative Sensory Testing (QST) were re-measured at each visit. Monophasic continuous doppler waveforms increased while triphasic waveforms decreased during the study period. Protective sensation did not decrease during the study period. The mean TBPI decreased during the study period. The relationship between the TBPI and duration of dialysis was found to be significant. Both DM and dialysis duration were identified as significant predictors of reduction in TBPI. Conclusion: This study demonstrates a high prevalence of foot morbidity among patients with ESRD on dialysis. This study highlighted the importance of expanding practice by introducing a podiatry service within the renal unit to provide foot screening, foot assessments, and foot care education, with the aim to reduce severe foot complications.

Short-term outcomes of endovascular therapy for chronic lower extremity arterial disease

Background: Chronic lower extremity arterial disease, mostly caused by atherosclerotic etiology, has been increasing in recent years. Currently, there has been a shift in the treatment chronic lower extremity arterial disease from open surgical treatment to endovascular intervention. According to the TASC classification, surgical treatment is preferred for patients with complex lesions of TASC C, D but recent studies have shown that endovascular intervention has had good results for high-grade lesions.&#x0D; Objective: To determine the efficacy, short-term results of endovascular intervention in patients with symptomatic lower extremity artery disease&#x0D; Methods: From January to December 2021, the cross sectional, descriptive study was carried out on 38 patients with lower limb artery disease, treated by endovascular intervetion in Interventional Department, Hanoi Heart hospital. All patients were evaluated by clinical symptoms, ankle- brachial index and lesion characteristic before and after the intervention to determine the initial success&#x0D; Results: Majority of lesions belong to TASC II C and D (78,9%). Injured arteries can be isolated in the aortoiliac (21,1%), femoropopliteal (21,1%), below-knee artery (21,1%) or combine aortoiliac and femoropopliteal (10,5%), femoropopliteal and BTK (15,8%). The ankle- brachial index before and after the intervention respectively 0,57 and 0.83 (p&lt;0,001). The technical successful rate was 94,7%. Balloon angioplasty and stent placement were in 21 patients (55,3%) and balloon angioplasty in 17 patients (44,7%). Post-procedural complications included stent thrombosis (2.6%), amputation (2.6%), pseudoaneurysm at the puncture site (2.6%).&#x0D; Conclusion: Endovascular intervention is a safe, effective, minimally invasive method in the treatment of chronic lower extremity arterial disease

Relationship between shunt sounds at anastomotic sites and mean brachial artery blood flow and vascular resistance index according to Doppler ultrasound

Relationship between shunt sounds at anastomotic sites and mean brachial artery blood flow and vascular resistance index according to Doppler ultrasound

Risk factors for spinal cord ischemia in frozen elephant trunk\u2013induced upper spinal cord ischemia in patients with combination of degenerative arch aneurysms and peripheral artery diseases: a possible mechanism

BackgroundDegenerative aortic arch aneurysms are known to develop through a pathological process of arterial atherosclerosis, which could be accompanied by peripheral artery diseases and resultant development of intrapelvic collateral arteries to the ischemic lower limbs. The aim of this study was to investigate the relationship between peripheral collateral circulation and postoperative paraplegia after total arch repair with a frozen elephant trunk in patients with degenerative aortic arch aneurysms and peripheral artery diseases.MethodsBetween October 2014 and March 2020, 27 patients (20 men; 69.8 ± 7.7 years old) underwent total arch repair with a frozen elephant trunk. Two of the 27 patients developed paraplegia postoperatively. The patients were divided into two groups, spinal cord ischemia (SCI) group (2 patients) and no-SCI group (25 patients). The aortic shagginess score, arterial calcification (subclavian artery; hypogastric artery) score, and the number of hypogastric artery branches, assessed using preoperative contrast-enhanced computed tomography images, were compared between the two groups.ResultsThe ankle brachial artery pressure index (i.e., lower side value each patient) was lower in the SCI group than that in the no-SCI group (0.64, 0.71, and 1.09±0.07, respectively). There was no difference between the two groups in the arterial calcification scores or the aortic shagginess score. The number of hypogastric artery branches was greater in the SCI group than in the no-SCI group (66, 66, and 30.7±7.5, respectively).ConclusionsEnhanced collateral circulation to the ischemic lower limbs in patients with combination of degenerative aortic arch aneurysms and peripheral artery diseases may be involved in paraplegia the upper thoracic spinal cord injury after total arch repair with a frozen elephant trunk.

PREVALENCE OF PERIPHERAL ARTERIAL DISEASE AMONG HEMODIALYSIS PATIENTS

Background: Peripheral arterial disease (PAD) is common in patients with end-stage renal disease on hemodialysis, but is frequently underdiagnosed. The risk factors for PAD are well known within the general population, but they differ somewhat in hemodialysis patients. This study aimed to determine the prevalence of PAD and its risk factors in patients on hemodialysis. Objective: To assess the prevalence of peripheral arterial disease in end stage renal disease patients on hemodialysis. Patients and Methods: This was across-sectional study carried out at Hemodialysis Unit of Al-Hussein University Hospital over a period of six month; from September 2019 to April 2020, and conducted on 80 hemodialysis patients. Demographic data and clinical information were recorded. Laboratory data including CBC, calcium, phosphate, total cholesterol, triglyceride, high-density lipoprotein, and iron profile were evaluated. The ankle-brachial index was measured in all patients. PAD was diagnosed if ankle-brachial index 0.9. Results: As regard description of demographic data, the mean age of all studied patients was 45.3 ± 8.8 years with minimum age of 24 years and maximum age of 62 years. There were 43 males (53.8%) and 37 females (46.3%). Thirty-five patients (43.7%) were diabetic, and 48 patients (60%) were hypertensive. According to laboratory profile, the mean of WBCs, Hb, platelets, serum calcium, PO4, and iPTH were 6.5 x10³/ul, 10.4 g/dl, 228.2 x10³/ul, 8.3 mg/dl, 9.4 mg/dl and 477.2 ug/ml respectively. Regarding lipid profile, the mean of total cholesterol, HDL and triglyceride were 214.7 mg/dL, 41.9 mg/dL,and 172.2 mg/dL, respectively. Regarding to iron profile, the mean of iron serum, ferritin and TIBC were 62.7 mg/dl, 603.3 ng/ml and 236.7 mg/dl, respectively. According to ABI, there were 22 patients (27.5%) ≤ 0.9, while there were 58 patients (72.5%) > 0.9. The prevalence of peripheral arterial disease among HD patients was 27.5%. Conclusions: High prevalence of peripheral arterial disease in CKD patients on hemodialysis and Ankle –brachial index was clearly more sensitive than physical examination in detecting of peripheral arterial disease in CKD patients on hemodialysis.

CLINICORADIOLOGICAL ASSESSMENT OF PERIPHERAL ARTERIOPATHY IN DIABETICS

Background :The steady rise in prevalence of Diabetes mellitus has resulted in increase in the complications related to diabetes. Peripheral arterial disease in diabetes is an independent risk factor for subsequent ulceration and limb loss in diabetics. It is therefore essential that peripheral arterial disease is identified in all patients with diabetics. Methods : The present prospective observational study conducted at a tertiary centre in central India was aimed at clinico-radiological assessment of lower limb vessels in patients with diabetes. 184 patients with diabetes were assessed clinically and with doppler ultrasound. Results :Peripheral vascular disease was more common among patients with type II diabetes. Ankle Brachial Pressure Index (ABPI) of &lt; 0.8 was common among patients with longer duration (&gt; 10 years), Doppler ultra sound of lower limbs revealed significant changes bilaterally with type II diabetes and increased duration of diabetes. Conclusion : Peripheral arteriopathy is an important risk factor for diabetic foot especially with longer duration of type II diabetes.

357-P: Advanced Glycation End Products Associate with Vascular Stiffness in Diabetic, Prediabetic, and Normoglycemic Individuals

Advanced glycation end-products are proteins that become glycated after contact with sugars and are implicated in endothelial dysfunction and arterial stiffening. We hypothesized that advanced glycation end-products associate with vascular stiffness independent of glycemic status. Advanced glycation end-products were measured as skin autofluorescence, vascular stiffness was measured as pulse wave velocity, augmentation index and ankle-brachial index in 3,535 participants from the European Prospective Investigation into Cancer and Nutrition Potsdam cohort (median age 67 years, 60% women). A subset of 1,348 participants underwent an oral glucose tolerance test. Participants were sub-phenotyped into normoglycemic, prediabetes and diabetes groups. Skin autofluorescence associated with pulse wave velocity, augmentation index and ankle-brachial index, adjusted beta coefficients (95% CI) per unit skin autofluorescence increase: 0.38 (0.21; 0.55) for carotid-femoral pulse wave velocity, 0.25 (0.14; 0.37) for aortic pulse wave velocity, 1.00 (0.29; 1.70) for aortic augmentation index, 4.12 (2.24; 6.00) for brachial augmentation index and -0.04 (-0.05; -0.02) for ankle-brachial index. The associations were strongest in men, younger individuals and were consistent across all glycemic strata: for carotid-femoral pulse wave velocity 0.36 (0.12; 0.60) in normoglycemic, 0.33 (-0.01; 0.67) in prediabetes and 0.45 (0.09; 0.80) in diabetes groups; with similar estimates for aortic pulse wave velocity. Augmentation index was associated with skin autofluorescence only in normoglycemic and diabetes groups. Ankle-brachial index inversely associated with skin autofluorescence across all sex, age and glycemic strata. Our findings indicate that advanced glycation end-products are involved in vascular stiffening independent of glycemic status, age and other cardiometabolic risk factors. Disclosure A. Birukov: None. R. Cuadrat: None. E. Polemiti: None. F. Eichelmann: None. M. B. Schulze: None. Funding German Ministry of Education and Research; State of Brandenburg (82DZD00302)

MO642DAPAGLIFLOZIN HAS NO IMPACT ON SHORT-TERM BLOOD PRESSURE VARIABILITY IN PATIENTS WITH TYPE-2 DIABETES MELLITUS

Abstract Background and Aims Increased blood-pressure-variability (BPV) is associated with increased cardiovascular and all-cause mortality in patients with type 2 diabetes mellitus (T2DM). Sodium-glucose co-transporter-2 (SGLT-2) inhibitors decrease the incidence of cardiovascular events, renal events, and death in this population. This study aimed to evaluate the effect of dapagliflozin on short-term BPV in patients with T2DM. Method This is a secondary analysis of a double-blind, randomized, placebo-controlled trial in 85 patients with T2DM (NCT02887677). Subjects were randomized to oral dapagliflozin 10mg once daily or placebo for 12 weeks. All participants underwent 24-h ambulatory blood pressure (BP) monitoring with the Mobil-O-Graph NG device at baseline and study-end. Standard deviation (SD), weighted SD (wSD), coefficient of variation (CV), average real variability (ARV) and variation independent of mean (VIM) were calculated with validated formulae for the 24-h and the daytime and nighttime periods. Results Dapagliflozin reduced 24-h brachial BP compared to placebo. From baseline to study-end 24-h brachial BPV indexes did not change with dapagliflozin (SBP-ARV: 11.51±3.45 vs 11.05±3.35; p=0.326, SBP-wSD: 13.59±3.60 vs 13.48±3.33; p=0.811) or placebo (SBP-ARV: 11.47±3.63 vs 11.05±3.00; p=0.388, SBP-wSD: 13.85±4.38 vs 13.97±3.87; p=0.308). Similarly, no significant changes in BPV indexes for daytime and nighttime were observed in any group. At study-end, no differences between the groups were observed for any BPV index. Deltas (Δ) of all indexes during follow-up were minimal and not different between-groups (SBP-wSD: dapagliflozin: -0.11±3.05 vs placebo: 0.12±4.20; p=0.227). Conclusion This study is the first to evaluate the effects of an SGLT-2 inhibitor on short-term BPV in patients with T2DM, showing no effect on dapagliflozin on all BPV indexes studied.

Is it safe to compress venous leg ulcers without an ankle brachial pressure index?

Is it safe to compress venous leg ulcers without an ankle brachial pressure index?

Ultrasound therapy for treatment of lower extremity intermittent claudication

BackgroundWhile often thought of as a diagnostic tool, ultrasound (US) can also potentially be used as a therapeutic modality. US applies mechanical stress on endothelial cells and induces nitric oxide synthase, which regulates the secretion of nitric oxide, a potent vasodilator. In animal ischemic models, US has been shown to improve hindlimb, myocardial, and cerebral perfusion. We performed a pilot trial of US therapy in the lower extremities of human subjects with intermittent claudication. Methods10 subjects (5 male, 5 female, mean age 69.7 ± 10.3) with intermittent claudication were recruited. Both legs were placed in a specially designed boot with a water interface between US transducers and the legs. Subjects underwent pulsed US therapy at 250 kHz frequency for 30 min for three treatments a week for six weeks. Pre and post treatment ankle:brachial index (ABI), 6-min walk (6 MW), Walking Impairment Questionnaire (WIQ), and Short Form 36 (SF36) were performed. Pre and post-treatment results were compared with paired t-test. ResultsSix minute walking distance at baseline was 352 ± 70 m, after one treatment session 353 ± 70 m (p = 0.99), and at completion 372 ± 71 m (p = 0.015). There was a trend toward improved ABI after 6 weeks of treatment (0.53 ± 0.17 vs 0.64 ± 0.12, p = 0.083). After six weeks, significant improvements were noted in overall WIQ score (2.00 ± 1.48 vs 2.63 ± 1.38, p = 0.0001), WIQ (distance) 2.07 ± 1.54 vs 2.73 ± 1.42 (p = 0.036), and WIQ (stair) 2.00 ± 1.67 vs 2.62 ± 1.24, p = 0.034, with a trend in WIQ (speed), 1.89 ± 1.26 vs 2.46 ± 1.43, p = 0.069. In the SF-36, significant improvements were noted in the domains of physical functioning (44.0 ± 41.6 vs 50.5 ± 41.1, p = 0.009) and role limitations – physical (35.0 ± 48.3 vs 60.0 ± 49.6, p = 0.006) after six weeks. ConclusionsTherapeutic US is a potential noninvasive treatment for intermittent claudication. Pilot study patients noted significant improvements in 6 MW and WIQ results after 6 weeks of treatment. A nonsignificant improvement in ABI was noted. Further research will be needed to clarify optimal treatment frequency and duration.

Transcutaneous oxygen tension and ankle brachial pressure index as predictors of outcome in diabetic foot

Transcutaneous oxygen tension and ankle brachial pressure index as predictors of outcome in diabetic foot

Incremental value of carotid elasticity modulus using shear wave elastography for identifying coronary artery disease in patients without carotid plaque.

Shear wave elastography (SWE) directly quantifies the local arterial wall stiffness by calculating the elastic modulus. However, whether carotid wall elastic modulus can predict obstructive coronary artery disease (CAD) is not well known. We aimed to investigate the value of carotid wall elastic modulus measured using SWE in identifying obstructive CAD. We prospectively enrolled 61 patients without carotid plaque referred for clinically indicated coronary angiography. Twenty-seven (44.3%) patients were diagnosed with obstructive CAD (≥50% coronary stenosis). The elastic modulus of common carotid artery was quantified using SWE. Ankle--brachial index (ABI) and echocardiographic global cardiac calcium score (GCCS) were measured. Patients with obstructive CAD had significantly higher elastic modulus than those without obstructive CAD. The maximum elastic modulus (EMmax) was independently associated with obstructive CAD after adjusting for the Framingham risk score, ABI, and GCCS. EMmax had the highest area under the curve (AUC) to identify obstructive CAD (AUC 0.70; P = 0.003). In the nested models, the model based on the Framingham risk score and ABI (χ2 = 3.74) improved by adding GCCS (χ2 = 9.95) and further improved by adding EMmax (χ2 = 15.86). Adding EMmax to the combined ABI and GCCS model increased integrated discrimination index from 0.10 to 0.19. Carotid wall elastic modulus measured using SWE is a useful predictor of obstructive CAD in patients without carotid plaque. We demonstrated the incremental and independent value of carotid wall elastic modulus in identifying obstructive CAD compared with clinical risk factors and other imaging predictors, including ABI and GCCS. Please see the video, in Supplemental Digital Content 1, http://links.lww.com/HJH/B551 for more insights from the authors.