Marker Of Peripheral Arterial Disease Research Articles

P221 ANKLE BRACHIAL INDEX AND ASSOCIATION WITH CHRONIC KIDNEY DISEASE IN THE H3 AFRICA KIDNEY DISEASE RESEARCH NETWORK

Background and Objective: Abnormal ankle brachial index (ABI) is common in patients with chronic kidney disease (CKD). We evaluated the association of ABI, a non-invasive tool to evaluate peripheral arterial disease and arterial stiffness, with CKD among West Africans enrolled in the H3Africa Kidney Disease Research Network (H3AKDRN). Methods: We recruited 9206 participants (5356 with CKD), from Ghana and Nigeria in the H3AKDRN, a multinational case-control study. CKD was defined as estimated glomerular filtration rate of <60 ml/min/1.73m2 and/or albuminuria as albumin/creatinine ratio >3.0 mg/mmol (>30 mg/g) for ≥3months. ABI was divided into low (≤0.9), normal (0.91 – 1.3), and high (>1.3). We assessed low ABI, a marker of peripheral artery disease, and high ABI, the marker of arterial stiffness. We determined association of ABI with CKD by multivariate logistic regression. Results: The mean age of participants was 45.8±15.36 years and 56.3% were males. The prevalence of low ABI was higher in CKD group (32%% versus 16% (control), p=0.013). The prevalence of high ABI was also higher in CKD (15% versus 10.9% (control), p = 0.01). Patients with CKD and low ABI have reduced BMI, low haemoglobin, higher systolic BP and increased albuminuria. Male gender, history of hypertension and diabetes were independently associated with CKD. Higher BMI was associated with reduced odds of CKD (p = < 0.03). After adjustment for covariates, low ABI was associated with CKD, with 26% increased odd (aOR 1.26 (CI, 1.01 – 1.56; p = 0.037)), but high ABI was not associated with CKD (aOR 1.45 (0.88 – 2.38, p = 0.147)). Conclusion: The prevalence of abnormal ankle brachial index is high among adult populations of Ghana and Nigeria, with and without CKD. The Marker of peripheral arterial disease, but not marker of arterial stiffness was associated with CKD. A longitudinal study is required to determine the true relationship between ABI and CKD in West Africa.

The Promoter Polymorphism rs3918226 of the Endothelial Nitric Oxide Synthase Gene as a Novel Susceptibility Marker for Peripheral Artery Disease

This pilot study aimed to investigate the association between the single nucleotide polymorphism (SNP) rs3918226 in the promoter of the nitric oxide synthase (NOS3) gene and the risk of peripheral artery disease (PAD). DNA samples from 1,263 unrelated subjects of Slavic origin, including 620 patients with PAD and 643 controls, were genotyped for the SNP rs3918226 using the MassArray-4 system. The rs3918226 polymorphism was found to be strongly associated with an increased risk of PAD regardless of coronary artery disease, hypertension, or cigarette smoking (odds ratio [OR]=2.86; 95% confidence interval [CI] 1.89-4.32; Pperm < 0.0001). The SNP-PAD association was almost 3 times stronger in females (OR=8.31; 95% CI 3.07-22.48) than in males (OR=1.79; 95% CI 1.10-2.93). SNP rs3918226 was correlated with ankle-brachial index and total plasma cholesterol in patients with PAD (Рperm < 0.05). The NOS3 polymorphism was closely associated with SNPs rs7692387 and rs13139571 in guanylate cyclase soluble subunit alpha-3 (GUCY1A3) to determine the risk of PAD, suggesting that the rs3918226 polymorphism may disrupt signaling in the NO-soluble guanylyl cyclase pathway. Diplotypes with wild-type alleles, such as NOS3 rs3918226-C/C×GUCY1A1 rs7692387G/G and NOS3 rs3918226-C/C×GUCY1A1 rs13139571C/C, showed strong protection against disease risk (false discovery rate ≤ 0.001). Functional SNP annotation revealed that the allele rs3918226-T was associated with decreased expression of NOS3, most strongly in the tibial arteries than in the coronary artery or aorta. The present study is the first to show that the rs3918226 polymorphism of NOS3 is a novel susceptibility marker for PAD. Further research in independent populations is necessary to reproduce the association between polymorphism rs3918226 and disease risk.

Ankle Brachial Index: An Easy and First-Choice Screening Marker of Peripheral Artery Disease and Physical Function.

Ankle Brachial Index: An Easy and First-Choice Screening Marker of Peripheral Artery Disease and Physical Function.

Study to Evaluate Serum Homocysteine Levels as Marker of Peripheral Arterial Disease in a Tertiary Care Hospital in India

Background: The study is aimed to evaluate the association between raised serum Homocysteine levels and severity of Peripheral Vascular Disease (PVD) and its role as a prognostic marker in PVD. Thereby, Vitamin K therapy can be instituted for lowering Homocysteine levels as prophylaxis against cerebral and coronary events in PVD patients. Methods: The serum homocysteine levels was measured in all patients admitted for peripheral vascular disease of upper and/or lower limb and to correlate the abovevalues with Doppler ultrasonography (USG) in the duration between 2020-2022(18 months) Results: The comparison of homocysteine levels with Doppler shows corresponding significant increase in Serum homocysteine levels only in cases of moderate PVD. Statistical analysis with binary logistic regression does show a significant association with moderate severity of PVD and serum homocysteine levels with 80% predictability. Conclusions: There was significant association of homocysteinemia only in Moderate PVD with no statistically significant correlation with mild, severe cases of peripheral arterial disease (PAD) and radiological normal cases, further large randomized trials are required to elucidate its clinical relevance in PAD as a prognostic marker of Severity.

Abstract 311: Fatty Acid Synthase Targeting Reduces Aortic Atherosclerosis And Inflammation

Fatty acid synthase (FAS) catalyzes the elongation of saturated fatty acids. FAS is elevated in liver and adipose tissue in the setting of diabetes, and serum circulating FAS (cFAS) is a marker of peripheral arterial disease. The natural antibiotic Platensimycin (PTM) competitively inhibits FAS. However, the impact of chemical FAS inhibition on atherosclerosis is unknown. We hypothesized that PTM and a liver-specific knockdown of FAS would reduce the burden of aortic atherosclerosis. ApoE-/- mice were placed on a 42% high-fat diet (HFD) with or without PTM (100mpk) for 16 weeks. Similarly, ApoE-/- mice with or without liver-specific knockdown of FAS ( ApoE-/- FasL-/- vs ApoE-/- FasL+/+ ) were placed on a 42% HFD for 16 weeks (Fig. A). Tissue FAS, cFAS, and serum triglycerides (TG) content were measured. FAS/cFAS activity was evaluated with a modified measurement of malonyl-CoA consumption of NADPH, and normalized to content. At 16 weeks, mouse aortas were harvested and stained with oil-red O and CD68 to assess the burden of atherosclerosis and inflammation. Comparisons between murine groups were analyzed using Mann-Whitney and Student t-tests. ApoE-/- mice treated with PTM, significantly reduced tissue FAS and serum cFAS activity (p&lt;0.05), and significantly reduced serum TG (p&lt;0.01). ApoE-/- FasL-/- mice demonstrated increased adipose FAS content and activity (p&lt;0.05), reduced cFAS activity (p&lt;0.05), and increased serum TG (p&lt;0.05). Targeting FAS/cFAS with PTM or in FasL-/- led to decrease in overall total aortic plaque, particularly in the low-resistance thoracic aorta (B; p&lt;0.05).Targeting FAS/cFAS also demonstrated reduced aortic root plaque, and macrophage content(C; p&lt;0.05).This study reveals that selective targeting of FAS/cFAS either with PTM of via liver knockdown, appear to significantly alter serum lipid profiles, aortic atherosclerosis, and plaque inflammation. Thus, FAS/cFAS may be an important therapeutic target to inhibit atheroprogression.

Myoglobinemia, Peripheral Arterial Disease, and Patient Mortality.

Peripheral arterial disease (PAD) causes leg muscle damage due to inadequate perfusion and increases cardiovascular events and mortality 2- to 3-fold. It is unclear if PAD is a biomarker for high-risk cardiovascular disease or if skeletal muscle injury harms arterial health. The objective of this work is to test if serum myoglobin levels (myoglobinemia) are a marker of PAD, and if so, whether myoglobin impairs vascular health. Patient blood samples were collected from PAD and control (no PAD) patients and interrogated for myoglobin concentrations and nitric oxide bioavailability. Patient mortality over time was captured from the medical record. Myoglobin activity was tested on endothelial cells and arterial function. Myoglobin is a biomarker for symptomatic PAD and was inversely related to nitric oxide bioavailability; 200 ng/mL myoglobin in vitro increased endothelial cell permeability in vitro and decreased nitrate bioavailability. Ex vivo, 100 ng/mL myoglobin increased vascular tone in naive murine aortas approximately 1.5 times, impairing absolute vessel relaxation. In vivo, we demonstrated that myoglobinemia caused impaired flow-mediated dilation in a porcine model. Patients presenting with myoglobin levels of 100 ng/mL or greater had significantly more deaths than those with myoglobin levels of less than 100 ng/mL. Using a combination of patient data, in vitro, ex vivo, and in vivo testing, we found that myoglobin is a biomarker for symptomatic PAD and a potent regulator of arterial health that can increase vascular tone, increase vascular permeability, and cause endothelial dysfunction, all of which may contribute to the vulnerability of PAD patients to cardiovascular events and death.

Serum osteoprotegerin level in relation to ankle-brachial index among type 2 diabetic patients with subclinical hypothyroidism

Background Osteoprotegerin (OPG) acts as an important regulatory molecule in vascular disease. The presence of diabetes mellitus greatly increases the risk of peripheral artery disease (PAD), and also both subclinical and overt hypothyroidism have been clearly linked with dyslipidemia, which is a known risk factor for peripheral arterial disease. Aim We aimed to evaluate the relation between serum OPG and PAD among type 2 diabetic patients with subclinical hypothyroidism (SCH). Patients and methods A total of 60 participants were enrolled in the study who were divided into three groups: group 1 included 20 type 2 diabetic patients with normal thyroid function, group 2 included 20 type 2 diabetic patients with SCH, and group 3 included 20 healthy participants. They were subjected to complete history taking, complete clinical examination, routine laboratory investigations, serum OPG level, neck ultrasound, and Doppler study for ankle-brachial index (ABI). Results We found that OPG levels were statistically elevated in type 2 diabetic patients with SCH group compared with type 2 diabetic patients with euthyroidism (P=0.040). Also there was lower ABI in type 2 diabetic patients with SCH compared with those with euthyroidism, showing an increased incidence of PAD in group 2 than group 1 and nondiabetic patients, with statistically significant results in between groups. Conclusions Our results found that diabetic patients with SCH revealed an independent association between thyroid-stimulating hormone and serum level of OPG. Likewise, we found a statistically significant difference between OPG level and ABI among type 2 diabetic patients. Therefore, OPG can act as a marker of PAD among diabetic patients with SCH.

Serum Adipocyte Fatty-Acid Binding Protein as an Independent Marker of Peripheral Artery Disease in Patients with Type-2 Diabetes Mellitus.

The adipocyte fatty-acid binding protein (A-FABP) is predominantly expressed in macrophages and adipocytes and is an essential mediator of inflammation and atherosclerosis pathogenesis. Atherosclerosis is an aggravating factor for peripheral arterial disease (PAD). Our study intended to study the association between PAD and serum A-FABP levels in type-2 diabetes mellitus (T2DM) patients. One hundred and twenty T2DM subjects were enrolled in the study. Fasting blood samples were collected to determine biochemical data and A-FABP levels. By the automatic oscillometric method, the ankle–brachial index (ABI) was measured. Low ABI was defined as any value < 0.9. Twenty participants with T2DM (16.7%) were included in the low ABI group. Low ABI T2DM participants had an increased mean body mass index, body fat mass, systolic blood pressure, C-reactive protein, urine albumin–creatinine ratio, and A-FABP levels compared to those in the normal ABI group. After variables significantly associated with PAD were adjusted by multivariate logistic regression analyses, circulating A-FABP levels (odds ratio [OR]: 1.138; 95 percent confidence interval [CI]: 1.023–1.266; p = 0.017) were identified as the independent marker of PAD. In conclusion, fasting serum A-FABP value has positive association with PAD in T2DM patients.

Decrease serum anti-oxLDL antibody is an independent marker of peripheral arterial disease in peritoneal dialysis patients

Background and Aims : Autoantibodies to oxidized low-density lipoprotein (oxLDL) has an inverse associated with carotid artery atherosclerosis and predict development of future cardiovascular disease. Peripheral arterial disease (PAD), defined by low ankle-brachial index (ABI), is associated with increased mortality in patients with chronic renal failure. The present study aimed to determine the relationship between serum anti-oxLDL antibody level and PAD in peritoneal dialysis (PD) patients.Methods: The present cross-sectional, single-center study included 90 PD patients. Serum IgG anti-oxLDL antibody levels were measured using a commercial enzyme immunoassay. ABI values were measured using an automated oscillometric device. Patients with ABIs of <0.9 were categorized into the low ABI group.Results: In the study, 23 of the 90 patients (25.6%) had low ABIs. The rates of diabetes mellitus (P = 0.010) as well as the older age (P = 0.006), serum levels of triglyceride (P = 0.008), fasting glucose (P < 0.001), and C-reactive protein (P < 0.001) were higher, while serum levels of anti-oxLDL antibody (P = 0.008) were lower in the low ABI group compared with the normal ABI group. The multivariable logistic regression analysis revealed that serum levels of anti-oxLDL antibody (odds ratio [OR]: 0.978, 95% confidence interval [CI]: 0.958–1.000, P = 0.046) and C-reactive protein (each 0.1 mg/dL increase, OR: 1.662, 95% CI: 1.151–2.398, P = 0.007) were independently associated with PAD in PD patients.Conclusions: Serum anti-oxLDL antibody level is negatively associated and C-reactive protein is positively associated with PAD in PD patients. Background and Aims : Autoantibodies to oxidized low-density lipoprotein (oxLDL) has an inverse associated with carotid artery atherosclerosis and predict development of future cardiovascular disease. Peripheral arterial disease (PAD), defined by low ankle-brachial index (ABI), is associated with increased mortality in patients with chronic renal failure. The present study aimed to determine the relationship between serum anti-oxLDL antibody level and PAD in peritoneal dialysis (PD) patients. Methods: The present cross-sectional, single-center study included 90 PD patients. Serum IgG anti-oxLDL antibody levels were measured using a commercial enzyme immunoassay. ABI values were measured using an automated oscillometric device. Patients with ABIs of <0.9 were categorized into the low ABI group. Results: In the study, 23 of the 90 patients (25.6%) had low ABIs. The rates of diabetes mellitus (P = 0.010) as well as the older age (P = 0.006), serum levels of triglyceride (P = 0.008), fasting glucose (P < 0.001), and C-reactive protein (P < 0.001) were higher, while serum levels of anti-oxLDL antibody (P = 0.008) were lower in the low ABI group compared with the normal ABI group. The multivariable logistic regression analysis revealed that serum levels of anti-oxLDL antibody (odds ratio [OR]: 0.978, 95% confidence interval [CI]: 0.958–1.000, P = 0.046) and C-reactive protein (each 0.1 mg/dL increase, OR: 1.662, 95% CI: 1.151–2.398, P = 0.007) were independently associated with PAD in PD patients. Conclusions: Serum anti-oxLDL antibody level is negatively associated and C-reactive protein is positively associated with PAD in PD patients.

Correlation between the markers of peripheral arterial disease, albuminuria, dyslipidemia with the change in HbA1c in patients with T2DM

Correlation between the markers of peripheral arterial disease, albuminuria, dyslipidemia with the change in HbA1c in patients with T2DM

MO723: Ankle-Brachial Index is Associated with Subendocardial Viability Ratio in Chronic Hemodialysis Patients

Abstract BACKGROUND AND AIMS Ankle-brachial index (ABI) is a marker of peripheral arterial disease and is associated with increased cardiovascular morbidity and mortality. Structural alterations in the arterial walls lead to functional central haemodynamic changes, potentially impacting pulse wave reflection and, consequently, myocardial perfusion. The aim of this study was to determine the association between ABI and subendocardial viability ratio (SEVR) as a non-invasive measure of coronary perfusion in chronic haemodialysis patients. METHOD We measured ABI using an automated non-invasive waveform analysis device (MESI®, Slovenia) and SEVR using applanation tonometry (Sphygmocor, Atcor Medical, Sydney, Australia). All the measurements were performed on a non-dialysis day and SEVR on the non-arteriovenous fistula (non-AVF) hand. ABI was calculated as the ratio between systolic blood pressure on the non-AVF hand and systolic blood pressure on the calves of both legs. Mean ABI of both sides was used in the statistical analysis. RESULTS A total of 29 patients (mean age 63.6 ± 10.5 years, 69.0% male) were included. In Table 1, descriptive parameters are presented. Of those, 4 patients (13.8%) have an ABI &amp;lt;0.9 and the other 25 patients (86.2%) have a normal ABI between 0.9 and 1.3. Using the independent-samples T-test, patients with a lower ABI have a statistically significant lower SEVR compared with patients with normal ABI (109 versus 142%; P = 0.039). CONCLUSION Low ABI is independently associated with decreased subendocardial perfusion in chronic haemodialysis patients, suggesting that both methods of ABI and SEVR measurement may reflect an atherosclerotic process in peripheral and coronary arteries.

Triglyceride Glucose Index Was Associated With the Risk of Peripheral Artery Disease.

This study aims to investigate the relationship between the triglyceride glucose (TyG) index and peripheral artery disease (PAD). A total of 3125 participants with completed TyG and ankle brachial pressure index (ABPI) records were enrolled from the National Health and Nutrition Examination Survey (NHANES) cycle of 1999-2004. The TyG index was calculated as ln [triglycerides (mg/dL) × glucose (mg/dL)/2], and the presence of PAD was defined as ABPI ≤.9. The participants were 59.9 ± 12.9years old and 51.5% (1608) were male. The prevalence of PAD was 7.2% (225). Compared with the reference lowest quartile of TyG index, the highest quartile was associated with 1.27-fold increased (odds ratio [OR] 2.27, 95% confidence interval [CI] 1.53-3.41; P < .001) risk of PAD. After adjusting for sociodemographic, lifestyles, and cardiometabolic factors, the multivariate-adjusted OR and 95% CI were 1.74 (1.02-3.01; P = .044) in participants within the highest quartile. Subgroup analysis showed that the association between TyG index and the risk of PAD was still consistent across subgroups. In conclusion, higher TyG index was significantly associated with the higher risk of PAD, which could be a marker of PAD.

Functional and transcriptomic analysis of extracellular vesicles identifies calprotectin as a new prognostic marker in peripheral arterial disease (PAD)

ABSTRACT Peripheral arterial disease (PAD) is associated with a high risk of cardiovascular events and death and is postulated to be a critical socioeconomic cost in the future. Extracellular vesicles (EVs) have emerged as potential candidates for new biomarker discovery related to their protein and nucleic acid cargo. In search of new prognostic and therapeutic targets in PAD, we determined the prothrombotic activity, the cellular origin and the transcriptomic profile of circulating EVs. This prospective study included control and PAD patients. Coagulation time (Procoag-PPL kit), EVs cellular origin and phosphatidylserine exposure were determined by flow cytometry in platelet-free plasma (n = 45 PAD). Transcriptomic profiles of medium/large EVs were generated using the MARS-Seq RNA-Seq protocol (n = 12/group). The serum concentration of the differentially expressed gene S100A9, in serum calprotectin (S100A8/A9), was validated by ELISA in control (n = 100) and PAD patients (n = 317). S100A9 was also determined in EVs and tissues of human atherosclerotic plaques (n = 3). Circulating EVs of PAD patients were mainly of platelet origin, predominantly Annexin V positive and were associated with the procoagulant activity of platelet-free plasma. Transcriptomic analysis of EVs identified 15 differentially expressed genes. Among them, serum calprotectin was elevated in PAD patients (p < 0.05) and associated with increased amputation risk before and after covariate adjustment (mean follow-up 3.6 years, p < 0.01). The combination of calprotectin with hs-CRP in the multivariate analysis further improved risk stratification (p < 0.01). Furthermore, S100A9 was also expressed in femoral plaque derived EVs and tissues. In summary, we found that PAD patients release EVs, mainly of platelet origin, highly positive for AnnexinV and rich in transcripts related to platelet biology and immune responses. Amputation risk prediction improved with calprotectin and was significantly higher when combined with hs-CRP. Our results suggest that EVs can be a promising component of liquid biopsy to identify the molecular signature of PAD patients.

Intima-media Thickness of Superficial Femoral Artery Measured with Dupplex-scan as a Marker for Peripheral Arterial Disease.

Intima-media Thickness of Superficial Femoral Artery Measured with Dupplex-scan as a Marker for Peripheral Arterial Disease.

Assessment of Age-related Oxygenation Changes in Calf Skeletal Muscle by Photoacoustic Imaging: A Potential Tool for Peripheral Arterial Disease.

Peripheral artery disease is often asymptomatic, and various imaging and nonimaging techniques have been used for assessment and monitoring treatments. This study is designed to demonstrate the ability of photoacoustic imaging to noninvasively determine changes in tissue oxygenation that occur in mice's hind limb skeletal muscle as they age. Mice from two age cohorts were scanned bilaterally with a pulsed laser. The photoacoustic signal was unmixed to generate a parametric map of estimated oxygen saturation and then overlaid on grayscale ultrasound images. Tissue oxygenation measured in young and old mice was compared. Photoacoustic imaging visually and quantitatively showed the decrease in skeletal muscle oxygenation that occurs with age. Percent tissue oxygenation decreased from 30.2% to 3.5% (p < 0.05). This reduction corresponded to reduced fractional area of oxygenation, which decreased from 60.6% to 6.0% (p < 0.05). The change in oxygenation capacity of the still active vascular regions was insignificant (p > 0.05). Intrasubject, intra-, and interobserver comparisons showed low variability in measurements, exhibited by high regression and intraclass correlations exceeding 0.81 for all ages. The decrease in oxygenation detected by photoacoustic imaging paralleled the known oxygenation decrease observed in aging tissues, demonstrating that photoacoustic imaging can assess age-related changes in a mouse calf muscle. These intramuscular changes could potentially act as a strong diagnostic marker for peripheral artery disease. This study thus opens the doors for a novel, affordable, noninvasive method of evaluation free of radiation or exogenous material.

The ankle-brachial index value in patients with purulent-necrotic complications of diabetic foot syndrome

Diabetes and predetermined him heavy purulent-necrotic complications is actual problem medicine today’s. It is proved that patients with diabetes have big risk to development of heart-vessel disease due to the development of atherosclerosis. Standard of diagnosis peripheral arterial disease of lower limb is finding ankle-brachia index (ABI). This method is good at definition of degree of arterial occlusion.&#x0D; Purpose of the study. Purpose of the work: to analyse the diagnostic capability of ABI in patients who have purulent-necrotic complications of diabetic foot.&#x0D; Material and methods. The prospective studies covered 218 patients. The average patients age 54,2 ± 10,3years, 45,5% of them – men. The mild form of disease was in 33,2%, moderate severity – in 45,2%, severe – in 21,6%. The duration of purulent-necrotic complications was 11,5 ± 1,2 days.&#x0D; Results. We have seen that 128 patients have different degrees of macroangiopathy. in patients who performed amputation at the level of the thigh of ABI was 0,41 ± 0,13; at the level of the leg – 0,59 ± 0,12.&#x0D; Conclusion. 1. Timely diagnosis is the basis of effective treatment of purulent necrotic complications of diabetic foot. 2. In treatment, it is necessary to take into account the indicators of ABI as the main diagnostic marker of peripheral artery disease of lower limb. 3. Definition of ABI is an objective and valuable predictive marker.

Lower Limb Pulse Rise Time as a Marker of Peripheral Arterial Disease.

The aim of the study was to show if pulse rise times (PRTs) extracted from photoplethysmographic (PPG) pulse waves (PWs) have an association with peripheral arterial disease (PAD) or its endovascular treatment, percutanoeus transluminal angioplasty (PTA) of the superficial femoral artery. Lower and upper limb PPG PWs were recorded and analyzed from 24 patients who suffered from PAD. The measurements were conducted before and after the treatment, and one month later by using transmission-mode PPG-probes placed in the index finger and second toe. Ankle-to-brachial pressure index and toe pressures were used as references in clinical patient measurements. PRTs, i.e., the time from the foot point to the peak point of the PW, were extracted from the PWs and compared bilaterally. The results from the PAD patients were also compared with 31 same-aged and 34 younger control subjects. Statistically significant differences were found between the pretreatment PRTs of the treated limb of the PAD patients and the same-aged control subjects ( , Mann-Whitney U-test). The changes in the PRT of the treated lower limb were observed immediately after the PTA ( , Student's t-test), and after one month ( ), whereas the PRTs of the non-treated lower limb and upper limb did not indicate changes between different examinations. Results show that a PRT greater than 240 ms indicates PAD-lesions in the lower limb. This proof-of-concept study suggests that the PRT could be an effective and easy-to-use indicator for PAD and monitoring the effectiveness of its treatment.

Lack of Correlation of Carotid Intima-Media Index and Peripheral Artery Disease

Increased carotid intima-media thickness (IMT) measurement is usually seen as a surrogate marker of peripheral artery disease (PAD) but there is scarce cumulated evidence to support this view. To evaluateprevalence of increased IMT among patients with symptomatic PAD as well as the frequency of some cardiovascular risk factors in these patients. They were recruited 230 patients with diagnosis of medium peripheral artery disease in the Vascular Surgery Service outpatient's office. Serum cystatin C, homocysteine, and lipoprotein (a) were measured. GFR was estimated using the CKD-EPI equation and the Larsson one from cystatin C. The global prevalence of increased IMT was 16.5% (n = 38, 95% CI 12.3-21.9). In all the frequency of hyperlipoproteinemia (a) was 34.2% (95% CI 28.4-40.5%). The global prevalence of hyperhomocysteinemia was 61.5% (95% CI 54.6-68.1%) and the proportion of patients with high cystatin C levels was 38.5% (95% CI 32.1-42.5). The prevalence of stage III chronic kidney disease or higher by CKD-EPI formula was much lesser (13.6%, 95% CI 9.7-18.7) as was the frequency obtained by the Larsson equation (28.7%, 95% CI 23.2-34.9). No differences were found between groups. Increased IMT is not common among PAD patients. Hyperlipoproteinemia (a) and hyperhomocysteinemia are very frequent in these patients. High serum cystatin levels are also very prevalent but reduced GFR is not so frequent. There were no differences in the prevalence of the studied cardiovascular risk factors between those patients with increased IMT and those ones with normal IMT.

Femoral Intima-media Thickness, Risk Factors, and Markers of Inflammation in Cardiovascular Disease

Abstract Introduction: The burden of coronary artery disease (CAD) and peripheral vascular pathologies caused by atherosclerosis is constantly increasing. There is continuous research aiming to develop new methods that can evaluate the extent of atherosclerotic disease in different vascular beds, thus estimating global risk. Similar to carotid artery thickness, which is an established marker for increased cardiovascular risk and cerebrovascular disease, femoral intima-media thickness (f-IMT) may have the same role in case of peripheral arterial involvement. The aim of the study was determine whether f-IMT, determined at the level of the superficial femoral artery, is related to traditional risk factors, markers of peripheral vascular atherosclerosis and inflammation. Material and methods: Forty-six patients with known cardiovascular disease were included in the study. Demographical data, cardiovascular history, and risk factors were assessed. We determined metabolic parameters (uric acid, fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides), renal function (creatinine and GFR), and inflammation status for all patients. Each patient underwent ultrasound examination of the superficial femoral artery, by which f-IMT was determined for right and left limbs. Ankle-brachial index was also calculated. Data from the low (f-IMT &lt;0.75 mm) and high (f-IMT &gt;0.75 mm) f-IMT groups were compared and correlation coefficients were determined in each groups for f-IMT in relation to the other parameters. Results: Mean age was 71.08 ± 9.78 years. 86.95% of the patients suffered from hyper-tension, 56.62% had coronary heart disease, and 21.73% had a history of stroke. More females had history of hypertension and CAD. The most prevalent cardiovascular risk factors were dyslipidemia (68.86%), diabetes (21.73%), and smoking (21.73%). There were significant differences between gender groups for total cholesterol levels (161.36 ± 25.04 mg/dL, 95%CI 150.26–172.47 in males vs. 201.33 ± 52.73 mg/dL, 95%CI 170.07–223.60 in females, p = 0.02), creatinine values (1.04 ± 0.22 mg/dL, 95%CI 0.94–1.14 for males vs. 0.91 ± 0.23 mg/dL, 95%CI 0.81–1.00 for females, p = 0.018), and left f-IMT (0.87 ± 0.18 mm, 95%CI 0.79–0.95 for males vs. 0.75 ± 0.10 mm, 95%CI 0.70–0.79 for females, p = 0.0049). In the group with low f-IMT, a significant, reverse correlation was established between f-IMT, uric acid (r = −0.483, p = 0.042), and right ABI (r = −730, p = 0.0006). In the group with high f-IMT, age (r = 0.408, p = 0.031), fasting glucose (r = 0.407, p = 0.034), total cholesterol (r = 0.429, p = 0.02), HDL-cholesterol (r = −0.56, p = 0.0019), triglycerides (r = 0.45, p = 0.01), hs-CRP (r = 0.45, p = 0.01), and left ABI (r = −0.71, p &lt;0.0001) showed a significant correlation to f-IMT. Conclusions: Increased femoral intima-media thickness is related to age, cardiovascular risk factors, and markers of peripheral arterial disease. Patients with higher f-IMT have a more augmented inflammatory status. Based on these correlations, in patients with cardiovascular disease, f-IMT could become a marker for increased cardiovascular risk.

Oxidative Stress Marker and Fibrinogen Level as Indicators of Severity of Diabetic Foot Ulcer

AbstractDiabetic foot ulcer (DFU) is the leading cause of lower extremity amputation and is very common in clinical practice. Oxidative stress is important in the pathogenesis of chronic wound and the lipid per oxidation product malondialdehyde (MDA) is toxic molecule which is also associated with pathogenesis of chronic complications of diabetes mellitus. Fibrinogen is a recognized marker in peripheral arterial disease (PAD) and increasing level predict an increased risk of amputation. The aim of this study was to investigate whether the plasma MDA and fibrinogen are associated with severity of DFU. In this study, the plasma MDA and fibrinogen levels were determined in 23 normal subjects, 25 diabetes without ulcer patients, 24 mild DFU patients and 25 severe DFU patients. The results showed that mean plasma MDA levels of normal subjects, diabetes without foot ulcer patients, mild DFU patients and severe DFU patients were 0.98± 0.12 μmol/L, 1.3±0.21 μmol/L, 1.61±0.22 μmol/L and 2.3±0.35 μmol/L respectively. Mean plasma fibrinogen levels of normal subjects, diabetes without foot ulcer patients, mild DFU patients and severe DFU patients were 307± 61.5 mg/dl, 429±63.8 mg/dl, 513.6±77.8 mg/dl and 643.5±71.3 mg/dl respectively. We found out that mean plasma MDA level of severe DFU patients was significantly higher than that of other groups (p&lt;0.001). Similarly, mean plasma fibrinogen level of severe DFU patients was significantly higher than that of normal subjects, diabetic without ulcer patients and mild DFU patients (p&lt;0.001). Therefore, we concluded that the higher level of plasma MDA and fibrinogen are significantly associated with severity of DFU.