Greg J Zahner1, Kimberly A Spaulding2, Joel L Ramirez1, Melinda S Schaller1, Shane C Walker1, Nancy K Hills3, Warren J Gasper2, S Marlene Grenon4. 1. Department of Surgery, University of California, San Francisco, San Francisco, California. 2. Department of Surgery, University of California, San Francisco, San Francisco, California; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, California. 3. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California. 4. Department of Surgery, University of California, San Francisco, San Francisco, California; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, California. Electronic address: marlene.grenon@ucsf.edu.
Abstract
BACKGROUND: Arterial stiffness, measured by the augmentation index (AIX) from radial artery tonometry, and endothelial dysfunction, measured by brachial-artery flow-mediated vasodilation (FMD), have each been associated with increased risk of cardiovascular events. However, their interrelationship in peripheral artery disease (PAD) patients is poorly understood. MATERIALS AND METHODS: In a cross-sectional analysis of 123 vascular surgery outpatients, the association between FMD and AIX was examined in controls with atherosclerotic risk factors (n = 32) and patients with PAD (n = 91). PAD was defined as claudication symptoms with an ankle-brachial index of <0.9 or a history of revascularization for symptomatic PAD. Controls had an ankle-brachial index ≥0.9 and no history of atherosclerotic vascular disease. RESULTS: Compared to controls, patients with PAD had lower FMD (6.3 ± 3.8 versus 8.4 ± 3.7, P = 0.008), while central AIX normalized to 75 beats per minute (25.5 ± 9.0 versus 19.3 ± 8.6, P = 0.001) and peripheral AIX (91.3 ± 14.5 versus 81.3 ± 11.4, P = 0.001) were higher. FMD was not significantly correlated with either central or peripheral AIX (central AIX: P = 0.58; peripheral AIX: P = 0.89) across the entire cohort, or in either the patients with PAD (central AIX: P = 0.48; peripheral AIX: P = 0.23) or controls (central AIX: P = 0.43; peripheral AIX: P = 0.92). In a multivariate model including FMD, higher AIX remained independently associated with PAD. CONCLUSIONS: In an analysis of vascular surgery outpatients, no correlation between FMD and AIX was detected. Larger prospective studies are needed to determine whether the inclusion of both parameters improves predictive models for the early identification and potential risk stratification of PAD patients. Published by Elsevier Inc.
BACKGROUND: Arterial stiffness, measured by the augmentation index (AIX) from radial artery tonometry, and endothelial dysfunction, measured by brachial-artery flow-mediated vasodilation (FMD), have each been associated with increased risk of cardiovascular events. However, their interrelationship in peripheral artery disease (PAD) patients is poorly understood. MATERIALS AND METHODS: In a cross-sectional analysis of 123 vascular surgery outpatients, the association between FMD and AIX was examined in controls with atherosclerotic risk factors (n = 32) and patients with PAD (n = 91). PAD was defined as claudication symptoms with an ankle-brachial index of <0.9 or a history of revascularization for symptomatic PAD. Controls had an ankle-brachial index ≥0.9 and no history of atherosclerotic vascular disease. RESULTS: Compared to controls, patients with PAD had lower FMD (6.3 ± 3.8 versus 8.4 ± 3.7, P = 0.008), while central AIX normalized to 75 beats per minute (25.5 ± 9.0 versus 19.3 ± 8.6, P = 0.001) and peripheral AIX (91.3 ± 14.5 versus 81.3 ± 11.4, P = 0.001) were higher. FMD was not significantly correlated with either central or peripheral AIX (central AIX: P = 0.58; peripheral AIX: P = 0.89) across the entire cohort, or in either the patients with PAD (central AIX: P = 0.48; peripheral AIX: P = 0.23) or controls (central AIX: P = 0.43; peripheral AIX: P = 0.92). In a multivariate model including FMD, higher AIX remained independently associated with PAD. CONCLUSIONS: In an analysis of vascular surgery outpatients, no correlation between FMD and AIX was detected. Larger prospective studies are needed to determine whether the inclusion of both parameters improves predictive models for the early identification and potential risk stratification of PAD patients. Published by Elsevier Inc.
Authors: Dick H J Thijssen; Mark A Black; Kyra E Pyke; Jaume Padilla; Greg Atkinson; Ryan A Harris; Beth Parker; Michael E Widlansky; Michael E Tschakovsky; Daniel J Green Journal: Am J Physiol Heart Circ Physiol Date: 2010-10-15 Impact factor: 4.733
Authors: Naomi M Hamburg; Joseph Palmisano; Martin G Larson; Lisa M Sullivan; Birgitta T Lehman; Ramachandran S Vasan; Daniel Levy; Gary F Mitchell; Joseph A Vita; Emelia J Benjamin Journal: Hypertension Date: 2011-01-24 Impact factor: 10.190
Authors: Alexander Massmann; Jennifer Stemler; Peter Fries; Reinhard Kubale; Lutz Erwin Kraushaar; Arno Buecker Journal: Clin Res Cardiol Date: 2017-02-06 Impact factor: 5.460
Authors: Matthew A Fuglestad; Hernan Hernandez; Yue Gao; Henamari Ybay; Molly N Schieber; Katyarina E Brunette; Sara A Myers; George P Casale; Iraklis I Pipinos Journal: J Vasc Surg Date: 2019-08-21 Impact factor: 4.268
Authors: Joel L Ramirez; Sukaynah A Khetani; Greg J Zahner; Kimberly A Spaulding; Melinda S Schaller; Warren J Gasper; Nancy K Hills; Anne L Schafer; S Marlene Grenon Journal: J Vasc Surg Date: 2018-10-03 Impact factor: 4.268