open access

Vol 27, No 2 (2020)
Original articles — Clinical cardiology
Published online: 2018-03-26
Get Citation

The relationship between pulse waveform analysis indices, endothelial function and clinical outcomes in patients with peripheral artery disease treated using percutaneous transluminal angioplasty during a one-year follow-up period

Paweł Kaczmarczyk, Paweł Maga, Rafał Niżankowski, Rafał Januszek, Marzena Frołow, Mikołaj Maga, Jolanta Kościelniak, Andrzej Belowski
DOI: 10.5603/CJ.a2018.0026
·
Pubmed: 29611173
·
Cardiol J 2020;27(2):142-151.

open access

Vol 27, No 2 (2020)
Original articles — Clinical cardiology
Published online: 2018-03-26

Abstract

Background: Several predictors of clinical outcomes after percutaneous transluminal angioplasty (PTA) interventions in patients with peripheral arterial disease (PAD) have been investigated. Indices of endothelial function, arterial pulse waveform analysis (aPWA) and markers of peripheral artery ischemia were among the most commonly examined. The aim of the current study was to assess the relationship between potential predictors of clinical outcomes after peripheral artery PTA during a 1-year follow-up period.

Methods: The study included 72 individuals with PAD at a mean age of 66.3 ± 7.2 (79.1% males). All patients underwent PTA of the peripheral arteries. Among them, 42.8% presented critical limb ischemia (CLI). During the first visit and at 1 month and 6 months after PTA, endothelial function and aPWA measurements were taken. Ankle-brachial index (ABI), toe-brachial index (TBI) and physical evalu­ation of the limbs took place during the first visit and at 1, 6 and 12 months after the PTA. The study endpoints included myocardial infarction, amputation, death, stroke and reintervention. All subjects included in the study were observed for 386 days after the PTA.

Results: A significant improvement was noted in walking distance after PTA at the following time points, as well as transient improvement of ABI and flow-mediated dilatation (FMD) and no significant change in aPWA indices and reactive-hyperaemia index (RHI). The mean ABI, TBI, FMD and RHI values did not correlate with each other at baseline. There were 25 study endpoints which occurred in 16 patients during the follow-up period (22.2%). Patients with CLI, hypercholesterolemia, lower dias­tolic blood pressure, higher subendocardial viability ratio, a greater number of pack-years and lower TBI at baseline presented significantly poorer clinical outcomes in terms of endpoint events.

Conclusions: Endothelial function assessed as FMD and reactive hyperemia–peripheral arterial tonometry (RH-PAT) before PTA in patients with advanced PAD do not predict clinical outcomes during the 1-year follow-up.

Abstract

Background: Several predictors of clinical outcomes after percutaneous transluminal angioplasty (PTA) interventions in patients with peripheral arterial disease (PAD) have been investigated. Indices of endothelial function, arterial pulse waveform analysis (aPWA) and markers of peripheral artery ischemia were among the most commonly examined. The aim of the current study was to assess the relationship between potential predictors of clinical outcomes after peripheral artery PTA during a 1-year follow-up period.

Methods: The study included 72 individuals with PAD at a mean age of 66.3 ± 7.2 (79.1% males). All patients underwent PTA of the peripheral arteries. Among them, 42.8% presented critical limb ischemia (CLI). During the first visit and at 1 month and 6 months after PTA, endothelial function and aPWA measurements were taken. Ankle-brachial index (ABI), toe-brachial index (TBI) and physical evalu­ation of the limbs took place during the first visit and at 1, 6 and 12 months after the PTA. The study endpoints included myocardial infarction, amputation, death, stroke and reintervention. All subjects included in the study were observed for 386 days after the PTA.

Results: A significant improvement was noted in walking distance after PTA at the following time points, as well as transient improvement of ABI and flow-mediated dilatation (FMD) and no significant change in aPWA indices and reactive-hyperaemia index (RHI). The mean ABI, TBI, FMD and RHI values did not correlate with each other at baseline. There were 25 study endpoints which occurred in 16 patients during the follow-up period (22.2%). Patients with CLI, hypercholesterolemia, lower dias­tolic blood pressure, higher subendocardial viability ratio, a greater number of pack-years and lower TBI at baseline presented significantly poorer clinical outcomes in terms of endpoint events.

Conclusions: Endothelial function assessed as FMD and reactive hyperemia–peripheral arterial tonometry (RH-PAT) before PTA in patients with advanced PAD do not predict clinical outcomes during the 1-year follow-up.

Get Citation

Keywords

endothelial function, percutaneous transluminal angioplasty, arterial pulse waveform analysis, clinical outcomes

About this article
Title

The relationship between pulse waveform analysis indices, endothelial function and clinical outcomes in patients with peripheral artery disease treated using percutaneous transluminal angioplasty during a one-year follow-up period

Journal

Cardiology Journal

Issue

Vol 27, No 2 (2020)

Pages

142-151

Published online

2018-03-26

DOI

10.5603/CJ.a2018.0026

Pubmed

29611173

Bibliographic record

Cardiol J 2020;27(2):142-151.

Keywords

endothelial function
percutaneous transluminal angioplasty
arterial pulse waveform analysis
clinical outcomes

Authors

Paweł Kaczmarczyk
Paweł Maga
Rafał Niżankowski
Rafał Januszek
Marzena Frołow
Mikołaj Maga
Jolanta Kościelniak
Andrzej Belowski

References (35)
  1. Zagura M, Serg M, Kampus P, et al. Association of osteoprotegerin with aortic stiffness in patients with symptomatic peripheral artery disease and in healthy subjects. Am J Hypertens. 2010; 23(6): 586–591.
  2. Kals J, Zagura M, Serg M, et al. β2-microglobulin, a novel biomarker of peripheral arterial disease, independently predicts aortic stiffness in these patients. Scand J Clin Lab Invest. 2011; 71(4): 257–263.
  3. Brewer LC, Chai HS, Bailey KR, et al. Measures of arterial stiffness and wave reflection are associated with walking distance in patients with peripheral arterial disease. Atherosclerosis. 2007; 191(2): 384–390.
  4. Amoh-Tonto CA, Malik AR, Kondragunta V, et al. Brachial-ankle pulse wave velocity is associated with walking distance in patients referred for peripheral arterial disease evaluation. Atherosclerosis. 2009; 206(1): 173–178.
  5. Zagura M, Serg M, Kampus P, et al. Aortic stiffness and vitamin D are independent markers of aortic calcification in patients with peripheral arterial disease and in healthy subjects. Eur J Vasc Endovasc Surg. 2011; 42(689e95).
  6. Kals J, Kampus P, Kals M, et al. Impact of oxidative stress on arterial elasticity in patients with atherosclerosis. Am J Hypertens. 2006; 19(9): 902–908.
  7. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010; 55(13): 1318–1327.
  8. Catalano M, Scandale G, Carzaniga G, et al. Aortic augmentation index in patients with peripheral arterial disease. J Clin Hypertens (Greenwich). 2014; 16(11): 782–787.
  9. Wilkins JT, McDermott MM, Liu K, et al. Associations of noninvasive measures of arterial compliance and ankle-brachial index: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Hypertens. 2012; 25(5): 535–541.
  10. Khaleghi M, Kullo IJ. Aortic augmentation index is associated with the ankle-brachial index: a community-based study. Atherosclerosis. 2007; 195(2): 248–253.
  11. Corretti MC, Anderson TJ, Benjamin EJ, et al. International Brachial Artery Reactivity Task Force. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol. 2002; 39(2): 257–265.
  12. Weber T, Auer J, O'Rourke MF, et al. Arterial stiffness, wave reflections, and the risk of coronary artery disease. Circulation. 2004; 109(2): 184–189.
  13. Celermajer DS, Sorensen KE, Gooch VM, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992; 340(8828): 1111–1115.
  14. Kuvin JT, Patel AR, Sliney KA, et al. Assessment of peripheral vascular endothelial function with finger arterial pulse wave amplitude. Am Heart J. 2003; 146(1): 168–174.
  15. Hamburg NM, Palmisano J, Larson MG, et al. Relation of brachial and digital measures of vascular function in the community: the Framingham heart study. Hypertension. 2011; 57(3): 390–396.
  16. Inaba Y, Chen JA, Bergmann SR. Prediction of future cardiovascular outcomes by flow-mediated vasodilatation of brachial artery: a meta-analysis. Int J Cardiovasc Imaging. 2010; 26(6): 631–640.
  17. Ras RT, Streppel MT, Draijer R, et al. Flow-mediated dilation and cardiovascular risk prediction: a systematic review with meta-analysis. Int J Cardiol. 2013; 168(1): 344–351.
  18. Xu Y, Arora RC, Hiebert BM, et al. Non-invasive endothelial function testing and the risk of adverse outcomes: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging. 2014; 15(7): 736–746.
  19. Matsuzawa Y, Kwon TG, Lennon RJ, et al. Prognostic Value of Flow-Mediated Vasodilation in Brachial Artery and Fingertip Artery for Cardiovascular Events: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2015; 4(11).
  20. Prince C, Secrest A, Mackey R, et al. Pulse wave analysis and prevalent cardiovascular disease in type 1 diabetes. Atherosclerosis. 2010; 213(2): 469–474.
  21. Tsiachris D, Tsioufis C, Syrseloudis D, et al. Subendocardial viability ratio as an index of impaired coronary flow reserve in hypertensives without significant coronary artery stenoses. J Hum Hypertens. 2012; 26(1): 64–70.
  22. Sarnoff SJ, Braunwald E, Welch GH, et al. Hemodynamic determinants of oxygen consumption of the heart with special reference to the tension-time index. Am J Physiol. 1958; 192(1): 148–156.
  23. Buckberg GD, Towers B, Paglia DE, et al. Subendocardial ischemia after cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1972; 64(5): 669–684.
  24. Prince CT, Secrest AM, Mackey RH, et al. Augmentation pressure and subendocardial viability ratio are associated with microalbuminuria and with poor renal function in type 1 diabetes. Diab Vasc Dis Res. 2010; 7(3): 216–224.
  25. Theilade S, Hansen T, Rossing P. Central Hemodynamics Are Associated With Cardiovascular Disease and Albuminuria in Type 1 Diabetes. Am J Hypertens. 2014; 27(9): 1152–1159.
  26. Secrest AM, Marshall SL, Miller RG, et al. Pulse wave analysis and cardiac autonomic neuropathy in type 1 diabetes: a report from the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Technol Ther. 2011; 13(12): 1264–1268.
  27. Prince CT, Secrest AM, Mackey RH, et al. Cardiovascular autonomic neuropathy, HDL cholesterol, and smoking correlate with arterial stiffness markers determined 18 years later in type 1 diabetes. Diabetes Care. 2010; 33(3): 652–657.
  28. Turzyniecka M, Wild SH, Krentz AJ, et al. Diastolic function is strongly and independently associated with cardiorespiratory fitness in central obesity. J Appl Physiol (1985). 2010; 108(6): 1568–1574.
  29. Di Pino A, Alagona C, Piro S, et al. Separate impact of metabolic syndrome and altered glucose tolerance on early markers of vascular injuries. Atherosclerosis. 2012; 223(2): 458–462.
  30. Sandoo A, Protogerou AD, Hodson J, et al. The role of inflammation, the autonomic nervous system and classical cardiovascular disease risk factors on subendocardial viability ratio in patients with RA: a cross-sectional and longitudinal study. Arthritis Res Ther. 2012; 14(6): R258.
  31. Di Micco L, Salvi P, Bellasi A, et al. Subendocardial viability ratio predicts cardiovascular mortality in chronic kidney disease patients. Blood Purif. 2013; 36(1): 26–28.
  32. Foley TR, Armstrong EJ, Waldo SW. Contemporary evaluation and management of lower extremity peripheral artery disease. Heart. 2016; 102(18): 1436–1441.
  33. Shishehbor MH, White CJ, Gray BH, et al. Critical Limb Ischemia: An Expert Statement. J Am Coll Cardiol. 2016; 68(18): 2002–2015.
  34. Egorova NN, Guillerme S, Gelijns A, et al. An analysis of the outcomes of a decade of experience with lower extremity revascularization including limb salvage, lengths of stay, and safety. J Vasc Surg. 2010; 51(4): 878–85, 885.e1.
  35. Celermajer DS. Reliable endothelial function testing: at our fingertips? Circulation. 2008; 117(19): 2428–2430.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl