Jornal Vascular Brasileiro
https://app.periodikos.com.br/journal/jvb/article/doi/10.1590/1677-5449.007318
Jornal Vascular Brasileiro
Original Article

Association between critical limb ischemia and arterial stiffness measured by brachial artery oscillometry

Associação entre isquemia crítica do membro e rigidez arterial medida por oscilometria da artéria braquial

Daniel Mendes-Pinto; José Márcio Ribeiro; Maria da Glória Rodrigues-Machado

http://dx.doi.org/10.1590/1677-5449.007318 J Vasc Bras, vol.18, e20180073, 2019
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Abstract

Abstract: Background: Elevated arterial stiffness is associated with increased cardiovascular mortality. The relationship between arterial stiffness and critical limb ischemia (CLI) is not well established.

Objectives: The objective of this study is to analyze the relationship between arterial stiffness indices and the degree of limb ischemia measured by the ankle-brachial index (ABI).

Methods: A cross-sectional study comparing patients with CLI and controls. Arterial stiffness was measured using brachial artery oscillometry. The arterial stiffness indices pulse wave velocity (PWV) and augmentation index normalized to 75 beats/min (AIx@75) were determined. Multiple linear regression was applied to identify predictors of arterial stiffness indices.

Results: Patients in the CLI group had higher PWV (12.1±1.9 m/s vs. 10.1±1.9 m/s, p < 0.01) and AIx@75 (31.8±7.8% vs. 17.5±10.8%, p < 0.01) than controls. Central systolic pressure was higher in the CLI group (129.2±18.4 mmHg vs. 115.2±13.1 mmHg, p < 0.01). There was an inverse relationship between AIx@75 and ABI (Pearson coefficient = 0.24, p = 0.048), but there was no relationship between ABI and PWV (Pearson coefficient = 0.19, p = 0.12). In multiple regression analysis, reduced ABI was a predictor of elevated levels of AIx@75 (β = -25.02, p < 0.01).

Conclusions: Patients with CLI have high arterial stiffness measured by brachial artery oscillometry. The degree of limb ischemia, as measured by the ABI, is a predictor of increased AIx@75. The increased AIx@75 observed in CLI may have implications for the prognosis of this group of patients with advanced atherosclerosis.

Keywords

arterial stiffness, peripheral arterial disease, pulse wave analysis, ankle brachial index

Resumo

Resumo: Contexto: A rigidez arterial aumentada está associada ao aumento da mortalidade cardiovascular. A relação entre rigidez arterial e isquemia crítica do membro (IC) não está bem estabelecida.

Objetivos: O objetivo deste estudo é analisar a relação entre índices de rigidez arterial e o grau de isquemia de membro medido pelo índice tornozelo-braço (ITB).

Métodos: Foi feito um estudo transversal em pacientes com IC e controles. A rigidez arterial foi medida usando a oscilometria da artéria braquial. Os índices de rigidez arterial mensurados foram a velocidade de onda de pulso (VOP) e o índice de aumentação corrigido para a frequência cardíaca de 75 batimentos/min (AIx@75). Regressão linear múltipla foi aplicada para identificar preditores dos índices de rigidez arterial.

Resultados: Pacientes do grupo IC tiveram VOP (12,1±1,9 m/s vs. 10,1±1,9 m/s, p < 0,01) e AIx@75 (31,8±7,8% vs. 17,5±10,8%, p < 0,01) maiores que controles. Pressão sistólica central foi maior no grupo IC (129,2±18,4 mmHg vs. 115,2±13,1 mmHg, p < 0,01). Houve uma relação inversa entre o AIx@75 e o ITB (coeficiente de Pearson = 0,19, p = 0,12). A análise de regressão múltipla mostrou que o ITB reduzido foi um preditor de elevação do AIx@75 (β = -25,02, p < 0,01).

Conclusões: Pacientes com IC têm elevada rigidez arterial medida por oscilometria da artéria braquial. O grau de isquemia do membro, medido pelo ITB, é um preditor do AIx@75 elevado. O aumento do AIx@75 na IC pode ter implicações de prognóstico no grupo de pacientes com aterosclerose avançada.
 

Palavras-chave

rigidez arterial, doença arterial periférica, análise da onda de pulso, índice tornozelo-braço

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