Tempo de aceleração plantar está relacionado a rigidez arterial em pacientes com isquemia crônica ameaçadora ao membro
Pedal acceleration time is related to arterial stiffness in patients with chronic limb-threatening ischemia
Daniel Mendes-Pinto; Larissa Jardim Melo; Guilherme Galvone Fonseca Costa; Izabella Campolina Santos; Ana Paula Pires Silva; Roberto Lucas Senna de Avelar; Guilherme de Castro-Santos; Maria da Glória Rodrigues-Machado
Resumo
Palavras-chave
Abstract
Background: Pedal acceleration time (PAT) is a novel indicator of peripheral arterial disease in the lower limbs. Elevated PAT values are associated with worse limb ischemia. Arterial stiffness indexes are another class of indicators recently studied in patients with chronic limb-threatening ischemia (CLTI). The correlation between PAT and arterial stiffness has not yet been established
Objectives: To analyze correlations between PAT and arterial stiffness indexes in patients with CLTI.
Methods: A cross-sectional analysis was conducted of patients with CLTI from August to December of 2022. The PAT measurements were performed using a vascular ultrasound machine and stiffness indexes were measured using a brachial artery oscillometry unit. An analysis was conducted of the correlations between central blood pressure, peripheral blood pressure, arterial stiffness, and PAT
Results: A total of 55 patients were analyzed, of whom 23 were women and 83.6% had diabetes. Mean PAT was 166.6 ms; mean pulse wave velocity (PWV) was 11.8 m/s, and the mean augmentation index corrected for a heart rate of 75 beats per minute (AIx@75) was 29.8%. There were positive correlations between PAT and PWV (Spearman r = 0.69; p < 0.001) and between PAT and AIx@75 (Spearman r = 0.59, p < 0.001) and an inverse relationship with the ankle/brachial index (Spearman r = -0.79; p < 0.001).
Conclusions: There is a correlation between arterial stiffness indexes and PAT in patients with CLTI. These indicators are important for quantification of limb ischemia.
Keywords
References
1 Fowkes FGR, Aboyans V, Fowkes FJI, McDermott MM, Sampson UKA, Criqui MH. Peripheral artery disease: epidemiology and global perspectives. Nat Rev Cardiol. 2017;14(3):156-70.
2 Darling JD, McCallum JC, Soden PA, et al. Predictive ability of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system after first-time lower extremity revascularizations. J Vasc Surg. 2017;65(3):695-704.
3 Mendes-Pinto D, Rodrigues-Machado MG, Navarro TP, Dardik A. Association between critical limb ischemia, the Society for Vascular Surgery Wound, Ischemia and Foot Infection (WIfI) Classification System and Arterial Stiffness. Ann Vasc Surg. 2020;63:250-258.e2.
4 Barani J, Nilsson JÅ, Mattiasson I, Lindblad B, Gottsäter A. Inflammatory mediators are associated with 1-year mortality in critical limb ischemia. J Vasc Surg. 2005;42(1):75-80.
5 Hajibandeh S, Hajibandeh S, Shah S, Child E, Antoniou GA, Torella F. Prognostic significance of ankle brachial pressure index: a systematic review and meta-analysis. Vascular. 2017;25(2):208-24.
6 Misra S, Shishehbor MH, Takahashi EA, et al. Perfusion assessment in critical limb ischemia: principles for understanding and the development of evidence and evaluation of devices: a scientific statement from the American Heart Association. Circulation. 2019;140(12):e657-72.
7 Sommerset J, Teso D, Feliciano B, et al. Innovative arterial duplex examination: a guide to evaluate flow in the foot using pedal acceleration time. J Vasc Ultrasound. 2019;43(1):11-7.
8 Castro-Santos G, Gonçalves PEO, Procópio RJ, Dardik A, Navarro TP. Accuracy of the pedal acceleration time to diagnose limb ischemia in patients with and without diabetes using the WIfI classification. Vasc Med. 2023;28(1):36-44.
9 Trihan JE, Mahé G, Croquette M, et al. Accuracy of acceleration time of distal arteries to diagnose severe peripheral arterial disease. Front Cardiovasc Med. 2022;8:744354.
10 Mendes-Pinto D, Rodrigues-Machado MG. Applications of arterial stiffness markers in peripheral arterial disease. J Vasc Bras. 2019;18:e20180093.
11 Lortz J, Halfmann L, Burghardt A, et al. Rapid and automated risk stratification by determination of the aortic stiffness in healthy subjects and subjects with cardiovascular disease. PLoS One. 2019;14(5):e0216538.
12 Milan A, Zocaro G, Leone D, et al. Current assessment of pulse wave velocity: comprehensive review of validation studies. J Hypertens. 2019;37(8):1547-57.
13 Mendes-Pinto D, Rodrigues-Machado MG, Avelar GL, Navarro TP, Dardik A. Arterial stiffness predicts amputation and death in patients with chronic limb-threatening ischemia. J Vasc Surg. 2021;74(6):2014-2022.e4.
14 Vlachopoulos C, Xaplanteris P, Aboyans V, et al. The role of vascular biomarkers for primary and secondary prevention: a position paper from the European Society of Cardiology Working Group on peripheral circulation: Endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society. Atherosclerosis. 2015;241(2):507-32.
15 Bujang MA, Baharum N. Sample size guideline for correlation analysis. World J Soc Sci Res. 2016;3(1):37.
16 Enhancing the Quality and Transparency of Health Research. STROBE statement: checklist of items that should be included in reports of observational studies [Internet]. Oxford: University of Oxford; 2023 [citado 2023 mar 20].
17 Khashram M, Sommerset J, August B, Abbott G, Hart O, Teso D. Successful virtual pedal acceleration time (PAT) training in the COVID-19 pandemic era. Ann Vasc Surg. 2022;2(3):100106.
18 Moneta GL. Tibial artery velocities in the diagnosis and follow-up of peripheral arterial disease. Semin Vasc Surg. 2020;33(3-4):65-8.
19 Teso D, Sommerset J, Dally M, Feliciano B, Vea Y, Jones RK. Pedal Acceleration Time (PAT): a novel predictor of limb salvage. Ann Vasc Surg. 2021;75:189-93.
20 Yagyu T, Funabashi S, Yoneda S, Noguchi T, Yasuda S. Novel evaluation method for lower extremity peripheral artery disease with duplex ultrasound: usefulness of acceleration time. Circ J. 2020;84(11):1990-8.
21 Wilson DG, Harris SK, Barton C, et al. Tibial artery duplex ultrasound-derived peak systolic velocities may be an objective performance measure after above-knee endovascular therapy for arterial stenosis. J Vasc Surg. 2018;68(2):481-6.
22 Stewart BT, Gyedu A, Giannou C, et al. Consensus recommendations for essential vascular care in low- and middle-income countries. J Vasc Surg. 2016;64(6):1770-1779.e1.
23 Ben-Shlomo Y, Spears M, Boustred C, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol. 2014;63(7):636-46.
24 Townsend RR, Wilkinson IB, Schiffrin EL, et al. Recommendations for improving and standardizing vascular research on arterial stiffness: a scientific statement from the American Heart Association. Hypertension. 2015;66(3):698-722.
25 Baumann M, Wassertheurer S, Suttmann Y, Burkhardt K, Heemann U. Aortic pulse wave velocity predicts mortality in chronic kidney disease stages 2-4. J Hypertens. 2014;32(4):899-903.
26 Kinjo Y, Ishida A, Kinjo K, Ohya Y. A high normal ankle-brachial index combined with a high pulse wave velocity is associated with cerebral microbleeds. J Hypertens. 2016;34(8):1586-93.
27 Zettervall SL, Buck DB, Darling JD, Lee V, Schermerhorn ML, Guzman RJ. Increased preoperative pulse pressure predicts procedural complications and mortality in patients who undergo tibial interventions for critical limb ischemia. J Vasc Surg. 2016;63(3):673-7.
28 Husmann M, Jacomella V, Thalhammer C, Amann-Vesti BR. Markers of arterial stiffness in peripheral arterial disease. Vasa. 2015;44(5):341-8.
29 Rossi-Monteiro EM, Sefair LR, Lima MC, et al. Pediatric obstructive sleep-disordered breathing is associated with arterial stiffness. Eur J Pediatr. 2022;181(2):725-34.
30 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):1318-27.
Submitted date:
03/20/2023
Accepted date:
08/01/2023
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email