Key result
Patients with PAD exhibit impaired vascular reactivity and ~69% longer oxygen saturation washout versus older controls.
Why the study?
An integrated CMR method to assess vascular reactivity in patients with peripheral artery disease and healthy controls was needed to quantify multiple aspects of vascular function.
Does an integrated CMR method detect impaired vascular reactivity in patients with peripheral artery disease compared to healthy controls?
Cross-Sectional (n=100)
No
Does an integrated CMR method detect impaired vascular reactivity in patients with peripheral artery disease compared to healthy controls?
An integrated CMR protocol successfully quantifies multiple aspects of impaired vascular reactivity and aortic stiffness in patients with peripheral artery disease compared to healthy controls.
Answers are grounded in this paper and cite their sources.
CMR protocol quantifies impaired vascular reactivity in PAD; hypothesis-generating for clinical tool development pending prospective validation.
BACKGROUND: The aim of this study was to develop and evaluate an integrated CMR method incorporating dynamic oximetry, blood flow and pulse-wave velocimetry to assess vascular reactivity in patients with peripheral artery disease (PAD) and healthy controls. METHODS AND RESULTS: The study population consisted of young healthy subjects (YH, 30 ± 7 yrs, N = 19),PAD (71 ± 9 yrs, N = 38), and older healthy controls (OHC, 68 ± 9 yrs, N = 43). Peripheral vascular reactivity was evaluated with two methods, time-resolved quantification of blood flow velocity and oxygenation level in the femoral artery and vein, respectively, performed simultaneously both at rest and hyperemia. Aortic stiffness was assessed via pulse-wave velocity. Oximetric data showed that compared to OHC, the time-course of the hemoglobin oxygen saturation in PAD patients had longer washout time (28.6 ± 1.2 vs 16.9 ± 1.1 s, p < 0.0001), reduced upslope (0.60 ± 0.1 vs 1.3 ± 0.08 HbO2/sec, p < 0.0001) and lower overshoot (8 ± 1.4 vs 14 ± 1.2 HbO2, p = 0.0064). PAD patients also had longer-lasting antegrade femoral artery flow during hyperemia (51 ± 2.1 vs 24 ± 1.8 s, p < 0.0001), and reduced peak-to-baseline flow rate (3.1 ± 0.5 vs 7.4 ± 0.4, p < 0.0001). Further, the pulsatility at rest was reduced (0.75 ± 0.32 vs 5.2 ± 0.3, p < 0.0001), and aortic PWV was elevated (10.2 ± 0.4 vs 8.1 ± 0.4 m/s, p = 0.0048). CONCLUSION: The proposed CMR protocol quantifies multiple aspects of vascular reactivity and represents an initial step toward development of a potential tool for evaluating interventions, extrapolating clinical outcomes and predicting functional endpoints based on quantitative parameters.
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Langham et al. (2013) conducted a cross-sectional in Peripheral artery disease (n=100). Peripheral artery disease vs. Older healthy controls was evaluated on Hemoglobin oxygen saturation washout time (p=<0.0001). Patients with peripheral artery disease exhibited significantly impaired vascular reactivity compared to older healthy controls, demonstrated by a prolonged hemoglobin oxygen saturation washout time (28.6 vs 16.9 s).
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