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

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

doi:10.1590/1677-5449.007318

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Brasil

Jornal Vascular Brasileiro

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Brasil

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Sumário

ORIGINAL ARTICLE • J. Vasc. Bras. 18 • 2019 • https://doi.org/10.1590/1677-5449.007318 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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

Variable	Whole sample (n = 142)	Control (n=70)	CLI (n=72)	p-value
Age	73.4±10.2	71.5±10.2	74.1±9.7	0.11 ^M M Mann-Whitney;
Male sex	82 (57.7%)	41 (58.6%)	41 (56.9%)	1.00 ^Q Q chi-square; and
Weight	76.8±13.6	78.6±17.2	75.3±12.6	0.09 ^T T Student’s t test for independent samples;
Height	1.69±0.18	1.71±0.10	1.66±0.11	0.01 ^M M Mann-Whitney;
Smokers	12 (8.4%)	5 (7.1%)	7 (9.7%)	0.59 ^F F Fischer’s exact test.
Hypertension	102 (71.8%)	49 (70.0%)	53 (73.6%)	0.63^Q
Diabetes	89 (67.4%)	41 (62.1%)	48 (72.7%)	0.32^Q
Dyslipidemia	68 (51.9%)	29 (43.9%)	39 (60%)	0.13^Q
Coronary disease	24 (18.2%)	6 (9.1%)	18 (27.3%)	< 0.01^Q
Stroke	7 (5.3%)	2 (3.0%)	5 (7.6%)	0.29^F
Antihypertensives	103 (78%)	51 (77.3%)	52 (78.8%)	0.93^Q
Antidiabetics	81 (61.4%)	33 (50%)	48 (72.7%)	0.02^Q
Insulin	43 (32.6%)	9 (13.6%)	34 (51.5%)	< 0.01^Q
Statins	83 (62.9%)	39 (59.1%)	44 (66.7%)	0.52^Q
Antiplatelets	66 (50%)	17 (25.8%)	49 (74.2%)	< 0.01^Q
Anticoagulants	13 (9.8%)	9 (13.6%)	4 (6.1%)	0.14^F

Variable	All (n = 142)	Control (n = 70)	CLI (n = 72)	p-value
Peripheral arterial pressure
SBPp (mmHg)	139.6±20.1	122.2±11.7	146.8±21.7	< 0.01 ^M M Mann-Whitney;
DBPp (mmHg)	81.5±10.9	77.1±8.9	84.5±11.9	0.02 ^T T Student’s t test for independent samples;
MAP (mmHg)	103.5±13.2	97.5±10.6	112.2±15.3	< 0.01^M
HR (bpm/min)	72.9±11.8	72.7±11.4	72.1±13.2	0.97^M
Central arterial pressure
SBPc (mmHg)	121.7±15.8	115.2±13.1	129.2±18.4	< 0.01^M
DBPc (mmHg)	83.2±10.2	78.2±8.1	86.1±11.2	< 0.01^T
PPc (mmHg)	42.2±11.4	38.4±7.2	46.6±14.3	< 0.01^M
Hemodynamics
Systolic volume (ml)	72.0±10.8	73.2±15.1	72.1±18.1	0.67^M
Cardiac output (l/min)	5.3±0.4	5.2±0.6	5.2±1.3	0.84^M
TVR (s*mmHg/ml)	1.8±0.4	1.8±0.3	2.1±0.3	< 0.01^M
Cardiac index (l/min*1/m²)	2.9±0.6	2.9±0.4	2.9±0.5	0.91^M
Arterial stiffness
AIx@75 (%)	25.2±11.2	17.5±10.8	31.8±7.8	< 0.01^T
PWV (m/s)	11.0±1.2	10.1±1.9	12.1±1.9	< 0.01^T
ABI	0.79±0.8	1.03±0.1	0.54±0.2	< 0.01^M

Variable	Univariate regression analysis				Multiple linear regression analysis
	CONTROL		CLI		CONTROL		CLI
	β (SE)	p-value	β (SE)	p-value	β (SE)	p-value	β (SE)	p-value
Male sex	-7.99 (2.11)	0.01	-6.02 (2.18)	0.01	-9.22 (1.85)	< 0.01	-	-
Age	-0.03 (0.12)	0.77	0.28 (0.12)	0.03	0.43 (0.12)	< 0.01	-	-
Diabetes	-3.32 (2.55)	0.21	7.94 (2.23)	< 0.01	-	-	8.86 (1.58)	< 0.01
Insulin use	-9.97 (3.52)	0.07	2.03 (2.57)	0.57	-6.45 (3.19)	< 0.01	-	-
ABI	-16.19 (12.54)	0.20	- 19.29 (9.48)	0.04	-	-	-25.02 (9.75)	< 0.01

Variable	Univariate regression analysis				Multiple linear regression analysis
	CONTROL		CLI		CONTROL		CLI
	β (SE)	p-value	β (SE)	p-value	β (SE)	p-value	β (SE)	p-value
Age	0.12 (0.02)	< 0.01	0.13 (0.01)	< 0.01	0.16 (0.01)	< 0.01	0.17 (0.01)	< 0.01
SBPp	0.02 (0.01)	< 0.01	0.03 (0.01)	< 0.01	0.03 (0.01)	< 0.01	0.03 (0.01)	< 0.01

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[1] Conflicts of interest: No conflicts of interest declared concerning the publication of this article.