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Prediction of Walking Performance After Revascularization of Arteries Supplying the Lower Extremities of Claudicating Patients With Peripheral Artery Disease

2020; Elsevier BV; Volume: 72; Issue: 3 Linguagem: Inglês

10.1016/j.jvs.2020.06.065

1097-6809

Shuai Li, Jonathan R. Thompson, Sara A. Myers, Julian Kim, Mark A. Williams, Gleb Haynatzki, Molly Schieber, Gregory Willcockson, Iraklis I. Pipinos, George P. Casale,

Cerebrovascular and Carotid Artery Diseases

Peripheral artery disease (PAD) affects >200 million patients globally. Revascularization is a mainline treatment of PAD; however, change in walking performance and quality of life (QoL) vary substantially among patients, ranging from no to marked improvement. We evaluated biochemical and histopathologic measurements of calf muscle and leg hemodynamics, before revascularization, as potential predictors of change in walking performance and QoL in response to revascularization. We measured, at baseline and 6 months after revascularization, ankle-brachial index, systolic pedal pressure at 15 seconds after postocclusive reactive hyperemia (SPP15sec), 6-minute walking distance (SMWD), initial claudication time, peak walking time, and QoL survey scores of 40 claudicating PAD patients. In addition, we determined the following: activities of mitochondrial citrate synthase, complexes 1 to 4, and manganese superoxide dismutase; myofiber morphology and oxidative damage (carbonyl adducts); and fibrosis in calf muscle. Prediction of walking performance and QoL was evaluated by Spearman rho and receiver operating characteristic curve. Baseline SPP15sec and change in SMWD were most strongly correlated (Rs = −0.72 at P < .0001; Fig 1). A receiver operating characteristic curve identified patients whose SMWD improved >20 m at a baseline SPP15sec cutoff of 50 mm Hg, with sensitivity of 89% and specificity of 100% (Fig 2). In addition, we detected significant improvements (P < .05) of hemodynamics (ankle-brachial index, SPP15sec), walking performance (SMWD, initial claudication time, and peak walking time), QoL survey scores, and calf muscle disease (citrate synthase, complexes 1 and 2, and manganese superoxide dismutase activities; myofiber shape; and carbonyl adducts). Our study shows that revascularization improves hemodynamics, walking performance, QoL, and calf muscle disease in claudicating PAD patients. Baseline SPP15sec (cutoff = 50 mm Hg) strongly predicts which patients will experience >20 m improvement of SMWD.Fig 2Receiver operating characteristic (ROC) curve analysis of baseline systolic pedal pressure at 15 seconds after postocclusive reactive hyperemia (SPP15sec) prediction on 6-minute walking distance (SMWD) improvement. At the cutoff value of 50 mm Hg, peripheral artery disease (PAD) patients’ baseline SPP15sec predicted whether their SMWD improved 20 m or not after revascularization, with a sencitivity of 89% and specificity of 100%.View Large Image Figure ViewerDownload Hi-res image Download (PPT)