Exercise transcutaneous oximetry significantly modifies the diagnostic hypotheses and impacts scheduled investigations or treatments of patients with exertional limb pain

Henni, Samir; Lamotte, C.; Laurent, Remi; Rivière, A. Bura; Aubourg, Marion; Sarlon, Gabrielle; Lanéelle, Damien; Long, Anne; Signolet, Isabelle; Picquet, Jean; Feuilloy, Mathieu; Ábrahám, Pierre

doi:10.1016/j.ejim.2018.01.008

Cited by 7 publications

(4 citation statements)

References 25 publications

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“…The DROP min value is proportional to the severity of arterial lesions (Abraham et al, 2005). The exercise‐TcpO2 technique was shown accurate on a multicenter analysis, to influence the diagnosis and scheduled investigations or treatments (Henni et al, 2018). It was shown that the average walking speed of patients with PAD was slower than controls (Gardner, Forrester, & Smith, 2001), and declines with the evolution and severity of PAD (Herman et al, 2009; McDermott et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

“…Aetiological diagnosis of claudication of the lower limb is important. We have used transcutaneous oxygen pressure (TcpO2) at exercise in the last 20 years, to argue for the vascular origin of exercise‐related pain during treadmill tests (Abraham et al, 2018; Gernigon et al, 2013; Henni et al, 2018; Jaquinandi et al, 2007; Signolet et al, 2016). As a routine, we use a constant load (3.2 km/hr, 10% slope) standard procedure.…”

Section: Introductionmentioning

confidence: 99%

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Specific slow tests are not mandatory in patients with extremely short standard (3.2 km/hr 10% slope) test durations during exercise oximetry

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Ramondou

Hersant

et al. 2020

Clin Physio Funct Imaging

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Aim To compare the transcutaneous oxygen pressure results observed in patients with severe walking limitation during standard procedures (3.2 km/hr, 10% slope) versus during a test performed at a low speed (2 km/hr, 10% slope). Methods In 31 patients, the decrease from rest of oxygen pressure (DROP) index was measured on both buttocks, both thighs and both calves during two consecutive tests on treadmill. The maximal walking time (MWT) and the minimal DROP values (DROPmin) observed during the 2 tests were compared with t test. Correlation of DROPmin values during the slow and standard procedure was performed with linear regression. The −15 mmHg cut‐off value defined for standard test interpretation was used arbitrarily for the interpretation of slow test results. Results MWT was 80 ± 52 s versus 376 ± 269 s at standard and slow speed, respectively (p < .001). No difference on all recorded DROPmin values at a standard (−9.5 ± 6.9 mmHg) and slow (−10.5 ± 7.9 mmHg) speed was found; n = 186, p = .168. Coefficient of correlation between DROPmins found at the two tests was r = 0.820 (p < .01), with regression line close to the line of identity. With the identical −15 mmHg cut‐off, 166 (89.2%) of 186 the results were classified similarly after standard and slow procedures. Conclusion Specific slow treadmill procedures are not mandatory in patients with extremely short test durations when performing standard (3.2 km/hr 10% slope) exercise oximetry. In patients expected to be unable to walk at standard speed, the −15 mmHg normal limit seems to be valid for the interpretation of tests with a slow procedure (2.0 km/hr).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Specific slow tests are not mandatory in patients with extremely short standard (3.2 km/hr 10% slope) test durations during exercise oximetry

Sempore

Ramondou

Hersant

et al. 2020

Clin Physio Funct Imaging

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“…A bias may result from the recruitement of our population, due to the specific interest of our laboratory in proximal claudication. 17 Although exercise TcpO 2 is not a routine technique, it is rapidly spreading in France 43 and abroad 44 and is more accurate than ultrasound or segmental pressures for the detection of proximal ischemia. 45,46 |Methodologies used in the study can also be discussed.…”

Section: Discussionmentioning

confidence: 99%

Identification of new factors associated to walking impairment in patients with vascular-type claudication

et al. 2018

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Objectives Mechanisms of walking limitation in arterial claudication are incompletely elucidated. We aimed to identify new variables associated to walking limitation in patients with claudication. Methods We retrospectively analyzed data of 1120 patients referred for transcutaneous exercise oxygen pressure recordings (TcpO2). The outcome measurement was the absolute walking time on treadmill (3.2 km/h, 10% slope). We used both: linear regression analysis and a non-linear analysis, combining support vector machines and genetic explanatory in 800 patients with the following resting variables: age, gender, body mass index, the presence of diabetes, minimal ankle to brachial index at rest, usual walking speed over 10 m (usual-pace), number of comorbid conditions, active smoking, resting heart rate, pre-test glycaemia and hemoglobin, beta-blocker use, and exercise-derived variables: minimal value of pulse oximetry, resting chest-TcpO2, decrease in chest TcpO2 during exercise, presence of buttock ischemia defined as a decrease from rest of oxygen pressure index ≤15 mmHg. We tested the models over 320 other patients. Results Independent variables associated to walking time, by decreasing importance in the models, were: age, ankle to brachial index, usual-pace; resting TcpO2, body mass index, smoking, buttock ischemia, heart rate and beta-blockers for the linear regression analysis, and were ankle to brachial index, age, body mass index, usual-pace, decrease in chest TcpO2, smoking, buttock ischemia, glycaemia, heart rate for the non-linear analysis. Testing of models over 320 new patients gave r = 0.509 for linear and 0.575 for non-linear analysis (both p < 0.05). Conclusion Buttock ischemia, heart rate and usual-pace are new variables associated to walking time.

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“…First, beyond the use of TcpO 2 at rest in severe peripheral artery disease (PAD), the authors could have referred to the use of TcpO 2 during exercise in patients with arterial claudication. [3][4][5] This point is of particular interest because exercise requires fast response time and motion-insensitive devices. Concerning this latter point, in paragraph 2.3, the authors indicate that flexible cables were used to reduce motion artifacts.…”

Section: E T T E R T O T H E E D I T O R a New Electron Paramagnetimentioning

confidence: 99%

A new electron paramagnetic resonance device to measure transcutaneous oxygen in humans

Henni

Hersant

Gourdier

et al. 2019

Magnetic Resonance in Med

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Exercise transcutaneous oximetry significantly modifies the diagnostic hypotheses and impacts scheduled investigations or treatments of patients with exertional limb pain

Cited by 7 publications

References 25 publications

Specific slow tests are not mandatory in patients with extremely short standard (3.2 km/hr 10% slope) test durations during exercise oximetry

Specific slow tests are not mandatory in patients with extremely short standard (3.2 km/hr 10% slope) test durations during exercise oximetry

Identification of new factors associated to walking impairment in patients with vascular-type claudication

A new electron paramagnetic resonance device to measure transcutaneous oxygen in humans

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