Prediction of claudication pain from clinical measurements obtained at rest

Gardner, Andrew W.; Cantwell, B. W.; Smith, L. Kent

doi:10.1249/00005768-199202000-00002

Cited by 52 publications

(60 citation statements)

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“…Several studies that included only PAD participants reported that lower ABI values are not associated with greater functional limitations. [93][94][95] These prior studies were limited by small sample sizes, by exclusion of functional measures other than treadmill walking performance, and by exclusion of participants without classic symptoms of intermittent claudication. [93][94][95] In other studies of patients with PAD, both with and without intermittent claudication symptoms, strong and independent associations of lower ABI values were observed with poorer 6-minute walk performance, slower walking velocity at usual and fastest pace, greater limitation in maximum treadmill walking performance, and lower Walking Impairment Questionnaire distance score.…”

Section: The Abi and Functional Impairment And Declinementioning

confidence: 99%

“…[93][94][95] These prior studies were limited by small sample sizes, by exclusion of functional measures other than treadmill walking performance, and by exclusion of participants without classic symptoms of intermittent claudication. [93][94][95] In other studies of patients with PAD, both with and without intermittent claudication symptoms, strong and independent associations of lower ABI values were observed with poorer 6-minute walk performance, slower walking velocity at usual and fastest pace, greater limitation in maximum treadmill walking performance, and lower Walking Impairment Questionnaire distance score. 90,96,97 No prospective studies in cohorts restricted to patients with PAD have demonstrated that lower ABI values are associated with a faster decline in functioning.…”

Section: The Abi and Functional Impairment And Declinementioning

confidence: 99%

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Measurement and Interpretation of the Ankle-Brachial Index

Aboyans

Criqui²,

Ábrahám³

et al. 2012

Circulation

1,331

827

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T he ankle-brachial index (ABI) is the ratio of the systolic blood pressure (SBP) measured at the ankle to that measured at the brachial artery. Originally described by Winsor 1 in 1950, this index was initially proposed for the noninvasive diagnosis of lower-extremity peripheral artery disease (PAD). 2,3 Later, it was shown that the ABI is an indicator of atherosclerosis at other vascular sites and can serve as a prognostic marker for cardiovascular events and functional impairment, even in the absence of symptoms of PAD. 4 -6 Rationale for Standardization of the ABIThe current lack of standards for measurement and calculation of the ABI leads to discrepant results with significant impact from clinical, public health, and economic standpoints. Indeed, the estimated prevalence of PAD may vary substantially according to the mode of ABI calculation. [7][8][9] In a review of 100 randomly selected reports using the ABI, multiple variations in technique were identified, including the position of the patient during measurement, the sizes of the arm and leg cuffs, the location of the cuff on the extremity, the method of pulse detection over the brachial artery and at the ankles, whether the arm and ankle pressures were measured bilaterally, which ankle pulses were used, and whether a single or replicate measures were obtained. 10 There is controversy about what ABI threshold should be used to diagnose PAD. The ABI threshold most commonly used is Յ0.90 based on studies reporting Ͼ90% sensitivity and specificity to detect PAD compared with angiography. 2,3 These studies were limited in that they included mostly older white men with PAD or who were at high risk for PAD and compared them with a younger healthy group. A recent metaanalysis of 8 studies of diverse populations, including diabetic patients, confirmed a high specificity but lower sensitivity (at best Ͻ80%) than that reported in earlier studies. 11 Similar to other vascular markers such as carotid intimamedia thickness 12 or coronary artery calcium score, 13 standardization of the techniques used to measure the ABI and the calculation and interpretation of its values is necessary. Aims and ScopeThe goals for this document are to provide a comprehensive review of the relevant literature on the measurement of the The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 10, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional repri...

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Section: The Abi and Functional Impairment And Declinementioning

confidence: 99%

Section: The Abi and Functional Impairment And Declinementioning

confidence: 99%

Measurement and Interpretation of the Ankle-Brachial Index

Aboyans

Criqui²,

Ábrahám³

et al. 2012

Circulation

1,331

827

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“…14,[25][26][27] Other studies, however, have shown that ABI is not strongly associated with exercise performance in symptomatic PAD patients. [6][7][8][9][28][29][30] In 133 patients with intermittent claudication, walking distance was lower in groups of patients with a progressively higher number of metabolic syndrome components, despite similar mean ABI across all groups. 30 In 66 patients with claudication, neither resting ABI (r = 0.14, p = NS) nor post-exercise ABI (r = 0.11, p = NS) correlated with absolute claudication time, and ABI was not significantly different between patients with short and long claudication distances.…”

Section: Factors Influencing Functional Performance In Patients With Padmentioning

confidence: 98%

“…Impaired functional performance is associated with poor quality of life, 3,4 and increased exercise endurance has been shown to positively affect quality of life measures and perception of health in this patient population. 5 The ankle-brachial index (ABI), a non-invasive measure of severity of atherosclerotic burden, does not reliably predict the degree of functional impairment observed in PAD patients, [6][7][8][9] and the pathophysiology of impaired functional performance in patients with PAD is not completely understood. In healthy adults, exercise performance is related to arterial stiffness 10 and endothelial dysfunction; 11 there is evidence to suggest that aerobic exercise can reduce arterial stiffness and improve endothelial function.…”

Section: Introductionmentioning

confidence: 99%

Arterial dysfunction and functional performance in patients with peripheral artery disease: A review

2011

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Functional performance influences quality of life in individuals with peripheral artery disease (PAD) and is also a powerful prognostic marker in these patients. The pathophysiology of impaired functional performance in patients with PAD is incompletely understood. The severity of atherosclerotic burden, non-invasively assessed by the ankle-brachial index (ABI), does not reliably predict the degree of functional impairment observed in PAD patients. We review associations of measures of arterial function (arterial stiffness and endothelial dysfunction) with functional performance in PAD patients, and also review potential therapies for arterial stiffness and endothelial dysfunction that could improve functional performance in PAD. Recent studies suggest that measures of arterial function, such as arterial stiffness and endothelial function, are associated with exercise performance in the setting of PAD. These studies have provided new insights into (1) the pathophysiology of functional impairment in PAD, (2) mechanisms of strategies known to be effective such as walking programs, and (3) potential new therapeutic interventions for improving functional performance. Thus, therapies aimed at arterial 'de-stiffening' and improving endothelial function (such as aerobic exercise, statins and angiotensinconverting enzyme inhibitors) may improve functional performance in patients with PAD; however, further investigations are needed.

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“…Despite the role diminished arterial flow has in claudication, altered hemodynamics of the affected limbs do not entirely explain the degree of functional limitation in patients with IC (6,7,11,29,41). Surgical revascularization does not completely normalize exercise performance (31), and exercise training, which does not modify hemodynamics, has been shown to improve walking capacity in patients with PAD (40).…”

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confidence: 99%

Relationship between leg muscle capillary density and peak hyperemic blood flow with endurance capacity in peripheral artery disease

Robbins

Jones

Duscha

et al. 2011

Journal of Applied Physiology

104

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WR, Annex BH. Relationship between leg muscle capillary density and peak hyperemic blood flow with endurance capacity in peripheral artery disease. J Appl Physiol 111: 81-86, 2011. First published April 21, 2011 doi:10.1152/japplphysiol.00141.2011.-The aim of this study was to determine if skeletal muscle capillary density is lower in patients with peripheral artery disease (PAD) and if capillary density relates to functional limitations. PAD patients with intermittent claudication (IC) have a decreased exercise tolerance due to exerciseinduced muscle ischemia. Despite the apparent role diminished arterial flow has in this population, the degree of walking pain and functional limitation is not entirely explained by altered hemodynamics of the affected limbs. We hypothesized that skeletal muscle capillary density is lower in PAD and is related to the functional impairment observed in this population. Sixty-four patients with PAD and 56 controls underwent cardiopulmonary exercise testing and a gastrocnemius muscle biopsy. A subset of these patients (48 PAD and 47 controls) underwent peak hyperemic flow testing via plethysmography. Capillary density in PAD patients was lower compared with controls (P Ͻ 0.001). After adjustment for several baseline demographic imbalances the model relating capillary density to peak oxygen consumption (V O2) remained significant (P Ͻ 0.001). In PAD subjects, capillary density correlated with peak V O2, peak walking time (PWT), and claudication onset time (COT). Peak hyperemic blood flow related to peak V O2 in both PAD and control subjects. PAD is associated with lower capillary density, and capillary density is related to the functional impairment as defined by a reduced peak V O2, PWT, and COT. These findings suggest that alterations in microcirculation may contribute to functional impairment capacity in PAD.claudication; skeletal muscle PERIPHERAL ARTERY DISEASE (PAD) is a major health problem that affects over eight million people in the United States (42). PAD is caused by atherosclerosis, which leads to arterial obstruction and decreased blood flow to the lower extremities. The most frequent clinical symptomatic manifestation of PAD is intermittent claudication (IC), which is defined as ischemic leg pain that occurs with walking and improves with rest (21). Patients with IC are known to have impaired exercise capacity and decreased ability to perform activities of daily living (31).Despite the role diminished arterial flow has in claudication, altered hemodynamics of the affected limbs do not entirely explain the degree of functional limitation in patients with IC (6,7,11,29,41). Surgical revascularization does not completely normalize exercise performance (31), and exercise training, which does not modify hemodynamics, has been shown to improve walking capacity in patients with PAD (40). These observations have prompted investigations of a mechanism distal to the arterial occlusion to explain these phenomena.A potential mechanistic target for study is the microcirculation as ...

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Prediction of claudication pain from clinical measurements obtained at rest

Cited by 52 publications

References 0 publications

Measurement and Interpretation of the Ankle-Brachial Index

Measurement and Interpretation of the Ankle-Brachial Index

Arterial dysfunction and functional performance in patients with peripheral artery disease: A review

Relationship between leg muscle capillary density and peak hyperemic blood flow with endurance capacity in peripheral artery disease

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