The ischemic window: A method for the objective quantitation of the training effect in exercise therapy for intermittent claudication

Feinberg, Richard; Gregory, Roger T.; Wheeler, Jock R.; Snyder, Stanley O.; Gayle, Robert G.; Parent, F. Noel; Patterson, Robert B.

doi:10.1016/0741-5214(92)90114-n

Cited by 65 publications

(66 citation statements)

References 16 publications

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“…Previous studies have shown slower half time to recovery in patients who were immobilized, 34 detrained, 27 and in patients with vascular disease. 35 We also used a novel method of assessing vascular control, the ratios of peak¯ow (2/ 10 and 4/10). This approach was modeled after in vitro studies and in situ pharmacological studies that assess ow responses to various infused concentrations of vasoactive substances.…”

Section: Discussionmentioning

confidence: 99%

Blood flow response in individuals with incomplete spinal cord injuries

2002

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Study design: Cross sectional comparison, control group. Objective: To determine if incomplete spinal cord injured patients (SCI) have an abnormal blood¯ow response to cu ischemia compared to able-bodied individuals (AB). Setting: Academic institution. Methods: Blood¯ow in ®ve chronic incomplete SCI patients (C4 ± C5) and 17 able bodied individuals was measured in the common femoral artery using quantitative Doppler ultrasound (GE LogiQ 400CL) at rest and after distal thigh cu occlusion of 2, 4 and 10 min to investigate whether blood¯ow or vascular control were di erent in SCI's and AB. Results: Blood¯ow and the diameter of the common femoral artery at rest were similar in incomplete SCI and AB. Peak¯ow after 10 min of cu ischemia (the highest found) was also comparable between incomplete SCI and AB. The half-time for recovery of blood¯ow to baseline after 2, 4 or 10 min of ischemia was 50% longer for incomplete SCI compared to the AB (P=0.023). In addition, peak blood¯ow after 2 and 4 min of ischemia relative to the maximum, 10 min value (2/10 and 4/10 ratios) was lower in incomplete SCI compared to AB (0.65+0.06 vs 0.76+0.15, P=0.029 and 0.75+0.10 vs 0.89+0.11, P=0.014, respectively). Conclusion: This study demonstrated that incomplete spinal cord injured patients have impaired vascular control seen as a slower return to resting¯ow after cu ischemia and reduced sensitivity to ischemia relative to maximum¯ow. However, incomplete SCI patients did not demonstrate impaired¯ow capacity as seen in complete SCI patients suggesting that smaller cardiovascular abnormalities are seen with incomplete versus complete SCI injury. Impaired vascular control may serve to limit exercise capacity and may contribute to increased cardiovascular disease. Impaired circulation could contribute to impaired muscle function and poor cardiovascular health in incomplete SCI's, although these ®ndings need to be replicated in a study with more subjects. Sponsorship: Paralyzed Vetrans Association and NIH grants HL65179 and HD33738.

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Section: Discussionmentioning

confidence: 99%

Blood flow response in individuals with incomplete spinal cord injuries

2002

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“…Feinberg et al 15 conducted a study evaluating the AUC, which they termed 'The Ischemic Window.' They studied 212 patients involved in a supervised exercise program and noted that these patients had a mean reduction of 58.7% in the ischemic window after a standardized workload.…”

Section: Discussionmentioning

confidence: 99%

“…12 Feinberg et al studied the time course of recovery of the systolic ankle pressure after exercise-induced ischemia was provoked on a treadmill. 15 A curve was constructed for an individual patient at each exercise session, representing the severity of the 'ischemic burden' produced in the extremity. The term 'ischemic window' was given to the area under the curve (AUC), a function of both the degree of postexercise ankle pressure reduction and the time required for the ankle pressure to return to the pre-exercise level.…”

Section: Introductionmentioning

confidence: 99%

Effects of cilostazol on resting ankle pressures and exercise-induced ischemia in patients with intermittent claudication

Mohler

Beebe²,

Salles-Cuhna³

et al. 2001

Vasc Med

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Abstract:During exercise, patients with intermittent claudication (IC) have decreased limb arterial blood pressure that recovers during rest. A novel method for assessing dynamic recovery of function is measurement of the hemodynamic response after exercise. Cilostazol (Pletal  ), a new agent for the treatment of IC, increases walking distance and may decrease ischemic burden. The objective of this study was to assess the effect of cilostazol versus placebo on hemodynamic measurements after exercise-induced ischemia in patients with IC.Two double-blind, placebo-controlled studies with similar inclusion/exclusion criteria and duration (24 weeks) were pooled. Patients walked on a treadmill at 2.0 miles/h (3.2 km/h) on a 12.5% grade until the claudication-limited maximal walking distance (MWD) was reached. Anterior and posterior tibial pressures were measured with Doppler ultrasound at baseline and at 1, 5, and 9 min during recovery. Area under the curve (AUC), a measure of the time course of recovery of systolic pressure after exercise-induced ischemia, and ankle-brachial index (ABI) were calculated and compared using analysis of variance (ANOVA).All three treatment groups (308 patients randomized to cilostazol 100 mg bid, 303 to cilostazol 50 mg bid, and 299 to placebo) had similar baseline characteristics. Mean post-exercise AUC for cilostazol 100 mg and 50 mg bid versus placebo increased by 0.31 (p = 0.001) and 0.26 (p = 0.004), respectively. Mean resting ABI increased by 0.03 (p = 0.0039) and 0.04 (p = 0.0001) in the cilostazol 100 mg and 50 mg bid groups, respectively.In conclusion, following 24 weeks of treatment, cilostazol increased the ABI at rest and improved the recovery time of ankle pressures post-exercise.

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“…Em um indivíduo normal, o ITB aumenta com o esforço, e em um paciente com DAP, diminui. Essa diminuição é diretamente proporcional ao grau da lesão arterial e inversamente ao grau de compensação pela rede colateral 35,36,43 .…”

Section: Métodos Diagnósticos Da Dmvunclassified

Envolvimento macrovascular e esclerose sistêmica

Godoi

Barbosa²,

Godoi³

et al. 2009

J. vasc. bras.

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ResumoEste artigo tem como objetivo revisar os aspectos descritos na literatura sobre o acometimento da macrovasculatura na esclerose sistêmica e avaliar a ocorrência e distribuição das alterações macrovasculares nos pacientes com esclerose sistêmica através do eco-Doppler e do índice tornozelo-braço, além da associação desses achados com as características demográficas, forma clínica, tempo de evolução da doença, fenômeno de Raynaud (FR), alterações digitais, ulcerações de membros, reabsorção de falange, amputação, bem como fatores de risco e antecedentes da doença ateromatosa. O estudo foi prospectivo, do tipo série de casos, constituído de 20 pacientes, sendo 19 do sexo feminino, com idade média de 46,30 anos. Todos os pacientes tinham fenômeno de Raynaud objetivo, 85% a forma clínica difusa, 55% alteração de polpa digital, 15% úlcera atual de membros, 25% reabsorção de falange, nenhuma amputação e 70% de um a quatro fatores de risco. Foram estudadas pelo eco-Doppler as artérias aorta e carótida, dos membros inferiores e superiores, para a avaliação de espessamento do complexo íntimo-medial e presença de placas e aneurismas. Nas artérias dos membros inferiores, foi também realizado o índice tornozelo-braço. O índice tornozelo-braço foi normal em todos os pacientes; entretanto, 12 (60%) destes apresentaram doença macrovascular pelo eco-Doppler, sendo nove (45%) na aorta, seis (30%) nas carótidas, uma (5%) nas artérias dos membros superiores e sete (35%) nas dos membros inferiores. Observou-se associação entre doença macrovascular e alterações de polpas digitais (p = 0,0045). A doença macrovascular foi identificada em 60% dos pacientes através do eco-Doppler, mas não pelo índice tornozelo-braço, que foi normal em todos. Verificou-se associação significante da doença macrovascular com as alterações atuais de polpas digitais, o que não ocorreu com as demais variáveis estudadas. Palavras-chave:Esclerose sistêmica, efeito Doppler, aterosclerose. AbstractThe objectives of this article are to review aspects described in the literature on macrovasculature onset in systemic sclerosis and to assess occurrence and distribution of macrovascular alterations in patients with systemic sclerosis using Doppler ultrasound and ankle-brachial index. In addition, the article evaluates the association of these findings with demographic characteristics, clinical form, clinical course of the disease, Raynaud's phenomenon, digital changes, limb ulcers, reabsorption of phalanges, amputation, and risk factors and antecedents of atheromatous disease. A prospective, case series study of 20 patients was performed. The sample was comprised of 19 women, with a mean age of 46.30 years. All patients had objective Raynaud's phenomenon, 85% were diffuse, 55% had digital pulp changes, 15% current limb ulcer, 25% reabsorption of phalange, no amputations, and 70% presented one to four risk factors. Studies were performed by color Doppler ultrasound of the aortic and carotid arteries and lower and upper limb arteries to assess thickening of the inti...

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The ischemic window: A method for the objective quantitation of the training effect in exercise therapy for intermittent claudication

Cited by 65 publications

References 16 publications

Blood flow response in individuals with incomplete spinal cord injuries

Blood flow response in individuals with incomplete spinal cord injuries

Effects of cilostazol on resting ankle pressures and exercise-induced ischemia in patients with intermittent claudication

Envolvimento macrovascular e esclerose sistêmica

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