Transcutaneous Oxygen Tension as a Potential Predictor of Cardiovascular Events in Type 2 Diabetes

Abstract

OBJECTIVETranscutaneous oxygen tension (TcPO2) measures tissue perfusion and is important in the management of peripheral artery disease (PAD). Ankle brachial index (ABI) is used for the diagnosis of PAD and represents a predictor of major adverse cardiovascular events (MACE), even if in diabetes its diagnostic and predictive value seems to be reduced. No study has evaluated TcPO2 as a predictor of cardiovascular events. Aim of this longitudinal study was to assess whether TcPO2 is better than ABI at predicting MACE in type 2 diabetic patients.RESEARCH DESIGN AND METHODSAmong 361 consecutive patients with apparently uncomplicated diabetes, 67 MACE occurred during a follow-up period of 45.8 ± 23.2 months.RESULTSThe percentage of both subjects with low ABI (≤0.9) and subjects with low TcPO2 (≤46 mmHg as measured by a receiver operating characteristic curve) was significantly (<0.001) greater among patients with than among those without MACEs (ABI 64.2 vs. 40.8; TcPO2 58.2 vs. 34%). The Kaplan-Meier method showed that both low ABI (Mantel log-rank test, 4.087; P = 0.043) and low TcPO2 (Mantel log-rank test, 33.748; P > 0.0001) were associated with a higher rate of MACEs. Cox regression analysis showed that low TcPO2 (hazard ratio 1.78 [95% CI 1.44–2.23]; P < 0.001) was a significant predictor of MACE, while ABI did not enter the model.CONCLUSIONSThis longitudinal study showed that TcPO2 may be a potential predictor of MACE among patients with uncomplicated type 2 diabetes and that its predictive value seems to be greater than that of ABI.

Prognostic impact of the ankle–brachial index on the development of micro- and macrovascular complications in individuals with type 2 diabetes: the Rio de Janeiro Type 2 Diabetes Cohort Study

“…Indeed, some previous studies have demonstrated a lack of prognostic value for the ABI in diabetic individuals in contrast to non-diabetic individuals [11][12][13], although others have reported similar positive predictive performances in diabetic and non-diabetic individuals [14][15][16][17]. Similarly, conflicting results regarding the prognostic value of the ABI have been reported by cohort studies comprised exclusively of individuals with type 2 diabetes, with some studies negating [18,19] and others demonstrating [20][21][22][23][24][25][26][27][28] its importance. Moreover, some of the positive studies [24,25,27,28] assessed whether the ABI, beyond being a risk marker, was also capable of improving risk stratification for adverse outcomes, with contradictory findings.…”

Transcutaneous oxygen tension measurements following peripheral transluminal angioplasty procedure has more specificity and sensitivity than ankle brachial index

“…15 When performed properly, forefoot TcPO 2 has a high prognostic value. 16 This is a straightforward, quick and rapid technique that can be carried out in all patients (except those with significant oedema). Indeed, in our study, it was used with all patients, including the most severe cases that were excluded when employing the ABI by Doppler.…”

Cilostazol attenuates the severity of peripheral arterial occlusive disease in patients with type 2 diabetes: the role of plasma soluble receptor for advanced glycation end-products

“…Angiography or magnetic resonance angiography may be more precise. Furthermore, non-invasive transcutaneous oxygen tension (TcPO2) had better predictive value than that of ABI, in predicting cardiovascular events and evaluating PAOD [ 38 ].…”